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IO vs External Jugular IV in trauma patients


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#1 RomeViking09

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Posted 07 September 2009 - 08:50 AM

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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#2 akflightmedic

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Posted 07 September 2009 - 11:06 AM

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.


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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#3 RomeViking09

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Posted 07 September 2009 - 11:11 AM

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.


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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#4 akflightmedic

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Posted 07 September 2009 - 12:16 PM

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)


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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#5 Dustdevil

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Posted 07 September 2009 - 07:48 PM

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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