Intraosseous Infusion as a Bridge to Definitive Access

2016 ◽  
Vol 82 (10) ◽  
pp. 876-880 ◽  
Author(s):  
Megan Johnson ◽  
Kenji Inaba ◽  
Saskya Byerly ◽  
Erika Falsgraf ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Life Support ◽  
Unit Length ◽  
Penetrating Trauma ◽  
Venous Access ◽  
Rapid Sequence Intubation ◽  
Inhospital Mortality ◽  
Rapid Sequence ◽  
Data Points ◽  
Level 1 Trauma Center ◽  
Difficult Venous Access

Intraosseous (IO) needle placement is an alternative for patients with difficult venous access. The purpose of this retrospective study was to examine indications and outcomes associated with IO use at a Level 1 trauma center (January 2008–May 2015). Data points included demographics, time to insertion, intravenous (IV) access points, indications, infusions, hospital and intensive care unit length of stay, and mortality. Of 68 patients with IO insertion analyzed (63.2% blunt trauma, 29.4% penetrating trauma, and 7.4% medical), 56 per cent were hypotensive on arrival and 38.2 per cent asystolic. The most common indications for IO infusion were difficult IV access (69%) and rapid sequence intubation (20.6%). The median time to IO access was three minutes. IV access was gained after IO in 72.1 per cent of patients. Through IO access, 30.9 per cent patients received crystalloid, 29.4 per cent received Advanced Care Life Support (ACLS) medications, 25 per cent rapid sequence intubation medications, 20.6 per cent blood products, and 2.9 per cent seizure medications. Overall, 80.9 per cent were intubated in the Emergency Department (ED), 26.5 per cent had ED thoracotomy, and 20.6 per cent had a laparotomy. Median crystalloid infused through IO was 180 cc in pediatric patients and 1 L in adults, respectively. Extravasation, the most common complication, was experienced by 7.4 per cent of patients. Inhospital mortality was 72.9 per cent. IO access should be considered when there is a need for rapid intervention requiring vascular access.

Principles of Initial Trauma Management and Evaluation

2018 ◽  
Author(s):  
Shelby Resnick ◽  
Brian Smith ◽  
Patrick Reilly
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Injured Patient ◽  
The United States ◽  
Rapid Sequence Intubation ◽  
Multidisciplinary Teams ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Secondary Survey

Trauma accounts for almost 10% of deaths worldwide and is the fourth most common cause of death in the United States. Treatment of the injured patient requires multiple unique resources, including multidisciplinary teams, surgical subspecialties, and dedicated resuscitation areas. Evaluation and initial management of the trauma patient is performed systematically to quickly identify and treat life-threatening injuries. This review serves as an introduction to care for the critically injured patient. It covers the initial steps for evaluation, resuscitation, diagnosis and treatment of the trauma patient and provides a brief overview of various injury patterns resulting from both blunt and penetrating trauma. This review contains 6 figures, 6 tables and 49 references Key Words: blunt trauma, damage control resuscitation, FAST exam, lateral canthotomy, penetrating trauma, primary survey, rapid sequence intubation, secondary survey, trauma systems

Principles of Initial Trauma Management and Evaluation

2018 ◽  
Author(s):  
Shelby Resnick ◽  
Brian Smith ◽  
Patrick Reilly
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Injured Patient ◽  
The United States ◽  
Rapid Sequence Intubation ◽  
Multidisciplinary Teams ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Secondary Survey

Trauma accounts for almost 10% of deaths worldwide and is the fourth most common cause of death in the United States. Treatment of the injured patient requires multiple unique resources, including multidisciplinary teams, surgical subspecialties, and dedicated resuscitation areas. Evaluation and initial management of the trauma patient is performed systematically to quickly identify and treat life-threatening injuries. This review serves as an introduction to care for the critically injured patient. It covers the initial steps for evaluation, resuscitation, diagnosis and treatment of the trauma patient and provides a brief overview of various injury patterns resulting from both blunt and penetrating trauma. This review contains 6 figures, 6 tables and 49 references Key Words: blunt trauma, damage control resuscitation, FAST exam, lateral canthotomy, penetrating trauma, primary survey, rapid sequence intubation, secondary survey, trauma systems

scholarly journals Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation

2021 ◽  
Vol 6 (1) ◽  
pp. e000588
Author(s):  
Jason Randall West ◽  
Brandon P O'Keefe ◽  
James T Russell
Keyword(s):  
Injury Severity ◽  
Penetrating Trauma ◽  
Rapid Sequence Intubation ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Rapid Sequence ◽  
Severity Scores ◽  
First Pass ◽  
Gcs Score

