Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 Obviously, you have not ben following the science. The prehospital administration of IV fluids is almost a thing of the past. There is minimal benefit and the time it takes to start an IV or IO increases the length of time to definitive care and disadvantageous. Thus, Mattox' point is there is no indication in any setting. BEB E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Adult IO I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 Obviously, you have not ben following the science. The prehospital administration of IV fluids is almost a thing of the past. There is minimal benefit and the time it takes to start an IV or IO increases the length of time to definitive care and disadvantageous. Thus, Mattox' point is there is no indication in any setting. BEB E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Adult IO I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 Obviously, you have not ben following the science. The prehospital administration of IV fluids is almost a thing of the past. There is minimal benefit and the time it takes to start an IV or IO increases the length of time to definitive care and disadvantageous. Thus, Mattox' point is there is no indication in any setting. BEB E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Adult IO I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 At time my dear learned Dr. in the field we can not access an iv for a med line and io serves that purpose rather well. You sir are welcome to come work a few cardiac arrest in the field. -------------------------------------------------------------------------------- Re: Adult IO I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 At time my dear learned Dr. in the field we can not access an iv for a med line and io serves that purpose rather well. You sir are welcome to come work a few cardiac arrest in the field. -------------------------------------------------------------------------------- Re: Adult IO I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 At time my dear learned Dr. in the field we can not access an iv for a med line and io serves that purpose rather well. You sir are welcome to come work a few cardiac arrest in the field. -------------------------------------------------------------------------------- Re: Adult IO I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 Trauma--we were talking trauma. E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Re: Adult IO At time my dear learned Dr. in the field we can not access an iv for a med line and io serves that purpose rather well. You sir are welcome to come work a few cardiac arrest in the field. ---------------------------------------------------------------------------- ---- Re: Adult IO I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 Trauma--we were talking trauma. E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Re: Adult IO At time my dear learned Dr. in the field we can not access an iv for a med line and io serves that purpose rather well. You sir are welcome to come work a few cardiac arrest in the field. ---------------------------------------------------------------------------- ---- Re: Adult IO I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 Trauma--we were talking trauma. E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Re: Adult IO At time my dear learned Dr. in the field we can not access an iv for a med line and io serves that purpose rather well. You sir are welcome to come work a few cardiac arrest in the field. ---------------------------------------------------------------------------- ---- Re: Adult IO I am sure that Dr. Mattox has never had an issue with IV access because physicians have the availibility to use central lines. In the EMS setting, we also need something to fall back on. I don't see central lines on ambulances in the near future, so IO access seems to be the next in line. In the service that I work for, we have the FAST1, EZ IO, and the Jamshidi IO needle. For example, in the case of cardiac arrest, we are to obtain either IO or IV access immediately in both adults and children. It is the paramedics decision which is used. IV is used more often, but if one can not be obtained, IO access is utilized. D. Stone > From the trauma list: > > Does anyone have experience of adult intraosseous infusion systems? Do they > add significantly to the management of adult trauma patients? The > manufacturers are trying to get us to buy them and I'd like to get some > inputs before recommending them in the field. > > Thanks > > Rangraj Setlur > > Department of Anaesthesiology > > Armed Forces Medical College > > Pune > > India > > > > In my view, ANY interosseous system for trauma care is an instrument of the > devil. I know of NO indication for such use. First, there is no need to > > give excessive fluids or raise the BP. Second, interosseous devices have > their own set of side effects, up to and including fat emboli syndrome. In > my > > view, interosseous gadgets are a device in search of an indication. So far, > such indications have not been discovered. > > Mattox, MD, FACS > > Chair of Surgery at Baylor > > > > Just out of curiosity, are many EMS systems placing IOs in adults as a > matter of routine? I have not really reviewed the science on these. