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Intraosseous access

Leonardo Trombelli, Anna Simonelli, Luigi Minenna, Giulio Rasperini, Roberto Farina
BACKGROUND: In the attempt to limit the post-surgery increase in buccal gingival recession (bREC), effect of a connective tissue graft (CTG) when combined with a buccal single flap approach (SFA) in the regenerative treatment of intraosseous defects is evaluated. METHODS: Data related to 30 patients with an intraosseous defect treated with a buccal SFA with (SFA+CTG group; n = 15) or without (SFA group; n = 15) placement of a CTG and regenerative treatment were retrospectively derived at three clinical centers...
April 2017: Journal of Periodontology
Christopher Kalhagen Bjerkvig, Theodor Fosse, Torunn Oveland Apelseth, Joar Sivertsen, Hanne Braathen, Håkon Skogrand Eliassen, Anne Berit Guttormsen, Andrew P Cap, Geir Strandenes
BACKGROUND: Intraosseous (IO) vascular access is increasingly used as an emergency tool for achieving access to the systemic circulation in critically ill patients. The role of IO transfusion of blood in Damage Control Resuscitation is however questionable due to possible inadequate flow rate and hemolysis. Some experts claim that IO transfusion is contraindicated. In this study we have challenged this statement by looking at flow rates of autologous fresh whole blood reinfusion and hemolysis using two of the commonly used FDA-approved and CE-marked sternal needles...
February 17, 2018: Journal of Trauma and Acute Care Surgery
Eva M Schwindt, Florian Hoffmann, Philipp Deindl, Thomas J Waldhoer, Jens C Schwindt
OBJECTIVES: To compare the duration to establish an umbilical venous catheter and an intraosseous access in real hospital delivery rooms and as a secondary aim to assess delaying factors during establishment and to provide recommendations to accelerate vascular access in neonatal resuscitation. DESIGN: Retrospective analysis of audio-video recorded neonatal simulation training. SETTINGS: Simulation training events in exact replications of actual delivery/resuscitation rooms of 16 hospitals with different levels of care (Austria and Germany)...
February 9, 2018: Pediatric Critical Care Medicine
Daniel Aiham Ghazali, Ivan Darmian-Rafei, Stéphanie Ragot, Denis Oriot
OBJECTIVES: The primary objective was to determine whether technical and nontechnical performances were in some way correlated during immersive simulation. Performance was measured among French Emergency Medical Service workers at an individual and a team level. Secondary objectives were to assess stress response through collection of physiologic markers (salivary cortisol, heart rate, the proportion derived by dividing the number of interval differences of successive normal-to-normal intervals > 50 ms by the total number of normal-to-normal intervals [pNN50], low- and high-frequency ratio) and affective data (self-reported stress, confidence, and dissatisfaction), and to correlate them to performance scores...
February 9, 2018: Pediatric Critical Care Medicine
Brett Gendron, Aaron Cronin, Jonathan Monti, Andrew Brigg
Background: Obtaining intraosseous (IO) access remains an invaluable skill in the management and resuscitation of patients on the battlefield. The U.S. Army Combat Medic is currently trained to utilize a sternal IO device (FAST1® Intraosseous Infusion System); however, the Arrow® EZ-IO® Intraosseous Vascular Access System offers unique benefits including ease of use, reload ability, and placement location versatility. Studies have demonstrated high success rates in the operational settings using the EZ-IO® System; however, no prospective studies have been conducted to assess the performance of U...
February 6, 2018: Military Medicine
Michael Wagner, Monika Olischar, Megan O'Reilly, Katharina Goeral, Angelika Berger, Po-Yin Cheung, Georg M Schmölzer
OBJECTIVE: During neonatal cardiopulmonary resuscitation, early establishment of vascular access is crucial. We aimed to review current evidence regarding different routes for the administration of medications during neonatal resuscitation. DATA SOURCES: We reviewed PubMed, EMBASE, and Google Scholar using MeSH terms "catheterization," "umbilical cord," "delivery room," "catecholamine," "resuscitation," "simulation," "newborn," "infant," "intraosseous," "umbilical vein catheter," "access," "intubation," and "endotracheal...
February 5, 2018: Pediatric Critical Care Medicine
Michael R Shapiro, Neville J McDonald, Richard J Gardner, Mathilde C Peters, Tatiana M Botero
INTRODUCTION: Profound pulpal anesthesia is difficult to achieve in mandibular molars with irreversible pulpitis (IP). However, there are no published randomized controlled clinical trials comparing the success of supplemental buccal infiltration (BI) in mandibular first versus second molars with IP. The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental BIs in mandibular first versus second molars with IP after a failed inferior alveolar nerve block (IANB)...
