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.

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

Here is a transcript of some of the discussion and review information.  You will find more links and information at the episode link above.

EMS Podcast Episode Transcript

Let's move on to this week’s Tip of the Week and this week’s Tip of the Week.  This week let's talk about intraosseous IO access and EMS providers in the field. Our good friend Jerry Barrett down in Australia sent in this tip idea in and it’s something I really haven’t covered a lot of in recent shows.

I think it’s probably been over a year since I’ve covered anything about I.O. access and it’s something that we should be aware of. It’s an alternative to our normal EMS I.V. access points that is available to us in our most critical patients and provides us a quick and easy route of medication administration, fluid bolus and just basic patient access that we can use when time is against us. We shouldn’t be fiddling around. We’re trying to find I.V. access in a patient who may have little or no blood pressure present to lift a vein enough to visualize or palpate.

The American Heart Association has discussed IO access for cardiac arrest patients in their most recent guidelines for ALS treatment. They say that I.O. access should be considered. We shouldn’t be playing around with getting I.V. access in a patient with difficult venous access points.

This is something that we should review and recover and understand because even if you’re a BLS provider, you should understand why I.O. access is such an important point to us in the ALS care arena, and be prepared to help us get the sites available, and protect those sites adequately once we have access. Because obviously once you’re going to the trouble of getting I.O. access, you don’t want to have anything dislodged or cause an issue with that I.O. access point because, clearly, it’s a point of access that we don’t want to have to do, again, if we don’t have to.

So what do we want to talk about? I found some good resources for I.O. access and there’ll be links in the show notes, so I urge you to head over to the MedicCast blog, find the “Podcast” category—“EMT Podcast” category there—and look up the links for this week’s show notes because you will be able to find a lot of other information that I’ve been able to discover for you.

Stay tuned for more on IO access for EMTs and paramedics here and at the MedicCast EMS Podcast.