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 I am curious about adult IO usage as well. My EMS officer is thinking about bring them online for us to use. I would think in cases of cardiac arrest where IV is non-obtainable they would be a good backup tool to have in the tool box. Also what about your long term IV drug users who you run on and good luck trying to find a vein for that overdose treatment or fluid challenge. And my favorite, non-compliant diabetic that you have been sticking for so long over the years you can just about write the run report in-route to the residence. I would love to hear from an EMS provider that has them and what their opinion is and the actual frequency of usage. Adult IO From the trauma list: Does anyone have experience of adult intraosseous infusion systems? Do they add significantly to the management of adult trauma patients? The manufacturers are trying to get us to buy them and I'd like to get some inputs before recommending them in the field. Thanks Rangraj Setlur Department of Anaesthesiology Armed Forces Medical College Pune India In my view, ANY interosseous system for trauma care is an instrument of the devil. I know of NO indication for such use. First, there is no need to give excessive fluids or raise the BP. Second, interosseous devices have their own set of side effects, up to and including fat emboli syndrome. In my view, interosseous gadgets are a device in search of an indication. So far, such indications have not been discovered. Mattox, MD, FACS Chair of Surgery at Baylor Just out of curiosity, are many EMS systems placing IOs in adults as a matter of routine? I have not really reviewed the science on these. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 I am curious about adult IO usage as well. My EMS officer is thinking about bring them online for us to use. I would think in cases of cardiac arrest where IV is non-obtainable they would be a good backup tool to have in the tool box. Also what about your long term IV drug users who you run on and good luck trying to find a vein for that overdose treatment or fluid challenge. And my favorite, non-compliant diabetic that you have been sticking for so long over the years you can just about write the run report in-route to the residence. I would love to hear from an EMS provider that has them and what their opinion is and the actual frequency of usage. Adult IO From the trauma list: Does anyone have experience of adult intraosseous infusion systems? Do they add significantly to the management of adult trauma patients? The manufacturers are trying to get us to buy them and I'd like to get some inputs before recommending them in the field. Thanks Rangraj Setlur Department of Anaesthesiology Armed Forces Medical College Pune India In my view, ANY interosseous system for trauma care is an instrument of the devil. I know of NO indication for such use. First, there is no need to give excessive fluids or raise the BP. Second, interosseous devices have their own set of side effects, up to and including fat emboli syndrome. In my view, interosseous gadgets are a device in search of an indication. So far, such indications have not been discovered. Mattox, MD, FACS Chair of Surgery at Baylor Just out of curiosity, are many EMS systems placing IOs in adults as a matter of routine? I have not really reviewed the science on these. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 I am curious about adult IO usage as well. My EMS officer is thinking about bring them online for us to use. I would think in cases of cardiac arrest where IV is non-obtainable they would be a good backup tool to have in the tool box. Also what about your long term IV drug users who you run on and good luck trying to find a vein for that overdose treatment or fluid challenge. And my favorite, non-compliant diabetic that you have been sticking for so long over the years you can just about write the run report in-route to the residence. I would love to hear from an EMS provider that has them and what their opinion is and the actual frequency of usage. Adult IO From the trauma list: Does anyone have experience of adult intraosseous infusion systems? Do they add significantly to the management of adult trauma patients? The manufacturers are trying to get us to buy them and I'd like to get some inputs before recommending them in the field. Thanks Rangraj Setlur Department of Anaesthesiology Armed Forces Medical College Pune India In my view, ANY interosseous system for trauma care is an instrument of the devil. I know of NO indication for such use. First, there is no need to give excessive fluids or raise the BP. Second, interosseous devices have their own set of side effects, up to and including fat emboli syndrome. In my view, interosseous gadgets are a device in search of an indication. So far, such indications have not been discovered. Mattox, MD, FACS Chair of Surgery at Baylor Just out of curiosity, are many EMS systems placing IOs in adults as a matter of routine? I have not really reviewed the science on these. