IO vs. IV

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Permalink Reply by blair4630 on August 3, 2009 at 1:22am

I would say if there's something there that you're pretty sure about, go for it, if there's nothing that you can see right off the primary assessment, and they need drugs yesterday, yeah, maybe.

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Permalink Reply by J Brooks on August 3, 2009 at 9:30am

Yes, we do it routinely on arrests all the time.

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Permalink Reply by Michael J Burke on August 8, 2009 at 10:12am

On Cardiac arrests if they have no IV access then the IO gun comes right out. Usually after two IV attempts. certain meds can still go down the ET tube if neccessary. IO guns works awesome though.

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Permalink Reply by Ed Cunningham on September 17, 2009 at 10:10pm

Most dept's have protocols that state how many attempts should be made before going to an IO. Our's states 3, However with all calls, you should always have in the back of your mind.."Can I justify my actions?" People who run straight to an IO too often are showing an ineptness at starting IV's. I am from the school of thought of least invasive first. Though a Stellar medic knows that rarely do we have a scenario that fits perfectly into a protocol mold. Our first objective should always be to "Do no further harm". If a medic does any procedure just brag about how many they have done, they need to give up their cert and go into a profession like dentistry where people pay for pain.... truth be told if anyone ever stuck a family member of mine with an IO without making at least one sincere IV attempt, their getting a bloody nose and a royal a** chewing.

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Permalink Reply by Loyd Dittfurth on September 17, 2009 at 10:37pm

im agreeing with the bloody nose and ass chewing

I was riding in a pickup had a wreck and hit my head on the windshield the bus that picked me up was from a nieghboring town and they knew me lost there head thought i was drunk or high and going into shock or hyperglycemia (they really didnt have a clue but they thought they better get some fluids into me) they couldnt hold my hands still enough to get an iv because i wouldnt let them because i was trying to tell them there was 2 guys in the back of the pickup they shoved that ###### ####### son of a ##### in and i litterally PISSED MY SELF they say needless to say i saw em at another wreck with a buddy of mine involved and i rode with them to the hospital aint happening to him to lol

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Permalink Reply by TIM BROOKE on October 31, 2009 at 1:01am

Very nicely said !agree 100 percent!

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Permalink Reply by Ben Waller on October 31, 2009 at 7:12am

Actually, there's a growing body of scientific evidence that shows that IOs are better for the patient in cardiac arrest, due to being so much faster to start. IVs also have a much higher complication rate - extravasation, infection, accidental D/Cs, etc.

The procedure needs to be about what's best for the patient, not about who can do what skill better.
We need to focus EMS on outcomes, not on skills.

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Permalink Reply by John Crabbe on September 18, 2009 at 12:16am

We will do it on occasion. The thing today is high quality CPR and studies are showing that drugs, IV and advanced airways are taking a distant second and third. Basically if you don't have enough personnel to do ACLS and CPR, concentrate on the CPR. If there are personnel to perform CPR while a medic can perfom IV, IO etc, then we will do that. We don't routinely use the IO right away, but we won't hesitate to go for it if it may be faster than looking for an IV.

We use the EZ IO drill, which for us works the best and the first choice of placement is the tibia, just below the knee. There is a video of a doctor having the EZ IO placed onhimself and does go on to state the most painful part of the procedure was doing a fluid bolus, moreso than the insertion itself. Not that I'm ready to try it by any means, but if I'm out of it and you can't get an IV, have at it.

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Permalink Reply by Ben Waller on October 31, 2009 at 7:17am

Absolutely - good BLS is the foundation, and if you're short-handed, BLS comes first.

Wake County, NC's EMS systems has one of the highest CPR save rates in the US, and their motto for CPR is "Pump 'em, King 'em, drill 'em, and chill 'em." In other words, do high quality CPR and don't interupt that CPR to establish an airway, insert a King airway because you can do it without interupting CPR, use IOs instead of wasting time with multiple IV pokes on a patient with no blood pressure, and use induced hypothermia to reduce the patient's cellular respiration rate and thereby preserve more hypoxic cells.

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Permalink Reply by FETC on September 18, 2009 at 1:12am

We do it all the time for cardiac arrests, work great. Actually did one on a conscious patient once, never even flinched when the drill was going bzzzzz, he did however, levitate when the pressure bag pushed the fluids in.

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Permalink Reply by Justin/ F-225 on September 20, 2009 at 9:42pm

There was a flight nurse who told a pt she was about to start an IO on that it wouldn't hurt. When asked how she knew she replied "it didn't hurt the guy in the video". Needless to say u could hear the pt screaming over three diesel engines.

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Permalink Reply by Loyd Dittfurth on September 20, 2009 at 9:52pm

LOL THATS FUNNY

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