ObjectiveThe predictors of first pass success (FPS) without hypoxemia among trauma patients requiring rapid sequence intubation (RSI) in the emergent setting are unknown.MethodsRetrospective study of adult trauma patients requiring RSI during a 5-year period comparing the trauma patients achieving FPS without hypoxemia to those who did not. The primary outcome was FPS without hypoxemia evaluated by multivariate logistic regression adjusting for the neuromuscular blocking agent used (succinylcholine or rocuronium), hypoxemia prior to RSI, Glasgow Coma Scale (GCS) scores, the presence of head or facial trauma, and intubating operator level of training.Results246 patients met our inclusion criteria. The overall FPS rate was 89%, and there was no statistical difference between those receiving either paralytic agent. 167 (69%) patients achieved FPS without hypoxemia. The two groups (those achieving FPS without hypoxemia and those who did not) had similar mean GCS, mean Injury Severity Scores, presence of head or facial trauma, the presence of penetrating trauma, intubating operator-level training, use of direct laryngoscopy, hypoxemia prior to RSI, heart rate per minute, mean systolic blood pressure, and respiratory rate. In the multivariate regression analysis, the use of succinylcholine and GCS score of 13–15 were found to have adjusted ORs of 2.1 (95% CI 1.2 to 3.8) and 2.0 (95% CI 1.0 to 3.3) for FPS without hypoxemia, respectively.ConclusionTrauma patients requiring emergency department RSI with high GCS score and those who received succinylcholine had higher odds of achieving FPS without hypoxemia, a patient safety goal requiring more study.Level of evidenceIV.Study typePrognostic.

scholarly journals Acute bronchiolitis: Why put an IV line?

2021 ◽  
Vol 9 (3) ◽  
pp. 185-189
Author(s):  
Sébastien Redant ◽  
Nora Nehar-Stern ◽  
Patrick M. Honoré ◽  
Rachid Attou ◽  
Caroline Haggenmacher ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Antimicrobial Therapy ◽  
Venous Access ◽  
Catheter Insertion ◽  
Rapid Sequence Intubation ◽  
Acute Bronchiolitis ◽  
Rapid Sequence ◽  
Pediatric Icu

Abstract Background Acute bronchiolitis is the most frequent cause of respiratory distress in pediatric emergency medicine. The risk of respiratory failure is frequently over evaluated, and results in systematic vascular access. Methods We conducted a prospective observational study in children under 18 months of age hospitalized for bronchiolitis. The aim of the study was to evaluate whether catheter insertion was useful for management. We monitored the number of catheters inserted in the emergency department and their subsequent use for rapid sequence intubation, adrenaline administration, or antimicrobial therapy. We recorded the number of secondary pediatric intensive care unit (ICU) admissions. Results We followed 162 patients and compared two populations, children with (population A, n = 35) and without (population B, n = 127) catheter insertion. There were no significant differences in age, oxygen saturation, heart rate, c-reactive protein, neutrophil count and the number of times nebulization was conducted at admission. Population A compared to B had a significantly higher temperature (38.1 ± 0.9 vs. 37.6 ± 0.7°C, P = 0.004) and respiratory rate (64 ±13 vs. 59 ±17, P = 0.033). Twelve patients were secondarily transferred to pediatric ICU, 3 from population A and 9 from B (NS). In a multivariate analysis, no significant relationship was found between ICU admission, venous access placement and potential confounding factors (pneumonia, age < 6 months, age < 3 months, food intake < 60%, temperature > 38° C, heart rate > 180 bpm, respiratory rate > 60/min, SpO2 < 95%, Spo2 < 90%, oxygen therapy, positive respiratory syncytial virus [RSV] sampling). Except for antimicrobial therapy (n = 32), catheters inserted in the emergency department were used in 5 patients for intravenous rehydration and in one patient in pediatric ICU for rapid sequence intubation. Conclusions There were no life-threatening events that required immediate venous access for cardiopulmonary resuscitation. Medical treatment could be administered orally or via nasogastric tube in most cases. Peripheral catheterization was useless in immediate emergency management and only one child required a differed rapid sequence intubation.