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 We carry them here at my fire department. Not used very often. Mostly used in CPR situations. I have found them easy to use and easy to flush. We have the fast one and it works quite well for us. --- Quinten wrote: --------------------------------- I am curious about adult IO usage as well. My EMS officer is thinking about bring them online for us to use. I would think in cases of cardiac arrest where IV is non-obtainable they would be a good backup tool to have in the tool box. Also what about your long term IV drug users who you run on and good luck trying to find a vein for that overdose treatment or fluid challenge. And my favorite, non-compliant diabetic that you have been sticking for so long over the years you can just about write the run report in-route to the residence. I would love to hear from an EMS provider that has them and what their opinion is and the actual frequency of usage. Adult IO From the trauma list: Does anyone have experience of adult intraosseous infusion systems? Do they add significantly to the management of adult trauma patients? The manufacturers are trying to get us to buy them and I'd like to get some inputs before recommending them in the field. Thanks Rangraj Setlur Department of Anaesthesiology Armed Forces Medical College Pune India In my view, ANY interosseous system for trauma care is an instrument of the devil. I know of NO indication for such use. First, there is no need to give excessive fluids or raise the BP. Second, interosseous devices have their own set of side effects, up to and including fat emboli syndrome. In my view, interosseous gadgets are a device in search of an indication. So far, such indications have not been discovered. Mattox, MD, FACS Chair of Surgery at Baylor Just out of curiosity, are many EMS systems placing IOs in adults as a matter of routine? I have not really reviewed the science on these. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 We have been using the EZ-OI in Montgomery County and love it. It is fast, easy and works well. Very little training is required and the success rate has been good. I have personally inserted the EZ-OI 7 times. I have never had a failure and have always had excellent flow results. System wide I am unsure of our actual stats. But I know of 3 failures. One was not properly placed, and two were no flow insertions. (possibly due to anatomical variances, thick bone, etc) I believe we have over 200 placements in the last 9 months to a year. Mostly arrests, some major trauma's and OD's. I can get you protocols and more info off line if you are interested. Curtis J. Mc EMT-P, CCEMT-P, FP-C Montgomery County Hospital District EMS Conroe, TX Adult IO From the trauma list: Does anyone have experience of adult intraosseous infusion systems? Do they add significantly to the management of adult trauma patients? The manufacturers are trying to get us to buy them and I'd like to get some inputs before recommending them in the field. Thanks Rangraj Setlur Department of Anaesthesiology Armed Forces Medical College Pune India In my view, ANY interosseous system for trauma care is an instrument of the devil. I know of NO indication for such use. First, there is no need to give excessive fluids or raise the BP. Second, interosseous devices have their own set of side effects, up to and including fat emboli syndrome. In my view, interosseous gadgets are a device in search of an indication. So far, such indications have not been discovered. Mattox, MD, FACS Chair of Surgery at Baylor Just out of curiosity, are many EMS systems placing IOs in adults as a matter of routine? I have not really reviewed the science on these. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 Doc- I have been trained in the use of the " F.A.S.T. " IO device and have deployed 3 of them. Yes, they provide rapid access and a free flowing IV, but since the patients they have been deployed on had no other usable sites due to their advanced state of shock and other associated issues such as obesity, vascular damage due to drug use, ect... none of the deployments materially affected our morbidity/mortality rate. All three patients remained as dead as when we found them..... Should I write these devices off totally? Or are there any situations where one might be in the " Right Patient / Right Time " ? TD > Obviously, you have not ben following the science. The > prehospital administration of IV fluids is almost a thing > of the past. There is minimal benefit and the time it > takes to start an IV or IO increases the length of time to > definitive care and disadvantageous. Thus, Mattox' point > is there is no indication in any setting. > > BEB > > > E. Bledsoe, DO, FACEP > Midlothian, TX > > Don't miss EMStock 2005 (http://www.EMStock.com) > > Re: Adult IO > > > > I am sure that Dr. Mattox has never had an issue with IV > access because physicians have the availibility to use > central lines. In the EMS setting, we also need something > to fall back on. I don't see central lines on ambulances > in the near future, so IO access seems to be the next in > line. > > In the service that I work for, we have the FAST1, EZ IO, > and the Jamshidi IO needle. For example, in the case of > cardiac arrest, we are to obtain either IO or IV access > immediately in both adults and children. It is the > paramedics decision which is used. IV is used more often, > but if one can not be obtained, IO access is utilized. > > D. Stone > > > > From the trauma list: > > > > Does anyone have experience of adult intraosseous > infusion systems? Do they > > add significantly to the management of adult trauma > > patients? The manufacturers are trying to get us to buy > them and I'd like to get some > > inputs before recommending them in the field. > > > > Thanks > > > > Rangraj Setlur > > > > Department of Anaesthesiology > > > > Armed Forces Medical College > > > > Pune > > > > India > > > > > > > > In my view, ANY interosseous system for trauma care is > an instrument of the > > devil. I know of NO indication for such use. First, > there is no need to > > > > give excessive fluids or raise the BP. Second, > interosseous devices have > > their own set of side effects, up to and including fat > emboli syndrome. In > > my > > > > view, interosseous gadgets are a device in search of an > indication. So far, > > such indications have not been discovered. > > > > Mattox, MD, FACS > > > > Chair of Surgery at Baylor > > > > > > > > Just out of curiosity, are many EMS systems placing IOs > in adults as a > > matter of routine? I have not really reviewed the > > science on these. