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Sat Mar 17 13:06:00 GMT 2007

As far as I am concerned, classical IO is an archaic tool and out-of-date
and, like venous cutdown, should no longer be taught on ATLS. If it is not
possible to get IV access and you really must resort to an alternative form
of access, then could try the following:-

1)- BIG (Bone Injection Gun) - Never had a problem with this and not aware
of the earlier problems reported with locking of the gun device. Only used
when IV access unobtainable and really quick to insert (in my experience
whilst most people still preparing to insert a traditional IO). This has a
number of safety mechanisms to ensure safe, proper and effective insertion
so don't see the reason for it failing. Would be interested to know more;

2)- F.A.S.T. 1 - Used a lot in the military and have some experience of this
device. Great to use, very quick and simple to insert and (despite initial
thoughts to the contrary) is relatively painfree. Although cannot be used in
sternal fractures or those requiring a sternotomy, it is a very useful aid
for those with multiple extremity fractures where IV and IO access is
contraindicated etc.

3)- VEID - Could use this device to assist in getting IV access (attached to
the IV cannula) where it appears obvious it won't be a useful
straight-forward insertion due to poor circulation etc. 

How much volume were you trying to infuse?? I personally wouldn't be too
worried about potential for volume infusion given that I apply permissive
hypotension with either no fluids or, at the very most, low volume fluid
resuscitation (just enough to maintain a femoral pulse.)

This week I was referred by our Accident & Emergency department (amongst
others) 3 multiple stabbings to both chest and abdomen and 2 severely
injured polytrauma RTAs with head, facial, chest, spinal, abdominal, pelvic
and extremity injuries (with prolonged entrapment times of near 1 hour.)
Although 1 of the RTA victims had been out in the cold at 3am, wearing very
little clothing and peripherally shutdown, I would have grabbed the BIG
first (rather than IO) if I had had a problem with IV access (F.A.S.T. 1
contradindicated due to multiple sternal fractures, sterno-manubrial
disruption, sterno-clavicular disruptions, pulmonary contusions and
mycocardial contusions). Thankfully my ability to obtain IV access didn't
let me down! Needless to say though I gave very little fluid anyway (in fact
none at all!!!).

Matthew Reeds

Surgery

U.K.

-----Original Message-----
From: Joe Nemeth [mailto:joe.nemeth at mcgill.ca] 
Sent: 16 March 2007 13:50
To: trauma-list at trauma.org
Subject: IO's?...good for?

our ED is thinking of purchasing high-end fancy-shmancy IO needles....

opinions/experiences on the necessity of these toys in tertiary care ED 

please?

joe

McGill University

MOntreal

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IO's?...good for?