January 31, 2018: Journal of Endodontics
Dru Perkins, Tudor I Stiharu, James Q Swift, Tran Volong Dao, Gisele N Mainville
Schwannomas are benign nerve sheath neoplasms composed almost entirely of Schwann cells. These tumors most often arise in the soft tissues of the head and neck. However, they seldom occur within bone. This article presents a rare case of a recurrent intraosseous schwannoma of the anterior mandible and another case of a posterior intraosseous mandibular schwannoma accessed through a sagittal split ramus osteotomy. Furthermore, an updated review of the literature on intraosseous schwannomas affecting the mandible and maxilla is provided...
December 28, 2017: Journal of Oral and Maxillofacial Surgery
Mario Vinicius Zendron, Matheus Völz Cardoso, Giovana Fuzeto Veronesi, Daniel Romeu Benchimol de Resende, Carla Andreotti Damante, Adriana Campos Passanezi Sant'ana, Sebastião Luis Aguiar Greghi, Mariana Schutzer Ragghianti Zangrando
PURPOSE: This animal study investigated vertical bone formation (VBF) around implants and used histomorphometric analysis to compare different bone-filling materials associated with a massive titanium dome as a tissue barrier. MATERIALS AND METHODS: Seven dogs were submitted to surgical procedures with extraoral access to the lower edge of the mandible, and four implants were semi-inserted in each animal. Each implant received one treatment: autogenous bone with clot (AB), control clot (C), synthetic graft (Biogran [BG]), or xenograft (Bio-Oss [BO])...
January 19, 2018: International Journal of Oral & Maxillofacial Implants
Takahisa Kawano, Brian Grunau, Frank X Scheuermeyer, Koichiro Gibo, Christopher B Fordyce, Steve Lin, Robert Stenstrom, Robert Schlamp, Sandra Jenneson, Jim Christenson
STUDY OBJECTIVE: We seek to determine the effect of intraosseous over intravenous vascular access on outcomes after out-of-hospital cardiac arrest. METHODS: This secondary analysis of the Resuscitation Outcomes Consortium Prehospital Resuscitation Using an Impedance Valve and Early Versus Delayed (PRIMED) study included adult patients with nontraumatic out-of-hospital cardiac arrests treated during 2007 to 2009, excluding those with any unsuccessful attempt or more than one access site...
January 6, 2018: Annals of Emergency Medicine
Kristen M Chreiman, Ryan P Dumas, Mark J Seamon, Patrick K Kim, Patrick M Reilly, Lewis J Kaplan, Jason D Christie, Daniel N Holena
BACKGROUND: Quick and successful vascular access in injured patients arriving in extremis is crucial to enable early resuscitation and rapid OR transport for definitive repair. We hypothesized that intraosseous (IO) access would be faster and have higher success rates than peripheral IVs (PIVs) or central venous catheters (CVCs). METHODS: High-definition video recordings of resuscitations for all patients undergoing Emergency Department Thoracotomy (EDT) from 4/2016-7/2017 were reviewed as part of a quality improvement initiative...
January 4, 2018: Journal of Trauma and Acute Care Surgery
Michael S Lallemand, Donald M Moe, John M McClellan, Michael Loughren, Shannon Marko, Matthew J Eckert, Matthew J Martin
BACKGROUND: The acute coagulopathy of trauma is often accompanied by hyperfibrinolysis. Tranexamic acid (TXA) can reverse this phenomenon, and, when given early, decreases mortality from bleeding. Establishing intravenous (IV) access can be difficult in trauma and intraosseous (IO) access is often preferred for drug administration. Currently, there are no data on the efficacy of IO administered TXA. Our objectives were to compare serum concentrations of TXA when given IV and IO and to compare the efficacy of IO administered TXA to IV at reversing hyperfibrinolysis...
February 2018: Journal of Trauma and Acute Care Surgery
Juan P Garrahan, Mark Lyttle, Ed Oakley, Stuart Dalziel, Lucia Nguyen, Arjun Rao, Santiago Mintegi, Franz Babl
BACKGROUND: Recent studies suggest that approximately one per thousand paediatric ED attendances may require some sort of critical procedure, with intubation being by far the most common. It is unknown how often critical non-airway procedures such as chest decompression, CPR, ED thoracotomy, defibrillation, pacing, and advanced vascular access techniques are performed by paediatric emergency clinicians. OBJECTIVE: To determine the recent performance or supervision, and confidence for various paediatric critical non-airway procedures by senior paediatric emergency clinicians...