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 So, you are saying that 1 minute will kill all patients? Should we not carry any IVs in an ambulance anymore? If you have a pt with no palpable blood pressure, can you justify the reasoning for not starting an IV or an IO? Lets say I am on the witness stand, and some ambulance chaser is trying to rip me and my documentation apart. He asks ... " The patients had no obtainable blood pressure and you didn't even start an IV?? " I would much rather take the extra minute or so to start one and give a bolus (my medical director, one who constantly researches emergency medicine, preaches fluid, fluid, fluid especially in trauma considering that hypotension kills so quickly) than to try and squirm out of that one. And lets say that you are 20 minutes from the closest ER and the pt is hypotensive (<90/p). No fluid? Not me...sorry, but lets be real and understand that some treatment and effort is definately better than none. To say that the time that it takes to start an IV is disadvantageous, in my opinion, is not true. D. Stone > > From the trauma list: > > > > Does anyone have experience of adult intraosseous infusion systems? > Do they > > add significantly to the management of adult trauma patients? The > > manufacturers are trying to get us to buy them and I'd like to get > some > > inputs before recommending them in the field. > > > > Thanks > > > > Rangraj Setlur > > > > Department of Anaesthesiology > > > > Armed Forces Medical College > > > > Pune > > > > India > > > > > > > > In my view, ANY interosseous system for trauma care is an > instrument of the > > devil. I know of NO indication for such use. First, there is no > need to > > > > give excessive fluids or raise the BP. Second, interosseous devices > have > > their own set of side effects, up to and including fat emboli > syndrome. In > > my > > > > view, interosseous gadgets are a device in search of an indication. > So far, > > such indications have not been discovered. > > > > Mattox, MD, FACS > > > > Chair of Surgery at Baylor > > > > > > > > Just out of curiosity, are many EMS systems placing IOs in adults > as a > > matter of routine? I have not really reviewed the science on these. > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 So, you are saying that 1 minute will kill all patients? Should we not carry any IVs in an ambulance anymore? If you have a pt with no palpable blood pressure, can you justify the reasoning for not starting an IV or an IO? Lets say I am on the witness stand, and some ambulance chaser is trying to rip me and my documentation apart. He asks ... " The patients had no obtainable blood pressure and you didn't even start an IV?? " I would much rather take the extra minute or so to start one and give a bolus (my medical director, one who constantly researches emergency medicine, preaches fluid, fluid, fluid especially in trauma considering that hypotension kills so quickly) than to try and squirm out of that one. And lets say that you are 20 minutes from the closest ER and the pt is hypotensive (<90/p). No fluid? Not me...sorry, but lets be real and understand that some treatment and effort is definately better than none. To say that the time that it takes to start an IV is disadvantageous, in my opinion, is not true. D. Stone > > From the trauma list: > > > > Does anyone have experience of adult intraosseous infusion systems? > Do they > > add significantly to the management of adult trauma patients? The > > manufacturers are trying to get us to buy them and I'd like to get > some > > inputs before recommending them in the field. > > > > Thanks > > > > Rangraj Setlur > > > > Department of Anaesthesiology > > > > Armed Forces Medical College > > > > Pune > > > > India > > > > > > > > In my view, ANY interosseous system for trauma care is an > instrument of the > > devil. I know of NO indication for such use. First, there is no > need to > > > > give excessive fluids or raise the BP. Second, interosseous devices > have > > their own set of side effects, up to and including fat emboli > syndrome. In > > my > > > > view, interosseous gadgets are a device in search of an indication. > So far, > > such indications have not been discovered. > > > > Mattox, MD, FACS > > > > Chair of Surgery at Baylor > > > > > > > > Just out of curiosity, are many EMS systems placing IOs in adults > as a > > matter of routine? I have not really reviewed the science on these. > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 So, you are saying that 1 minute will kill all patients? Should we not carry any IVs in an ambulance anymore? If you have a pt with no palpable blood pressure, can you justify the reasoning for not starting an IV or an IO? Lets say I am on the witness stand, and some ambulance chaser is trying to rip me and my documentation apart. He asks ... " The patients had no obtainable blood pressure and you didn't even start an IV?? " I would much rather take the extra