A theoretical question : the lesser of two evils ...

Look for an EJ. Then IO.
In the past, we weren't allowed to do IO's on conscious people. We are allowed to now, though(sucks for the pt).
 
The answer for you depends which state you are in, Aus protoclos don't usually recommend usuing a fistula most services here frown on it, having been a phlebotmist it doesn't really matter. If you can't find a view look a bit harder there are plenty even if you have to use a 24g.

As far as the IO the protocols here only allow for Tib and Humerus so either/or, the coroner takes a dim view of sitting back and not acting when it is in the scope of your protocols.

Do you have other options? Tubed, nebs with assisted chest compression?

Anyways as others put itgo with what you have got, people die from not breathing infection is slow, and fistulae can be replaced.
 
Someone mentioned a sternal I.O , are systems using those now? Before I got in the army my system had it, though it was frowned upon as "barbaric". They're all about it in the army, but thats only because the "sternal notch" area is generally well protected by body armor and makes for fast access when limbs are chewed up.

Ive had decent results with them, crappy though if you need a dedicated line for RSI and a line for resuscitation. E.J. is money. I feel bad for the whiskeys because they dont get taught to.

Next in line for me is a cutdown, they get pretty fast with a little practice. :)
 
Veneficus said:
I have not used an EZ-IO in my career, only trained with it. I have used the manual needles in EMS and never had any issue with them.
Click to expand...

If you've ever used a power drill, you can use an EZ-IO. The only real failings I've seen are:

  1. Because it is "so easy to use" people often lack in training on the basics...like identifying landmarks
  2. Even if they know where to go they view the 3 needle sizes as "absolutes" and may not realize the Long needle perhaps is required for a pediatric patient
  3. Providers seem hesitant to use them on conscious/semi-conscious patients because it is a "drill"

I love the EZ-IO and it has made life far less stressful, or if they are stressful it's made it shorter in duration, in emergent situations with poor intravenous access.
 
Drilling is more humane than manual pressure, who here has bent an I.O needle?
 
Here in Oz we can't go with sternal at all so we are limited with the 2 long bones. EJ is usually last resort and then mostly in arrests since it is a decent size. Depending on where you operate the EZ-IO is quick enough to use without too much pain. I use the B.I.G. and if the pt is conscous we can give 1% lignocaine anyway.
 
Protocols allow a; alternative access outside of peripheal IVs and IOs if meds are needed in an actual emergency.

It's inserted wherever I can get it.


Life > limb. Life > fistula.
 
Listening to some of the posts; I wish we had more in our protocols! We have peripheral IV's; EJ's; IO in the long bones, and the humerous. It would be cool to do a sternal or Illiac IO. We can't access fistala's or ports/ PICC's without medical direction so its basically a waste of time you might as well just try the EJ, or IO. We do have EZ IO which has been awesome compared to the manual IO's.
 
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