The MedicCast

This week on the MedicCast, host Jamie Davis the podmedic provides EMS students and providers a review on airway management. In this episode, listeners will be given an overview on the importance of airway management, the procedures, algorithms and the different equipment used to be able to establish a patent airway. Also, the show provides news items for EMS and links for this week's featured tip for a more comprehensive review.

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The MedicCast is a weekly show for EMTs, paramedics, and EMS students featuring news, products, interviews, comments, tips, tricks and more.

IO Contraindications

Now, there are also some issues associated with I.O. use by EMTs and paramedics in the field. We don’t want to use I.O. access in any patient with any kind of fracture in that extremity because obviously if the bone is broken, especially in the lower leg, you can’t tell which of the two bones is broken necessarily. You just might know you have a fracture because of some deformity. You don’t want to administer fluids or medications into a bone that has a hole in it other than the one you put in it. So if the bone is broken, you’re just going to be pushing the fluids out into the extracellular space and into the interstitial spaces of the tissues outside of the bone and it’s not going to get into the vasculature, so you don’t want to put it into a broken bone. Think about multi-system trauma patients, being very careful about trauma in-between your location and the center core structures of the body.

If you’ve already tried to place an I.O. device in that same site or leg, you don’t want to be putting it there, go to the other leg if you can. If there’s any history of bone cancer or bone disease in this patient, you don’t want to be treating this particular patient this way unless you’ve achieved medical direction first. So call in to your doctor. Usually it’s an isolated location. If they have had a history of bone cancer in this particular extremity you’d want to use the other extremity, but you talk to your medical direction and follow your own protocols as always. I shouldn’t have to tell you that but I’m going to anyway.

Patients with osteoporosis history should not be getting IO access as a primary IV access point. This is a degenerative bone problem. People with bone issues, with fragile bones because of deficiencies or disease or chronic issues are also not candidates for I.O. access in most cases. If patients have some kind of a problem with that lower leg, if they have an infection of the lower leg, we probably don’t want to be opening the bone to that infection, so we want to consider not using that as well.

IO Site Preparation and Devices

Once you found your site, because of the risk for infection just like we have with any I.V. placement, we want to make sure we’re very carefully cleansing the area first. We’re going to make access to the device, to the leg, or to the site. Once we selected our site and cleaned it, we'll gain access with an approved I.O. device. A lot of the agencies are still using this old hand-crank models where you just basically holding it in your hand and twisting it in. These things are brutal.

I’ve never had to place one, but I practiced a lot on chicken thighs which is what we used a lot in our area. If you haven’t heard that trick, I urge you to go out and buy a family pack of chicken thighs. You can get some I.V. fluids and practice—put your gloves on and practice placing in the bone of these chicken thighs. They’re actually pretty close to what you might feel when placing in a young child. You can get an idea of how it pops in to the marrow space. Then if you color your I.V. fluid with some food coloring, you can actually squeeze it in and infuse it and you can actually watch it color the tissues of the chicken thighs and then you can cook it up and have a nice barbecue later with your green or blue-colored chicken thighs infused with saline solution.

So you want to make sure that you practice and understand how this works. You want to clean your site carefully. You want to use your device in an approved manner. So if you are using one of the new I.O. devices like an I.O. drill, the EZ-IO comes to mind. It’s one of the ones that actually have my hands on and practice with although we don’t yet have it in our system, but you want to follow your device guidelines for how to use it properly, how to attach your I.O. and then attach your I.V. to the needle catheter.

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Find more EMS news, commentary, tips, skills reviews, and more at the MedicCast EMS Podcast web site.