Humeral head vs tibial IO

Lots of good information here !
 
I am a new medic with only a couple years behind me. I have only done maybe 4 I/O insertions, all proximal tibia. I have stuck with that because a medic of 14 years had talked of the difficulty in site location. The last arrest I was part of I witnessed a (successful) humeral head insertion and I also have watched a number of videos (Youtube can be a wonderful thing!) It really doesn't appear to be as difficult as I had thought. In school it was taked about But I don't remember any hands on, we only performed the proximal tibial insertion. I will be considering it on the next case.According to the paper presented the flow rates are similar but it does seem that having the med administration site near the head would be convenient since I often am riding with an EMT who cant administer drugs.
Where I am at in Southeast Georgia it seems that I/O access is reserved for cardiac arrest and unresponsive patients with inability to gain IV access. Has anyone out there done an I/O on a conscious Pt? I've seen it done on youtube. What situations would cause you to go to that point? I work on a county 911 ambulance with T/P time ranging from 15 to 30mins.
 
Harleyjon said:
I am a new medic with only a couple years behind me. I have only done maybe 4 I/O insertions, all proximal tibia. I have stuck with that because a medic of 14 years had talked of the difficulty in site location. The last arrest I was part of I witnessed a (successful) humeral head insertion and I also have watched a number of videos (Youtube can be a wonderful thing!) It really doesn't appear to be as difficult as I had thought. In school it was taked about But I don't remember any hands on, we only performed the proximal tibial insertion. I will be considering it on the next case.According to the paper presented the flow rates are similar but it does seem that having the med administration site near the head would be convenient since I often am riding with an EMT who cant administer drugs.
Where I am at in Southeast Georgia it seems that I/O access is reserved for cardiac arrest and unresponsive patients with inability to gain IV access. Has anyone out there done an I/O on a conscious Pt? I've seen it done on youtube. What situations would cause you to go to that point? I work on a county 911 ambulance with T/P time ranging from 15 to 30mins.
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Yeah. I placed a tibial IO on a seizure patient last week. She was postictal, but the flush woke her up fully. She had been in status for 15 minutes and I needed access.
 
I've drilled two conscious patient's after failing to get access by other means. One was for HyperK (he became less obtunded after getting a gram of calcium and an amp of bicarb bolused...), the other was some sort of odd overdoes where her pressure fell out and we had no other option.
 
I have done 2 conscious IOs. One was a diabetic patient who was responsive to verbal stimuli. No where near enough with it for oral glucose, I tried 4 sticks followed by my medic preceptor who tried 4-5. Ended up going distal tibia and it worked fine.

Second was a self inflicted GSW to the head. Patient AOx4. No IV access at all. I went humeral head with it. Patient had some pain until the lido kicked in. Then fluids went in very quickly with no pressure bag being needed.
 
DesertMedic66 said:
I have done 2 conscious IOs. One was a diabetic patient who was responsive to verbal stimuli. No where near enough with it for oral glucose, I tried 4 sticks followed by my medic preceptor who tried 4-5. Ended up going distal tibia and it worked fine.

Second was a self inflicted GSW to the head. Patient AOx4. No IV access at all. I went humeral head with it. Patient had some pain until the lido kicked in. Then fluids went in very quickly with no pressure bag being needed.
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Y'all can IO in CA? EZ IO or manual?
 
RocketMedic said:
Y'all can IO in CA? EZ IO or manual?
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Yeah we can IO in CA. It depends on your county and company if you have EZ IO or manual. For my county we have the EZ IO with distal tib, proximal tib, and humoral head standing orders.
 
Thanks for the responses guys. It is always nice to have alternate options for different scenarios. Especially for situations which one has yet to encounter.
 
@Harleyjon - the only consideration re: proximal humoral IO access is for conscious patients who are not able to follow commands. If they were to lift their arm, the acromium process can make contact with and subsequently dislodge the needle. For these patients, a proximal tibial placement may be a more suitable site.
 
Very good point @CWATT I will keep it in mind. Thanks!
 
TransportJockey said:
Humeral head insertion, at least with the EZ-IO, is rather straightforward with easy to find land marks. I prefer it now that I've done it a few times... but the needle it uses is huge
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I second that.
And it flows like a champ.
 
Yeah we have been talking about using the femur for awhile now now. We do use it in pediatrics right now.
 
CWATT said:
@Harleyjon - the only consideration re: proximal humoral IO access is for conscious patients who are not able to follow commands. If they were to lift their arm, the acromium process can make contact with and subsequently dislodge the needle. For these patients, a proximal tibial placement may be a more suitable site.
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Valid concern however I still prefer to go humoral and just secure the arm. Wrist restraint or Coban and keep the arm tucked across the body. Unless they are agitated and flailing about it shouldn't be too much of an issue.
 
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