Prehospital Rapid Sequence Intubation in an Emergency Medical Services System with Two Advanced Life Support Providers

2010 ◽  
Vol 25 (4) ◽  
pp. 341-345 ◽  
Author(s):  
Mark A. Merlin ◽  
Huma Safdar ◽  
Susan Calabrese ◽  
Alex Lewinsky ◽  
Joseph Manfre ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pulse Oximetry ◽  
Life Support ◽  
Advanced Life Support ◽  
Rapid Sequence Intubation ◽  
Success Rates ◽  
Rapid Sequence ◽  
Intubation Success ◽  
End Tidal

AbstractObjective:A rapid sequence intubation (RSI) method was introduced to a university-based emergency medical services (EMS) system. This is a report of the initial experience with the first 50 patients in a unique, two-tiered, two-advanced life support (ALS) providers system.Methods:The data were evaluated prospectively after an extensive RSI training period, consisting of didactic information and skills performance. Fifty consecutive patient records that documented the procedure were abstracted. Data abstracted included end-tidal CO2, heart rate, blood pressure, and pulse oximetry at various time intervals. Intubation success rates and number of attempts were documented. The consistency of proper documentation also was noted on patient care records.Results:No differences were noted in heart rate prior to RSI and one and five minutes after the RSI procedure was begun. No differences in blood pressure at one and five minutes were noted. Statistically significant improvements were found in pulse oximetry comparing prior to RSI and one minute after (p < 0.001; 95% CI = 3.15–11.41) as well as prior to RSI and five minutes after RSI was started (p < 0.0002; 95% CI = 4.60–13.33). No differences were observed in end-tidal CO2 at one and five minutes. Overall intubation success rate was 96%, with 82% on first attempt and 92% on two or less attempts. Documentation for individual vitals was consistently <75%.Conclusions:Patients had no significant worsening of vital signs during the RSI procedure and mild improvement in pulse oximetry. Intubation success rates were consistent with national averages. Proper documentation was lacking in more than one quarter of the charts. These data add to a body of literature that raises further concerns regarding prehospital RSI.

Common emergency procedures

2013 ◽  
Author(s):  
Martin Beed ◽  
Richard Sherman ◽  
Ravi Mahajan
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Fibreoptic Bronchoscopy ◽  
Rapid Sequence Intubation ◽  
Abdominal Pressure ◽  
Chest Drain ◽  
Laryngeal Mask Airway Insertion ◽  
Arterial Line ◽  
Emergency Procedures ◽  
Rapid Sequence

Transfers and retrievalsRapid sequence intubationLaryngeal mask airway insertionNeedle cricothyroidotomyNeedle thoracocentesisIntercostal chest drain insertionArterial line insertionCentral venous accessIntravenous cutdownIntraosseous accessExternal pacingPericardiocentesisFibreoptic bronchoscopyIntra-abdominal pressure measurementLumbar punctureSengstaken–Blakemore tube insertionProne positioning• Intrahospital transfer (e.g. to ICU or to CT scan)....

scholarly journals A survey of emergency medicine in 36 countries

CJEM ◽  
2001 ◽  
Vol 3 (02) ◽  
pp. 109-118 ◽  
Author(s):  
Jeffrey L. Arnold ◽  
Garth Dickinson ◽  
Ming-Che Tsai ◽  
David Han
Keyword(s):  
Emergency Medicine ◽  
Patient Care ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Pediatric Emergency ◽  
Rapid Sequence Intubation ◽  
Advanced Trauma Life Support ◽  
Rapid Sequence ◽  
The World ◽  
Pediatric Emergency Care

ABSTRACTObjective:To assess the current level of development of emergency medicine (EM) systems in the world.Design:Survey of EM professionals from 36 countries during a 90-day period from Aug. 25 to Nov. 24, 1998.Participants:Thirty-six EM professionals from 36 countries and 6 continents completed the survey. Thirty-five (97%) were physicians, of whom 25 (69%) gave presentations at 1 of 4 international EM conferences during the study period. Three potential participants from 3 countries were excluded because of language barriers. Five additional participants from 5 other countries did not respond within the study period and were excluded.Measurements:Respondents completed a 103-question questionnaire about the presence of EM specialty, academic, patient care, information and management systems and the factors influencing the future of EM in their countries.Results:The overall response rate was 88%. Nearly all respondents (97%) stated that their countries had hospital-based emergency departments (EDs). More than 80% of respondents reported that their countries have emergency medical services (EMS), national EMS activation phone numbers and ED systems for pediatric emergency care. More than 70% stated that their countries had national EM organizations, EM research, ED systems for patient transfer and peer review and emergency physician (EP) training in Advanced Cardiac Life Support (ACLS) and the ability to perform rapid sequence intubation. More than 60% reported ED systems for trauma care and triage and EP training in Advanced Trauma Life Support (ATLS) and the ability to perform thrombolysis for acute myocardial infarction. Fifty percent reported EM residency training programs, official recognition of EM as an independent specialty, and EM journals.Conclusions:Basic emergency medicine components now exist in the majority of countries surveyed. These include many specialty, academic, patient care and administrative systems. The foundation for further EM development is widely established throughout the world.

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