IO vs. IV

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Permalink Reply by Robert Owens on November 2, 2009 at 5:15pm

In a cardiac arrest we get 1 attempt at an IV then its straight to the IO. We are currently using the BIG (Bone Injection Gun) for our IO access with limited succes especially in our larger pts. We used to use sternal IO's but went away from that in favor of the BIG. Alot of people are switing to the EZIO in my area and we are starting to look at that.

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Permalink Reply by J Brooks on November 2, 2009 at 5:18pm

The learning curve and training on the EZ-IO is unbelievable. We taught a guy enroute to a call and he was very successful.

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Permalink Reply by Rich Garrett on November 2, 2009 at 6:00pm

We always start with the IV even in arrests. The IO is considered a last resort tool. Our med control even lets us go after EJ or Sub-clavian for the IV. The IO is usually better to prevent complications, but if they need the meds NOW (as in an arrest) being that it is delivered into the marrow space and has to travel into the blood stream and the finnally to the heart, IV is quicker. Also drugs with short half lives are not worth a crap IO.

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Permalink Reply by Ben Waller on November 2, 2009 at 10:15pm

The EZ IO training video shows a perfusion time of less than 4 seconds to the inferior vena cava from the proximal tibia site. That's pretty close to "now". If you consider that the marrow space can't collapse and is virtually always available in non-traumatic arrest as opposed to poking around for veins, I prefer the IO. It's a lot closer to a sure thing than an IV.

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Permalink Reply by Lt. Caleb French on November 3, 2009 at 2:40pm

We just starting using Easy IO's.

They are quite impressive.

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Permalink Reply by Rich Garrett on November 4, 2009 at 5:58pm

Thats just not what we've been told I guess. That and our MC is an old school doc and is much happier to see IVs rolling into his ER instead of IOs. We do carry the BIG, but like I said... I think that this is either gonna have to be decided by the docs that make up the training and protocol, otherwise its gonna be like a nozzle debate "smooth bore v. fog". I think alot comes down to training too. Always been trained to get the IV, and in an agressive system you get alot of them.

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Permalink Reply by Nicholas Alexander Wahl on November 3, 2009 at 12:08am

Im an emt not a medic, but if i was a pt in an ALS unit, i would never ever want an IO. Its just the idea that there is a needle and a drill going into my leg not the best of followers, They work first time round, unlike IVs but im not a big fan of having holes where they shouldnt be.

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Permalink Reply by Robert Owens on November 3, 2009 at 8:05am

So you would rather die???? I think the IO is great for non traumatic arrests I just dont think our IO device is very good....when it has worked we have gotten great results from it and have have had higher rates of ROSC in pts.

I personally think that sometimes we as EMS providers are doing to much in the field but this skill is right on.

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Permalink Reply by Oldman on November 3, 2009 at 8:34am

Back in my day... we just stabbed them in the neck. I guess EJ's are not something taught much anymore. We carry the BIG, but rarely use it. Protocol states we make two peripheral attempts, and rarely are we not able to get an IV by the second attempt.

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Permalink Reply by Lt. Caleb French on November 3, 2009 at 2:38pm

Per protocol, Medics have 90 seconds to try for and IV line. If this cannot be established, we have "Easy IO" kits. The IO can be established in a matter of seconds.

Be careful though, the replacement "Easy IO" needles are a hundred bucks a pop.

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Permalink Reply by Ben Waller on November 4, 2009 at 8:53pm

Here's the EZ IO training video. This is a demonstration - the simulated "patient" is Scotty Bolleter, an EMS lecturer and educator. Note that he just rolled up his pants leg and let the physician drill his tibia.

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Permalink Reply by Ben Waller on November 4, 2009 at 8:55pm

Here's another EZ IO training video. Note the absence of screaming.

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