Adult IO

[Guest cheekmedic]

Has anyone had the opportunity to utilize an Adult IO? if so do you have a specific SOG in place within your organization? has anyone heard if this practice has been approved for use within the Hudson Valley Region? I know that the practice itself of Adult IO insertion is an acceptable and useful adjunct, I just wanted to see if anyone has had the chance to utilze them in the field. Thanks

[Skooter92 7]

Both HVREMSCO and Westchester REMSCO allow adult intraosseous as a vascular access method. I have done a couple, one within the past month on a nursing home code on an emaciated patient with zippo for veins. Not even a good EJ to be found-went through the gear, found a 15 gauge Jamshidi IO needle, placed it in the proximal tibia, and pushed fluids and drugs without any issues. It works, and when needed, is perfectly acceptable.

[WAS967 97]

Both HVREMSCO and Westchester REMSCO allow adult intraosseous as a vascular access method.

Really? Interesting news. Can you provide some supporting documentation? (URL, etc). Thanks.

[Skooter92 7]

Holy schnikes, WAS!!!!!

Westchester's Protocol 1/RMC says IV or IO.....buuuuuuut......

IT'S NOT IN HUDSON VALLEY!!!!!

Thought it was, was even told it was......so much for listening to anyone else....

Good thing I ain't done one there!!!!!

Though, probably, a good MC doc would let you...........

Or would they?

But trust me, it does work (at least in Westchester County!)

http://www.wremsco.org/protocols.htm#paramedic

Edited November 14, 2005 by Skooter92

[medic13 0]

The service that I work for has just recently looked into the adult IO. We are looking into the auto injector and the EZ IO drill. When I was at the EMS Expo I took the CME class, It's very cool stuff, especially the EZ-IO drill. The company that makes the drill will come to your organizatin and inservice you as well a the hospitals that you transport to. Looks like the only disadvantage is the cost of the cath's. Our medical control M.D. is very into doing it..... so looks like it's a go. I will let you know if I find out any more info. You should check out the website for the drill.

http://www.vidacare.com/products/adult_ezio/adult-ezio.html

[WAS967 97]

Westchester's Protocol 1/RMC says IV or IO

Jesus. Guess I missed that one. For some reason I thought they only had IO in the peds protocols. I'll have to keep that in mind JIC. Good call (on both notes). Bring that call to Don's attention. Would make a good call audit review.

[Guest]

Both HVREMSCO and Westchester REMSCO allow adult intraosseous as a vascular access method.  I have done a couple, one within the past month on a nursing home code on an emaciated patient with zippo for veins.  Not even a good EJ to be found-went through the gear, found a 15 gauge Jamshidi IO needle, placed it in the proximal tibia, and pushed fluids and drugs without any issues.  It works, and when needed, is perfectly acceptable.

←

Skooter, I'm sure you did a great job on the call. I just wonder if a nursing home patient in that condition is really getting what they would want.

[Skooter92 7]

I don't ration care according to whether someone's in a nursing home or not. This woman wasn't in a state of deterioration-she was medically needy, so was then placed in a nursing home. Her arrest was secondary to the staff inattentively feeding her, causing her to aspirate and have an obstructed airway. That was not a natural progression of her ailments-she was killed by negligence. An IO, to give her a better chance, was not unwarranted.

When we start to decide who deserves better or more comprehensive care according to our personal assessment of someone's circumstances, are we really acting in their best interests?

[WAS967 97]

The review at a recent call audit regarding the use of an IO in an adult met with some disfavor in the two doctors that were there. Most seemed surprised that there was any reasonable patency in a the tibia of a person that age. Thier sites of choice seemed to be the sternum or the pelvic crest, tho we're not trained to access those sights so it's a moot point. Perhaps if we had the newer IO guns or sternal access, we'd have more options available.

They also stated that the use of IO on adults per protocol one was a very liberal interpretation, but there is nothing there that implicitly disallows it. (I guess for a change it's an ommission that works in our favor.

Both newer IO access methods and more advanced airway methods (RSI) came up recently. Perhaps our new director can push for some more aggresive protocols for both.

Edited December 3, 2005 by WAS967