# EJ or IO during a full arrest?



## emtchick171 (Oct 29, 2010)

Just wondering who prefers an EJ or IO during a cardiac arrest...

In our protocol we can use either in an emergent situation, I prefer the IO...just wondering what everyone else likes and what makes you prefer it?

All feedback is appreciated.


----------



## Handsome Robb (Oct 29, 2010)

Protocol for the company I am going to school at is an IO. Easier and faster is the thought process.


----------



## emtchick171 (Oct 29, 2010)

NVRob said:


> Protocol for the company I am going to school at is an IO. Easier and faster is the thought process.



I agree with that, do y'all use the leg IOs or sternal IOs?


----------



## Handsome Robb (Oct 29, 2010)

We go leg, then arm if you can't gain access in the leg for some reason, I'd have to look again but I believe sternals are bad juju in our protocols.


----------



## emtchick171 (Oct 29, 2010)

NVRob said:


> We go leg, then arm if you can't gain access in the leg for some reason, I'd have to look again but I believe sternals are bad juju in our protocols.



That's good to know, just to see how EMS systems vary...the only way we do leg IO is with pediatrics, and...if our PT is over the age of 12, they get the sternal IO. We have had wonderful success with our sternal IO system.


----------



## TacoMEDIC (Oct 29, 2010)

We always go with the IO. It's much quicker and the 1st attempt success rate is higher than EJ. We use 2 sites for adults, distal tibia and proximal humerous. On pediatrics we use the proximal tibia.


----------



## citizensoldierny (Oct 29, 2010)

Suffolk County IO protocol is good for proximal tibia only. As for my choice I'll take IO, faster and easier. Hence the name EZ-IO which is what we use on my FD. I'm sure the commissioners would love if I we got better acquainted with doing EJ's as those IO needles are a bit on the pricey side.


----------



## emtchick171 (Oct 29, 2010)

citizensoldierny said:


> Suffolk County IO protocol is good for proximal tibia only. As for my choice I'll take IO, faster and easier. Hence the name EZ-IO which is what we use on my FD. I'm sure the commissioners would love if I we got better acquainted with doing EJ's as those IO needles are a bit on the pricey side.




Ohhh yes the IO needles are definitely on the pricey side, but I haven't been on a call yet *knock on wood* that a sternal IO was not successful. We have great success rates with them, as for the tibia...we RARELY do one of these, we have the adult needles to use for the tibia but we have found that the sternal works much better!


----------



## jjesusfreak01 (Oct 29, 2010)

EJs and IOs both allow adequate flow for use in a cardiac arrest, so its really just a matter of how quickly you can do each one, since time is everything.


----------



## Firemedic262 (Oct 29, 2010)

Per protocol EZ-IO in Mississippi and Bone Gun in Alabama.


----------



## swissmedic (Oct 30, 2010)

In our protocols we can use EJ or EZ-IO.
I prefer the EZ-IO, Tibia proximal aera, but tibia distal or humerus 
I never tried it...
Matt


----------



## MrBrown (Oct 30, 2010)

IV works well, our Paramedics can do an EJ whereas Intensive Care (ALS) has IO.


----------



## socalmedic (Oct 30, 2010)

for the OP, how well does a sternal IO work with CPR? i dont think i would even try. my county has IO for peds only, i have not had any CA yet where i could not get an IV. if there are no viens we can go IL (intra lingual) with the epi and atropine.


----------



## swissmedic (Oct 30, 2010)

I think every medic is able to get an iv line, but sometimes you haven't soo much time (90sec. for iv line isn't much time) so EZ-IO or BIG are very fast and easy every doctor can learn this too B)
Matt


----------



## Aidey (Oct 30, 2010)

IO over EJ unless it is the sternal IO. Sorry, but in a code I want as little as possible in the way. We c-collar all of our intubated patients, and c-collars don't get along with the sternal IOs.


----------



## MasterIntubator (Oct 30, 2010)

Its provider choice in our area.  EJs are beautiful 'dead' people veins, plumped up and ready to stab.   Personally, its whatever I can get quicker in my hand and ready.... which lately, has been the IV cath.  I/Os are in the humeral head.  If that fails, its free game.


----------



## TransportJockey (Oct 30, 2010)

I have my choice. For IO we use the EZ and can do either humoral or tibial. It all depends on what I see when I take a look


----------



## emtchick171 (Oct 30, 2010)

I've never had a sternal IO get in the way during CPR (other than when it was being inserted).


----------



## Boston.Tacmedic (Nov 1, 2010)

emtchick171 said:


> Just wondering who prefers an EJ or IO during a cardiac arrest...
> 
> In our protocol we can use either in an emergent situation, I prefer the IO...just wondering what everyone else likes and what makes you prefer it?
> 
> All feedback is appreciated.


