IO vs External Jugular IV in trauma patients

[scubanurse]

Try warming it up...

[FireMedic65]

Cranial IO!

[Dustdevil]

Cranial IO!

Hehe... I was actually wondering how well a FAST1 might work on the forehead.

[FireMedic65]

I bet it would make a wicked cool sound.

[DwayneEMTP]

I find the decisions curious here, to tell the truth, unless we're assuming multiple I/O starts.

We've got a distending belly with obvious femur fracture which implies to me possible massive internal blood loss, yet each has chosen to start a single I/O so as not to be left having to manage the EJ. But what about flow rates?

I've only started two I/Os, and my delivery rate sucked. Both had B/P cuffs applied and inflated to 220mmHg, the second had, after 40cc Lido, 3 NS flushed 'slammed' into them to attempt to create a 'cavity', as I've been told that may have effected my flow rate, yet both still sucked. I've talked to many others that have started many, and they claim that they have never achieved any kind of aggressive fluid delivery rates with them. Perhaps your experiences have been different?

I believe I would utilize an EJ here despite the obvious inconveinciences based simply on the necessary flow rate needed to mitigate these injuries until extrication could possibly make other alternatives more available.

Not to mention you are sticking a needle into their neck!

I'm not realy sure of the relevence of this statement given the scenario.

Certainly no disrespect intended to the opinions of my betters, but given the scenario, I believe that I would take the EJ route. Immobilization will have to wait until I've stabilized circulation. (All of this of course assumes that physiological markers verify the above expected internal blood loss.)

Just a thought....

Dwayne

[akflightmedic]

I find the decisions curious here, to tell the truth, unless we're assuming multiple I/O starts.

We've got a distending belly with obvious femur fracture which implies to me possible massive internal blood loss, yet each has chosen to start a single I/O so as not to be left having to manage the EJ. But what about flow rates?

I've only started two I/Os, and my delivery rate sucked. Both had B/P cuffs applied and inflated to 220mmHg, the second had, after 40cc Lido, 3 NS flushed 'slammed' into them to attempt to create a 'cavity', as I've been told that may have effected my flow rate, yet both still sucked. I've talked to many others that have started many, and they claim that they have never achieved any kind of aggressive fluid delivery rates with them. Perhaps your experiences have been different?

I believe I would utilize an EJ here despite the obvious inconveinciences based simply on the necessary flow rate needed to mitigate these injuries until extrication could possibly make other alternatives more available.

I'm not realy sure of the relevence of this statement given the scenario.

Certainly no disrespect intended to the opinions of my betters, but given the scenario, I believe that I would take the EJ route. Immobilization will have to wait until I've stabilized circulation. (All of this of course assumes that physiological markers verify the above expected internal blood loss.)

Just a thought....

Dwayne

I could be wrong but it seems PHTLS taught opening the airway as you were taking cspine. Seems like they think it is a good idea to maintain spinal precautions in a high impact case, especially such as this. The caveat is I have not taken PHTLS recently so I could be misinformed.

Secondly, I have not had much issue with IO flow when placed properly... not saying you didn't, just merely noting the lack of troubles I experienced personally.

I did not rule out an EJ entirely, however have you placed many of them? It would certainly be based on that particular presentation at that time, however EJs have a high failure rate for placement when proper positioning is not used. As I noted, best positioning is a lateral movement of the head, a severe compromise of the cspine protection. Would you want me to save your life so you could be a veggie?? I wouldn't...

Now if I didn't know any better, I would say Mr.Dwayne has chose a topic to play devil's advocate cause he has been missing out on serious intelligent debates. However, I think he could have chosen a better topic...

Just sayin.

[stcommodore]

I would define an IV as "invasive", an EJ as "moderatly invasive" and an IO as "highly invasive" when it comes to the EMS setting. To continue, why would we be placing an IO into any site if we can obtain an EJ? If a C-Collar, entrapment, etc prevent EJ use then maybe an IO can be placed. Lastly, I would pray that nobody is starting IO's simply for having access. We should only be using such means if we need to administer drugs, fluids, etc.

[Kiwiology]

Start an IO in the right femur; an EJ isint gonna do much good when we slap a collar on and drag him out into a scoop!

Also I'd rather we do a quick IO in the leg and give a little lido for the pain rather than freak this guy out by shoving a needle into the side of his neck.

FYI we use EZ-IO or the Cooks screw in; we threw the BIG out after a high failure rate

[DwayneEMTP]

I could be wrong but it seems PHTLS taught opening the airway as you were taking cspine. Seems like they think it is a good idea to maintain spinal precautions in a high impact case, especially such as this. The caveat is I have not taken PHTLS recently so I could be misinformed.

Actually, you are certainly well informed. Yet, in every forum I've been exposed to it emphasized life over limb. Something about a well splinted corpse, or the such.

Secondly, I have not had much issue with IO flow when placed properly... not saying you didn't, just merely noting the lack of troubles I experienced personally.

Roj.

I did not rule out an EJ entirely, however have you placed many of them? It would certainly be based on that particular presentation at that time, however EJs have a high failure rate for placement when proper positioning is not used. As I noted, best positioning is a lateral movement of the head, a severe compromise of the cspine protection. Would you want me to save your life so you could be a veggie??

Nor would I hope you'd protect a hypothetical spinal injury in the face of a realistic hemodynamic emergency. In fact...if I remember right, a large part of my thinking on this was taught to me by some big hairy friggin' dude in Afg...his name escapes me...

Now if I didn't know any better, I would say Mr.Dwayne has chose a topic to play devil's advocate cause he has been missing out on serious intelligent debates.

Heh...Ok, so you might have a point, as it is getting difficult to find a decent argument here...

However, I think he could have chosen a better topic...

Story of my life...but I'll take my chances.

Thanks for your response ol' man...

Dwayne

[scubanurse]

I think all have valid points based on our own experiences, outcomes and training. In a situation like this, it is hard to develop a formalized opinion on what method I would choose, as I do not have a live patient in front of me to help me decide based on the numerous observations that can be made of a patient. Personally, I would probably go for the IO as it is quicker and in my experience (although limited) more reliable. I would want access ASAP to give fluids and medication if necessary.

On the topic of c-spine precaution, if the patient has a high cervical fracture then movement could end life. So as Dwayne put it, Life over Limb and by maintaining a neutral alignment on the c-spine, I could very well be preserving life.

Just my $.02 for what it's worth