EMS Intraosseous Fluids, Meds, Site Placement and Landmarks

Podcast: Play in new window | Download

The MedicCast EMS Podcast covers many topics for EMTs, paramedics and EMS students.  In one episode, the subject of intraosseous (IO) devices for paramedics was reviewed by host Jamie Davis, the Podmedic.

IO Fluids and Meds

Let's talk a little bit about I.O. access in general. You can administer I.V. fluids both crystalloid and colloidal fluid solutions. You can administer most medications. Most that are available for I.V. use can also be administered via I.O. access. I don’t know in the EMS arena of any medications that can’t be administered I.O. in the situation where you would have I.O. access. Also of course, blood products can be administered directly via I.O. access. It’s a non-collapsible area so you’re not going to have veins collapsing or causing issues. If you can get your needle in there, it will work.

When to Use Intraosseous Access

When would we use I.O. access? I mean we are going to be drilling in to a person’s bone here, and this is something we don’t want to do lightly. This should be only used for your most critical of patients. Just like I talked about administering therapeutic shocks to patients needing cardioversion, I don’t think you should be using I.O. access for any patient that would be able to complain about it.

That means that they should be unconscious or dead. We shouldn’t be using this for any but our most critical patients—our patients who are in cardiac arrest or are seriously injured with a multi-system trauma or something like that.

IO Placement and Landmarks

There are also some things we need to think about as far as placement of our I.O. access. I.O. access points typically are thought of, especially in children, as the proximal end of the tibia. There’s a flat surface, a few centimeters distal to the tibial tuberosity. There’s also a location farther down on the tibia, the medial malleolus (on the inside of the ankle). Just proximal to the medial malleolus you can find I.O. access there, and in older children and adults that may be a better point of access because up near the top of the tibia, it tends to become much thicker and harder up there as children age.

There are other access points such as the sternum. In some devices you may see that sternal access is allowed. In fact in many agencies, they’re starting to look at the proximal humerus as another access point for I.O. access. The key thing to think about here is because we’re talking about such critical patients, and in fact patients who may need CPR, if they don’t already have CPR in progress, we don’t want to put our device in such a location as to inhibit the effect of administration of CPR or to inhibit our ability to administer medications or deal with airway access and still do the other things we need to do around the torso and the head. So that’s one of the advantages of using the lower extremities.

—-

Find more tips and information for EMTs, paramedics, and EMS students at MedicCast.com