I use Intraosseous infusion often, it works exceptionally well in low light and austere environments. The "sternal Intraosseous method" also works well but can prove to be dangerous to the PT if there is an chance of unstable CX Fx. I agree with other posters EJ are wonderful "dead people" veins however we do what is best for the PT and best for the PT is needed treatment. Also we use 0.5mg-1.0mg/kg (100mg ;-) of lidocaine for living/alert non obtunded Pt's. 

Just my .05 cents.


----------



## emtchick171 (Nov 1, 2010)

Boston.Tacmedic said:


> I use Intraosseous infusion often, it works exceptionally well in low light and austere environments. The "sternal Intraosseous method" also works well but can prove to be dangerous to the PT if there is an chance of unstable CX Fx. I agree with other posters EJ are wonderful "dead people" veins however we do what is best for the PT and best for the PT is needed treatment. Also we use 0.5mg-1.0mg/kg (100mg ;-) of lidocaine for living/alert non obtunded Pt's.
> 
> Just my .05 cents.




I appreciate everyones feedback. I think its interesting to hear how in each area/department protocols for IO/EJ, etc. differ. I agree with the danger to the PT if there is a chance of Fx...but so far we have not ran into anything that has caused a problem with us using a sternal IO. *knock on wood* We also just recently (within the last 2 days) received the IO drills which will make matters much easier for us, rather than having to do everything manual.


----------



## Boston.Tacmedic (Nov 1, 2010)

emtchick171 said:


> I appreciate everyones feedback. I think its interesting to hear how in each area/department protocols for IO/EJ, etc. differ. I agree with the danger to the PT if there is a chance of Fx...but so far we have not ran into anything that has caused a problem with us using a sternal IO. *knock on wood* We also just recently (within the last 2 days) received the IO drills which will make matters much easier for us, rather than having to do everything manual.



No not causing a Fx, I mean using it with a Cx Fx that is unseen


----------



## emtchick171 (Nov 1, 2010)

Boston.Tacmedic said:


> No not causing a Fx, I mean using it with a Cx Fx that is unseen



I understood what you meant, sorry I didn't make it clear when I posted a reply. My fault, sorry for the confusion.


----------



## EMSLaw (Nov 2, 2010)

As far as I know, both are permitted in NJ, though IO is used mainly on children and in the case of unavailability of IV access.  Long bone only for IO, no sternal.  I've never seen a medic go for the EJ, but since it's a peripheral vein, I don't see why they couldn't.    

They're talking about removing ET tube as a route of administration.  I've only seen it done once - patient with bilateral femur and humerus fractures.  No IV, no IO.  Got one epi in down the tube.  Of course, he also had bilateral hemopneumo, so I'm not sure how much good it did.


----------



## Aidey (Nov 2, 2010)

Sounds like that patient had a serious case of dead.


----------



## EMSLaw (Nov 2, 2010)

Aidey said:


> Sounds like that patient had a serious case of dead.



He was having what you might call a really bad day. 

As you well know, nobody dies in the ambulance.  At the scene, or in the hospital, yes, but not in the ambulance.  So, when he coded half-way to the Trauma Center, we had to work it.


----------



## MrBrown (Nov 2, 2010)

and yet you didn't call Brown to come swan out the sky in orange suit and go "yep, he's dead now lets go get something to eat"?


----------



## EMSLaw (Nov 2, 2010)

MrBrown said:


> and yet you didn't call Brown to come swan out the sky in orange suit and go "yep, he's dead now lets go get something to eat"?



Despite the fact that I've had two cases in the last two weeks of nursing homes performing CPR on breathing patients (the latter of which was sitting up and talking to me when I arrived), we generally don't pronounce breathing patients. :wacko:

And alas, your helicopter was too far away.  18 minutes out as we loaded the patient, as I recall, and the hospital was about 20-25 minutes.


----------



## MrBrown (Nov 2, 2010)

EMSLaw said:


> And alas, your helicopter was too far away.  18 minutes out as we loaded the patient, as I recall, and the hospital was about 20-25 minutes.



You should have told Ambulance Communications, Brown would have hopped in the car and come for a blast thru rural NJ at 120 miles an hour 

Come on Oz, its a go, you can drive!


----------



## wyoskibum (Nov 2, 2010)

*definately IO*



emtchick171 said:


> Just wondering who prefers an EJ or IO during a cardiac arrest...
> 
> In our protocol we can use either in an emergent situation, I prefer the IO...just wondering what everyone else likes and what makes you prefer it?
> 
> All feedback is appreciated.



Unless there is a contraindication, I prefer to use the Easy IO.  Between compressions and ventilations, there is a lot going which makes it harder to get in there and start an EJ.


