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IO vs External Jugular IV in trauma patients

51 posts in this topic

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You respond to a high speed MVC, you find a patient entrapped in a SUV with signs and symptoms of shock, abdominal tenderness, and a broken left femur. Your standing orders and protocols call for vascular access on all trauma patients with signs and symptoms of shock but you and your partner can't gain IV access on his arms. What method of access do you think is best: IO access in the right anterior medial tibia with the EZ-IO or start a External Jugular IV. Give you reasons for your chosen method.

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Posted · Report post

[quote name='RomeViking09' date='07 September 2009 - 09:50 AM' timestamp='1252313452' post='222933']
You respond to a high speed MVC, you find a patient entrapped in a SUV with signs and symptoms of shock, abdominal tenderness, and a broken left femur. Your standing orders and protocols call for vascular access on all trauma patients with signs and symptoms of shock but you and your partner can't gain IV access on his arms. What method of access do you think is best: IO access in the right anterior medial tibia with the EZ-IO or start a External Jugular IV. Give you reasons for your chosen method.
[/quote]

Are these failed attempts occurring while he is still entrapped? If you can not get an IV due to positioning what makes you think an EJ would be better or less risky?

Regardless, you also seem to be implying that the anterior medial tibia is the only place to inset an IO; the humerus sounds more readily accessible.

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[quote name='akflightmedic' date='07 September 2009 - 07:06 AM' timestamp='1252321594' post='222935']
Are these failed attempts occurring while he is still entrapped? If you can not get an IV due to positioning what makes you think an EJ would be better or less risky?

Regardless, you also seem to be implying that the anterior medial tibia is the only place to inset an IO; the humerus sounds more readily accessible.
[/quote]

Let's say you can't get an IV even after you get him out of the SUV. (in my area only anterior medial tibia site IO is authorized for EMS with the EZ-IO and B.I.G. the FAST-1 can be used in the Sternal Site)

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[quote name='RomeViking09' date='07 September 2009 - 12:11 PM' timestamp='1252321888' post='222936']
Let's say you can't get an IV even after you get him out of the SUV. (in my area only anterior medial tibia site IO is authorized for EMS with the EZ-IO and B.I.G. the FAST-1 can be used in the Sternal Site)
[/quote]

Well this is still easy question.

You have to immobilize him, the collar is in the way and it is much easier to do an EJ by turning the head lateral. Since this is contraindicated in this particular MOI, I would do the IO.

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Agreed. The humerus is greatly preferred for several reasons. First, it's more accessible. Second, it's more proximal. Third, it's not as dependent. Fourth, it's much less likely to be compromised by injuries typically seen in a high speed MVA. Fifth, it's much less likely to get entangled or dislodged during extrication.

Thank God for systems that don't limit their practitioners to "protocols".

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Posted · Report post

It's a lot harder to "miss" doing an IO. Properly trained people using the EZ-IO will be able to gain quick and easy access to give fluids and medications. An EJ leaves a lot more for error IMHO. The patient will be moving probably, adding difficulty for starters. Not to mention you are sticking a needle into their neck! If by chance you miss the vein, blow it or whatever else, you are stuck holding your finger over the site. Just my thoughts...

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OK so why are we still doing EJs when we have devices like the EZ-IO?

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[quote name='RomeViking09' date='07 September 2009 - 11:55 PM' timestamp='1252360512' post='222956']
OK so why are we still doing EJs when we have devices like the EZ-IO?
[/quote]

Because EJs are still acceptable/preferrable in pts that don't need to be immobilized.

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We still do EJ's in patients who have poor vascular access due to burns, dialysis shunts, trauma to the arms etc because an EJ is a different site, which may not be affected by the reasons another peripheral IV site would be. Also, here we can only use an IO in a last effort for access where sometimes an EJ would be more appropriate.

And humeral IO would be best in that situation for all the reasons listed above.


I hope that makes sense? COld medicine may be getting to my head.

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[quote name='scoobykate' date='08 September 2009 - 01:14 AM' timestamp='1252368873' post='222968'] COld medicine may be getting to my head.[/quote]


Try warming it up...

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