IO.pptx7777777777777777777777777777777777777777777777

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1. Intra-osseous access Sierra leone National ETAT Programme 2019

2. War: What has it taught us? Triage Tourniquet Intraosseous access Damage control resuscitation

3. Intraosseous Discovered 1936 by accident: Bone marrow transplant in rabbit experiments Tocantins and O’Neill Second world war used on the battle field

4. What is IO cannulation? Inserting a line into the marrow cavity providing access to non-collapsible venous plexus

5. Indication? When intravenous access is difficult or time critical Shocked patient Cardiac arrest Burns Oedematous patient Obese patients trauma

6. Site Sternum Humerus Femur Tibia- proximal and distal Ilium

7. Tibia Proximal or distal

8. Femur

9. Types of IO

10. Contraindications Distal trauma (fracture on the same side) Infection Previous attempt on the same site Osteogenesis imperfecta Bleeding problems (relative contraindication)

11. Uses Anything that you can put through a cannula: Blood products Medications (i.e. adrenaline) Dextrose Crystalloids, colloids

12. Reason for failure Incorrect identification of landmarks A bent needle Clogging of the needle with marrow Through-and-through penetration of both anterior and posterior cortices Fractures caused by excess force or by fragile bones Penetration of the mediastinal structures or space with the potential for pneumothorax, vascular injury, lung injury, in the case of a sternal needle

13. Complications Local infection Compartment syndrome secondary to fluid extravasation Local hematoma Pain Potential for growth plate Fat embolus Bone embolus (though this has not been reported in humans) Mediastinitis after sternal IO puncture

14. Let us try…