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http://www.ncbi.nlm.nih.gov/pubmed/20926627

There is actually a fair amount of literature about this issue. I am not sure how much physical science you have but Oxygen at "normal" levels is harmful. Mammals have evolved complex enzyme systems to deal with the consequences of Oxygen and highly reactive molecules and forms of Oxygen known as reactive Oxygen species or ROS. These are a natural consequence of normal cellular respiration. Heck, our immune system sometimes makes use of ROS as part of the inflammatory response and when attacking pathogens. While mammalian physiology is generally good at dealing with ROS, many situations can markedly increase the amount of ROS being produced. This is known as oxidative stress. Good luck looking for literature. It's certainly out there but a perfectly clear and concise picture has not been completely developed.

I have had some experience in IO, so I will give my opinion as well. First: No, I do not use it as 1st line in any adult pt. However, I have used it on both concious, uncouncious, and cardiac arrest victims, and in my opinion it is not that brutal. I think there is a stigma with drilling a needle into a bone, but it really is not that bad. To be honest, I would use it waay before an EJ based on risk of complications AND patient comfort. The first time I used one was on a pneumonia with aspiration/resp failure. She needed deep suctioning in the worst way so I decided to RSI her. She was a GCS of about 10. I drilled in the needle and she did not flinch at all! Once I infused a NaCl preload of 10 ml though she frickin near got up and ran!! At this point, lidocaine can be introduced, and numb the area...... I used narcotics of course, since I was RSI'ing. As you can tell, I am pretty comfortable with them, and in the situation presented, given there were NO veins palpable/visible, I may start one. Now, don't be jumping down my throat about IM narcan. If I get an Uncx OD they are getting an IV/IO for more reasons than just narcan.