December 2017: Emergency Medicine Journal: EMJ
Elysha L Pifko, Amanda Price, Carrie Busch, Curren Smith, Yunyun Jiang, Joseph Dobson, Rachel Tuuri
AIM: Intraosseous (IO) access is a life-saving option during resuscitations in the paediatric emergency department (PED). This study aimed to compare success rates and time to placement for Manual IO versus EZ-IO needles in PED patients ≤8 and >8 kg. METHODS: This was a retrospective cross-sectional descriptive study of IO use in a single-centre tertiary PED from 2006 to 2014. Cases were identified through diagnosis codes for IO infusion, cardiopulmonary resuscitation and cardiac arrest and admissions to the intensive care unit...
November 10, 2017: Journal of Paediatrics and Child Health
Muhammad Asghar Ali, Muhammad Yahya
Fundamental medical care includes intravenous (IV) access which provides prompt resuscitation and reliable delivery of analgesics, antibiotics, and vasoactive medication. Difficult access populations, especially in critical area, continue to challenge providers to consider and utilize alternative means to provide IV access. Potential options under such circumstances include intramuscular, intraosseous, and intratracheal drug administration, but in extreme cases where no other options are available, intra-arterial route might be considered...
October 2017: Saudi Journal of Anaesthesia
Onur Polat, Ahmet Burak Oguz, Muge Gunalp Eneyli, Ayhan Comert, Halil Ibrahim Acar, Eray Tuccar
Intraosseous access is a method for providing vascular access in resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. There is a lack of detailed description for the landmark for the insertion point in the literature. The aim of this study was to determine the exact location for intraosseous access. Radiographic computed tomography (CT) images of a total of 50 dry tibia bones were obtained. With 5-mm intervals, for all transverse images and by selecting transverse section, measurements were taken from the thickness of the cortex at anterior margin and mid-line medial surface, distance from anterior margin, and mid-line medial surface of the tibia to the posterior wall of medullar cavity, distance from anterior margin and mid-line medial surface of the tibia to the posterior surface of the tibia...
September 22, 2017: Clinical Anatomy
Milla Jousi, Simo Saikko, Jouni Nurmi
BACKGROUND: Point-of-care (POC) testing is highly useful when treating critically ill patients. In case of difficult vascular access, the intraosseous (IO) route is commonly used, and blood is aspirated to confirm the correct position of the IO-needle. Thus, IO blood samples could be easily accessed for POC analyses in emergency situations. The aim of this study was to determine whether IO values agree sufficiently with arterial values to be used for clinical decision making. METHODS: Two samples of IO blood were drawn from 31 healthy volunteers and compared with arterial samples...
September 11, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Mohammad W Kassem, Joshua Chern, Marios Loukas, R Shane Tubbs
PURPOSE: Intraosseous (IO) vascular access has been used since the Second World War and is warranted when there is an emergency and/or urgent need to replenish the vascular pool. Despite long-term and satisfactory results from delivering large quantities of intravenous fluid via the medullary space of bone, use of this space for a distant receptacle for cerebrospinal fluid (CSF) diversion has seldom been considered. METHODS: The current paper reviews the literature regarding the bony medullary space as a receptacle for intravenous fluid and CSF...
December 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Alison R Allukian, Amanda L Abelson, Jonathan Babyak, Elizabeth A Rozanski
OBJECTIVE: To compare the time required and the success rate of personnel with 4 different levels of experience to place a humeral intraosseous (IO) catheter versus a jugular venous catheter (IV) in cadaver dogs. DESIGN: Prospective study. SETTING: Veterinary university teaching hospital. INTERVENTIONS: Canine cadavers from recently euthanized dogs were obtained from the cadaver donation program between May and December 2014...
September 2017: Journal of Veterinary Emergency and Critical Care
Rachel Whitney, Melissa Langhan, Kathryn H Pade
Vascular access is a potentially life-saving procedure that is a mainstay of emergency medicine practice. There are a number of challenges associated with obtaining and maintaining vascular access, and the choice of the route of access and equipment used will depend on patient- and provider-specific factors. In this issue, the indications and complications of peripheral intravenous access, intraosseous access, and central venous access are reviewed. Timely and effective assessment and management of difficult-access patients, pain control techniques that can assist vascular access, and contraindications to each type of vascular access are also discussed...
June 22, 2017: Pediatric Emergency Medicine Practice
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