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Preop IO lines in unstable trauma patients

Rob Ojala Rob.Ojala at cdhb.govt.nz
Mon Aug 22 00:05:41 BST 2011


Brandon - what do you use the IO for in trauma patients pre-hospital?
[I'm not trying to be facetious]

Rob Ojala



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Brandon Oto
Sent: Monday, 22 August 2011 2:30 a.m.
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Preop IO lines in unstable trauma patients 

Mike, may I ask why you disagree with the general use of IO in the
prehospital setting? I have to admit that in time-sensitive situations I
see little disadvantage, other than perhaps cost; the "IV interval,"
whether it's taken on scene or whether it occupies most of the ride to
the ED, is typically a major portion of EMS's time with the patient. I
find it hard to justify, especially when they're not dying of
insufficient needles in their arms.

Brandon

***
http://degreesofclarity.com/
http://emsbasics.com/




On Aug 21, 2011, at 12:44 AM, McEvoyMike at aol.com wrote:

> I recognize we're talking about trauma and I agree with Ken et al.  I
see 
> both value and unintended consequence of IO.  In the prehospital  
> environment, their now widespread overuse (who wouldn't find it
appealing to use  a 
> power tool to attain venous access) seems to be rapidly  extinguishing

> vascular access skills and at no small cost (about $100 US  per IO).
In some 
> areas, IO has crept to first line use in cardiac arrests  despite the 
> questionable value of virtually any medications that might
subsequently be given.  In 
> my hospital, not unlike many others, our nurses  now place IO's in 
> emergencies, a practice that evolved from instances of  multiple
failed attempts at 
> access by some extremely skilled clinicians in our  ever increasing
bariatric 
> and vasculopath population.  These have been  lifesaving, cost saving
(one 
> IO versus a half dozen central line kits), patient  pain sparing (from

> repeated failed line attempts and even more so  with humeral head IO
placement 
> versus tibial IO), and allow rapidly  deteriorating situations to be
readily 
> rectified.  One classic sort of case  I see a few times a year is the 
> critically ill infant who emerges from sedation,  kicks out their
access line(s), 
> extubates, and flounders about like a fish out  of water.  A quick IO,
some 
> rapid sedation, and the train is back on the  tracks.
> 
> It certainly may be time to take a look at outcomes versus "everyone
is  
> doing it."  My opinions.
> 
> Mike:)
> 
> Mike McEvoy,  PhD, NRP, RN, CCRN
> EMS Coordinator - Saratoga County, NY
> Cardiothoracic  Surgery - Albany Medical Center
> Chair -  Resuscitation Committee - Albany Medical Center, New York,
USA
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