Intraosseous access in cardiac arrest.

[Tigger]

Brown is not against IO as a means of circulatory access in a cardiac arrest; but it should not be first choice because there is really no valid reason you cannot at least attempt an IV first, shove a 14ga. into his external jugular if you have to.

Brown supposes that the consensus view here, in AU and the UK is that its just not that important and to routinely drill an IO into some blokes leg is a bit of overkill.

I guess I don't see why an IV needs to be considered first? What's the difference beyond the difference in size (15/14ga)? Access is access right? I haven't heard of any weakness in the IO tibial route in terms of a delay in medication effect.

 

[Shishkabob]

Brown is not against IO as a means of circulatory access in a cardiac arrest; but it should not be first choice because there is really no valid reason you cannot at least attempt an IV first, shove a 14ga. into his external jugular if you have to.

So, you're against it being first simply because you CAN do something else first instead?

That's not a defendable view.




How is it overkill? It's a peripheral line, with complication rates equal to, or less than, IVs. Put the needle on the drill, attach the line and you're done, moving on to something else. There is no legitimate reason not to do an IV over an IO in a cardiac arrest.

 

[MrBrown]

So, you're against it being first simply because you CAN do something else first instead?

Sure, you even said it yourself; you have somebody doing your CPR and defibrillation and that is the most important thing.

There is no reason you need to drill an IO into somebodies leg when you can put an IV into their foot, external jugular or arm on the opposite side of the person doing CPR.

Drugs in cardiac arrest are just not that important.

Just because you have the flash whiz-bang technology doesn't mean you have to use it. We haven't been using it for almost four decades and have managed just fine. It is not routinely used in Australia or the UK either.

Yes, you "can" do it but we "can" do a lot of things too .... doesn't mean they are necessary.

Brown has never been to a cardiac arrest where an IO has been placed, or where Brown has wanted to place one. Even with two Ambulance Officers present, the focus is on CPR and defibrillation not using flash toys to do something which probably is not going to make jack crap of a difference anyway.

If you honestly can't get a drip into some bloke after two attempts then it is reasonable to put an in an IO.

 

[Shishkabob]

There is no reason you need to drill an IO into somebodies leg when you can put an IV into their foot, external jugular or arm on the opposite side of the person doing CPR.

And again, that is not a valid defense of using an IV over an IO. I'm still waiting on one.


An IO is typically faster, more secure, and easier when compared to an IV. I see no reason not to use an IO over an IV in a cardiac arrest.

 

[usalsfyre]

Brown has never been to a cardiac arrest where an IO has been placed, or where Brown has wanted to place one.

So then you're admitting you have no experience on which to base an educated opinion on. You're going totally off of your personal perception that the intraoseous route is much more invasive than an IV line, and can't make any claims on whether it would work better for your services situation or not as it's not a routine procedure.

I've worked without IOs, I've worked in systems where they were backups and I work in a system now where per the medical director and clinical department they are the preferred access in cardiac arrest. I will say this, it is much easier, faster and more secure FOR ME to place an IO in an arrest patient. In addition it keeps the line out of the work area and there's never a chance of someone asking to pause compressions for "just a second". The same with BIADS.

I've heard the same arguments presented here against 12 leads ("they don't change MY treatment, treat the patient and not the monitor"), any sort of BIAD ("a real paramedic will get a tube"[ignoring of course the hypoxia and trauma caused by crappy laryngoscopy]), IV pumps ("they taught me how to count drips back in medic school, I don't need a stinking pump) and ETCO2 ("it's wrong most of the time, I put tubes in for 20 years without it"). You occasionally still hear it about SpO2. ALL of these devices have value in patient care depending on the organizational set up. They all increase the efficacy of the care delivered in some way.

Until an organization has evaluated a device or treatment for themselves it's shortsighted to condemn others who have incorporated device. It's also a good way to end up eating crow, as you never know what you may be doing next year. That said, I've been guilty as sin of doing this before, even with the specific devices and protocols discussed here.

 

[MrBrown]

An IO is typically faster, more secure, and easier when compared to an IV. I see no reason not to use an IO over an IV in a cardiac arrest.

Speed is not an argument here, you have somebody doing your CPR and defibrillation, that is what is important. The bloke is already dead, drugs do squat, IO needles cost $200, an IV cannula costs $2, just because you have a flash toy to play with doesn't mean you have to use it.

If Brown had the choice between an IV and an IO, with just one other Ambulance Officer on scene and nobody else for the duration of the arrest, Brown would put an IV in. Why? What difference is the couple of minutes going to make that it might take for you to get a shock or two in before you can get an IV in place? It's not.

 

[MrBrown]

So then you're admitting you have no experience on which to base an educated opinion on. You're going totally off of your personal perception that the intraoseous route is much more invasive than an IV line, and can't make any claims on whether it would work better for your services situation or not as it's not a routine procedure.

More invasive or not is not the argument.

Are you wrong for doing it? No most certainly not.

Perhaps it is just another example of the collective "the good old ambo trick of more is better is always not true" cognition.

 

[usalsfyre]

Speed is not an argument here, you have somebody doing your CPR and defibrillation, that is what is important. The bloke is already dead, drugs do squat, IO needles cost $200, an IV cannula costs $2, just because you have a flash toy to play with doesn't mean you have to use it.