----------



## Ridryder911 (Nov 2, 2010)

I believe we will see the abolishment of EJ's overall. More and more research are beginning to demonstrate multiple risks of air embolism, high incidence of infiltration (subdermal hematoma are very risky in that area), and infection rate in comparision to the I/O route. 

As one that has performed literally huindreds of EJ, yes they are easy to cannulate, yes it is a large acess and venous route.. hence the complication associated with them. Now, with the introduction of easiness of I/O and very little associated risks in comparrision why continue to perform a procedure that has those associated complications? 

R/r 911


----------



## MrBrown (Nov 2, 2010)

Our Paramedics (ILS) are still taught EJs and have been doing them for years but Brown thinks they will probably go away in the future along with lasix.

We have used the BIG and Cooks screw-in IO needle for years and have introduced the EZIO last year however ... they are reasonably expensive and with ease of insertion comes the risk of the sparkier Officers whipping it out inappropriately when they cannot get a line into somebody.


----------



## emtchick171 (Nov 3, 2010)

MrBrown said:


> Our Paramedics (ILS) are still taught EJs and have been doing them for years but Brown thinks they will probably go away in the future along with lasix.
> 
> We have used the BIG and Cooks screw-in IO needle for years and have introduced the EZIO last year however ... they are reasonably expensive and with ease of insertion comes the risk of the sparkier Officers whipping it out inappropriately when they cannot get a line into somebody.




IO definitely made EJ around my area go almost nonexistent...due to the fact of the ease and reliability of an IO. Also, Lasix is already strict...we do carry it on the truck, but we ALWAYS have to call medical direction in order to administer Lasix to a PT.


----------



## jonmedic101 (Nov 8, 2010)

*Io*

I use IO very very often. I don't waste any more time today if I sense it will be hard to get an appropriate IV fast.
I prefer the BIG over the EZ, since it is not operated by batteries, its small size and comfort of use.
I can put some of these units in my vest and use even on MCI. for me holding to that case the EZ has is not comfortable.
This is how we do IO in Israel, and as you all probably know..... in Israel there a lot of scenarios requiring the use of the BIG for IO.
Jonmedic101


----------



## medic86 (Nov 8, 2010)

Does different states have different protocols on which levels can use IO's? Here in Indiana it is restricted to Paramedic only. Don't quote me on this but EMT-Intermediate may be able to. Not sure.


----------



## TransportJockey (Nov 8, 2010)

medic86 said:


> Does different states have different protocols on which levels can use IO's? Here in Indiana it is restricted to Paramedic only. Don't quote me on this but EMT-Intermediate may be able to. Not sure.



In NM it used to be EMT-Is could only do Pedi IOs, but that may have changed. In TX I can do an IO anywhere and on anyone that I see that need.


----------



## rescue329 (Nov 22, 2010)

EJ here, it is usually me and my partner in the back and a firefighter driving so with an EJ i can push drugs and bag at the same time


----------



## lightsandsirens5 (Nov 22, 2010)

rescue329 said:


> EJ here, it is usually me and my partner in the back and a firefighter driving so with an EJ i can push drugs and bag at the same time



IO here. Fast, easy, clean, very secure, all that good stuff. In an arrest, I don't want to dilly around with positioning his head to see the vein. Or have someone doing CPR enough to pressurize the vein and have to hit it while the pt is being bounced up and down. IO it like, ok, hold for one sec........locate site........zip! Ok, resume. Literally that long. 

And can't you can just as easily bag a pt and push drugs thru a proximal humeral IO.


----------



## rmellish (Nov 24, 2010)

humeral head is preferred IO location here per protocol. That said, I much prefer the EJ in an arrest, easier to secure in an arrest and very conveniently located near the airway. 

As far as the risk of air embolism...full arrest in the prehospital setting has a relatively poor prognosis as is.


----------



## jgmedic (Nov 25, 2010)

IO everytime, EZ-IO is awesome, our County Fire has the BIG and I have never seen it work properly. EJ's are apparently gone at our next protocol update.


----------



## jjesusfreak01 (Nov 27, 2010)

Lasix has been gone for a long time now here and IOs are the preferred method.


----------



## MediMike (Dec 1, 2010)

Around here we have the option to do either, I prefer the EJ due a combination of factors, namely I'm more comfortable with it, no risk of equipment failure, and the flow rate.  Most literature agrees that with a humeral head IO meds will reach central circulation in about 1 second, slightly longer with a tibial. Generally the flow rate is equivalent to that pushed through a 21-gauge catheter. Sternal I haven't read much on, but man it looks cool  I always look for a peripheral first, easier to secure and for all the reasons listed above.

Now, that being said, if I take a glance and don't see a darn thing I'm going straight for my drill rather than dig around in the meat!


----------

