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Mon Aug 22 01:45:00 BST 2011

Rob, fair question. I'll just flip it and say that IF access is desired, I would rather the crashing trauma patient get the IO than get an IV plus added delay. I agree that in many cases, if we're not going to be filling them with crystalloids (and I hope we're not), access can probably wait for the ED when more relevant resuscitation will be possible.

Brandon

***
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On Aug 21, 2011, at 7:05 PM, Rob Ojala wrote:

> 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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Preop IO lines in unstable trauma patients