If Brown had the choice between an IV and an IO, with just one other Ambulance Officer on scene and nobody else for the duration of the arrest, Brown would put an IV in. Why? What difference is the couple of minutes going to make that it might take for you to get a shock or two in before you can get an IV in place? It's not.

Because your dealing with at least two well trained ambulance officers and rarely have to manage a scene. I may be dealing a monosynaptic window licker of partner, if I'm lucky I get an old man from the local FD who has a CPR card and a desire to help. Speed is not important getting drugs on, it's important in my ability to "manage" the care being provided.

Again, you can't base your experince limited to your one system and declare everyone else as inferior for using a treatment that has been found to fit better in their situation. I'm arguing in my system it works well. I believe it would work well in certain other models as well (I REALLY believe this of BAIDS due to extensive experince of watching long periods with no compressions due to ETI attempts both in and out of the hospital).

Have you ever known me to be one of advising people to play with cool toys "just because"?

 

[MrBrown]

Because your dealing with at least two well trained ambulance officers and rarely have to manage a scene. I may be dealing a monosynaptic window licker of partner, if I'm lucky I get an old man from the local FD who has a CPR card and a desire to help. Speed is not important getting drugs on, it's important in my ability to "manage" the care being provided.

We still have holdovers from the day whose total education consists of a six week Proficiency Ambulance Aid Certificate ... so not all are well trained, Brown has seen some absolutely terrible arrests with such piss poor CPR the Ambulance Officer in question should be forever condemned to Hell Station

Brown's favourite was "oh this bloke is in asystole, with some PVCs!" um .... yes, oh look mandatory Bachelors Degree in 2014 FTW!

Again, you can't base your experince limited to your one system and declare everyone else as inferior for using a treatment that has been found to fit better in their situation. I'm arguing in my system it works well. I believe it would work well in certain other models as well (I REALLY believe this of BAIDS due to extensive experince of watching long periods with no compressions due to ETI attempts both in and out of the hospital).

Brown has never declared anybody as inferior, each system is a creature unto its own operating modality and praxis limitations bearing in mind vastly different political, funding, educational, cultural and operational differences.

You blokes are not "wrong" for drilling an IO into some blokes leg but its just difficult for the brain box to contemplate it as being necessary to do in place of putting a drip in.

Then again, we say funny words like adrenaline, bloke and shav and think Sprinters make good ambulances so what do we know?

*Brown gets Brown's large cowboy hat, Garth Brooks T-Shirt and hip pouch full of suxamethonium ... can Brown come play wild west frontier ambo now?

/taking the piss

Have you ever known me to be one of advising people to play with cool toys "just because"?

Brown really likes playing with the red lights weeeee!

/taking the piss

 

[ah2388]

I have no idea what taking the piss means..

/taking the piss

 

[Pelagic]

Brown gets Brown's

Would you stop talking about yourself in the third person FFS. Whatever clinical efficacy your statements may or may not have, doing that constantly has my "cock" meter pegged.

Taking the piss is an English colloquialism that means to rib someone or wind them up

 

[MrBrown]

Would you stop talking about yourself in the third person FFS. Whatever clinical efficacy your statements may or may not have, doing that constantly has my "cock" meter pegged.

Brown speaketh in the fourth person, Brown does not technically exist and is a kinda cross between a delusion and sort of comical character/alternate personality created by Brown's creator.

And what the bloody hell are you talking about, nothing Brown says has any sort of clinical efficacy

 

[Lady_EMT]

Would you stop talking about yourself in the third person FFS. Whatever clinical efficacy your statements may or may not have, doing that constantly has my "cock" meter pegged.

Taking the piss is an English colloquialism that means to rib someone or wind them up

You'll get used to it though Brown may have a lot of opposing ideas, from what I've seen he knows what he's doing. If you stick around, you'll notice that you won't even notice he speaks in the third person.

There's a lot of pros and cons to the IO argument. I just think that it's a new technology that people can either love or hate. As long you get access, that's all that matters. Do what you're comfortable with.


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[Shishkabob]

"new technology"?

Ha. Not even close


EMS may lack in a few things, but we're ahead of much of medicine in others.

 

[socalmedic]

You'll get used to it though Brown may have a lot of opposing ideas, from what I've seen he knows what he's doing.

Rob sounded like he knew what he was doing too... Just saying.

 

[silver]

Rob sounded like he knew what he was doing too... Just saying.

I thought this was appropriate http://www.wusa9.com/news/local/story.aspx?storyid=125578&provider=top

btw whose first post would so blatantly "attacks" an esteemed member of the community?

 

[the_negro_puppy]

Rob sounded like he knew what he was doing too... Just saying.

 

[epipusher]

as i stated previously, access is access.

/thread

 

[Smash]

as i stated previously, access is access.

/thread

Seriously? /thread? This isn't /b/, we aren't all twelve year olds and nobody "wins" threads here.

"Access is access" is complete rubbish, unless you are actually suggesting that an IO is identical to a peripheral IV which is identical to a EJ cannula, which is identical to a femoral cut-down, which is identical to a subclavian central line?

 

[usalsfyre]

"Access is access" is complete rubbish, unless you are actually suggesting that an IO is identical to a peripheral IV which is identical to a EJ cannula, which is identical to a femoral cut-down, which is identical to a subclavian central line?

(Since access is access, usalsfyre is telling his medical director he's going to start placing IJ PA lines)