IO's?...good for?

[Richard Wigle MD FACS]

The reason the cut down is taught in ATLS is that, despite
what people seem to think these days, ATLS is primarily
still for the practitioner out in the boondocks, alone and
without a bunch of gadgets,

A ctdown can be done with materials usally at hand in
almost any circumstance

The same is true for the other techniques taught in ATLS

There s nothing wrong with any of the devices or gadgets
mentioned other than if you don't got them, you don't got
them

 R Wigle MD FACS
--- Matthew Reeds <mgreeds at reeds.uk.com> wrote:

> As far as I am concerned, classical IO is an archaic tool
> and out-of-date
> and, like venous cutdown, should no longer be taught on
> ATLS. If it is not
> possible to get IV access and you really must resort to
> an alternative form
> of access, then could try the following:-
> 
>  
> 
> 1)- BIG (Bone Injection Gun) - Never had a problem with
> this and not aware
> of the earlier problems reported with locking of the gun
> device. Only used
> when IV access unobtainable and really quick to insert
> (in my experience
> whilst most people still preparing to insert a
> traditional IO). This has a
> number of safety mechanisms to ensure safe, proper and
> effective insertion
> so don't see the reason for it failing. Would be
> interested to know more;
> 
>  
> 
> 2)- F.A.S.T. 1 - Used a lot in the military and have some
> experience of this
> device. Great to use, very quick and simple to insert and
> (despite initial
> thoughts to the contrary) is relatively painfree.
> Although cannot be used in
> sternal fractures or those requiring a sternotomy, it is
> a very useful aid
> for those with multiple extremity fractures where IV and
> IO access is
> contraindicated etc.
> 
>  
> 
> 3)- VEID - Could use this device to assist in getting IV
> access (attached to
> the IV cannula) where it appears obvious it won't be a
> useful
> straight-forward insertion due to poor circulation etc. 
> 
>  
> 
> How much volume were you trying to infuse?? I personally
> wouldn't be too
> worried about potential for volume infusion given that I
> apply permissive
> hypotension with either no fluids or, at the very most,
> low volume fluid
> resuscitation (just enough to maintain a femoral pulse.)
> 
>  
> 
> This week I was referred by our Accident & Emergency
> department (amongst
> others) 3 multiple stabbings to both chest and abdomen
> and 2 severely
> injured polytrauma RTAs with head, facial, chest, spinal,
> abdominal, pelvic
> and extremity injuries (with prolonged entrapment times
> of near 1 hour.)
> Although 1 of the RTA victims had been out in the cold at
> 3am, wearing very
> little clothing and peripherally shutdown, I would have
> grabbed the BIG
> first (rather than IO) if I had had a problem with IV
> access (F.A.S.T. 1
> contradindicated due to multiple sternal fractures,
> sterno-manubrial
> disruption, sterno-clavicular disruptions, pulmonary
> contusions and
> mycocardial contusions). Thankfully my ability to obtain
> IV access didn't
> let me down! Needless to say though I gave very little
> fluid anyway (in fact
> none at all!!!).
> 
>  
> 
>  
> 
>  
> 
> Matthew Reeds
> 
> Surgery
> 
> U.K.
> 
>  
> 
>  
> 
>  
> 
> -----Original Message-----
> From: Joe Nemeth [mailto:joe.nemeth at mcgill.ca] 
> Sent: 16 March 2007 13:50
> To: trauma-list at trauma.org
> Subject: IO's?...good for?
> 
>  
> 
>  
> 
> our ED is thinking of purchasing high-end fancy-shmancy
> IO needles....
> 
>  
> 
> opinions/experiences on the necessity of these toys in
> tertiary care ED 
> 
> please?
> 
>  
> 
> joe
> 
> McGill University
> 
> MOntreal
> 
>  
> 
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