minute or so to start one and give a bolus (my medical director, one who constantly researches emergency medicine, preaches fluid, fluid, fluid especially in trauma considering that hypotension kills so quickly) than to try and squirm out of that one. And lets say that you are 20 minutes from the closest ER and the pt is hypotensive (<90/p). No fluid? Not me...sorry, but lets be real and understand that some treatment and effort is definately better than none. To say that the time that it takes to start an IV is disadvantageous, in my opinion, is not true. D. Stone > > From the trauma list: > > > > Does anyone have experience of adult intraosseous infusion systems? > Do they > > add significantly to the management of adult trauma patients? The > > manufacturers are trying to get us to buy them and I'd like to get > some > > inputs before recommending them in the field. > > > > Thanks > > > > Rangraj Setlur > > > > Department of Anaesthesiology > > > > Armed Forces Medical College > > > > Pune > > > > India > > > > > > > > In my view, ANY interosseous system for trauma care is an > instrument of the > > devil. I know of NO indication for such use. First, there is no > need to > > > > give excessive fluids or raise the BP. Second, interosseous devices > have > > their own set of side effects, up to and including fat emboli > syndrome. In > > my > > > > view, interosseous gadgets are a device in search of an indication. > So far, > > such indications have not been discovered. > > > > Mattox, MD, FACS > > > > Chair of Surgery at Baylor > > > > > > > > Just out of curiosity, are many EMS systems placing IOs in adults > as a > > matter of routine? I have not really reviewed the science on these. > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2005 Report Share Posted April 18, 2005 See answers in text of your email. E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Adult IO So, you are saying that 1 minute will kill all patients? No. But IV and IO access takes longer than 1 minute unless you are exceptional. Should we not carry any IVs in an ambulance anymore? If you have a pt with no palpable blood pressure, can you justify the reasoning for not starting an IV or an IO? There is no science to show that it makes any difference. The delay in starting an IV could be criticized by very well placed trauma surgeons. Patients with no palpable blood pressure almost always die. Lets say I am on the witness stand, and some ambulance chaser is trying to rip me and my documentation apart. He asks ... " The patients had no obtainable blood pressure and you didn't even start an IV?? " You would say, " That is correct sir. Look at the paper by Bickell and Mattox and the subsequent studies. " I would much rather take the extra minute or so to start one and give a bolus (my medical director, one who constantly researches emergency medicine, preaches fluid, fluid, fluid especially in trauma considering that hypotension kills so quickly) than to try and squirm out of that one. First, moderated hypotension is protective. I don't know who your medical director is, but is he or she is saying " fluid, fluid, fluid " then he or she is not reading the research. Even BTLS and PHTLS now advocate small volumes of fluid and permissive hypotension. And lets say that you are 20 minutes from the closest ER and the pt is hypotensive (<90/p). No fluid? Not wil a blood pressure between 70-90 mm Hg. Transport. Not me...sorry, but lets be real and understand that some treatment and effort is definately better than none. To say that the time that it takes to start an IV is disadvantageous, in my opinion, is not true. You need to read the science then. You are about 5-7 years behind. D. Stone > > From the trauma list: > > > > Does anyone have experience of adult intraosseous infusion systems? > Do they > > add significantly to the management of adult trauma patients? The > > manufacturers are trying to get us to buy them and I'd like to get > some > > inputs before recommending them in the field. > > > > Thanks > > > > Rangraj Setlur > > > > Department of Anaesthesiology > > > > Armed Forces Medical College > > > > Pune > > > > India > > > > > > > > In my view, ANY interosseous system for trauma care is an > instrument of the > > devil. I know of NO indication for such use. First, there is no > need to > > > > give excessive fluids or raise the BP. Second, interosseous devices > have > > their own set of side effects, up to and including fat emboli > syndrome. In > > my > > > > view, interosseous gadgets are a device in search of an indication. > So far, > > such indications have not been discovered. > > > > Mattox, MD, FACS > > > > Chair of Surgery at Baylor > > > > > > > > Just out of curiosity, are many EMS systems placing IOs in adults > as a > > matter of routine? I have not really reviewed the science on these. > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 Dr Bledsoe are you a D.O. ? -------------------------------------------------------------------------------- Re: Adult IO > > > > I am sure that Dr. Mattox has never had an issue with IV > access because physicians have the availibility to use > central lines. In the EMS setting, we also need something > to fall back on. I don't see central lines on ambulances > in the near future, so IO access seems to be the next in > line. > > In the service that I work for, we have the FAST1, EZ IO, > and the Jamshidi IO needle. For example, in the case of > cardiac arrest, we are to obtain either IO or IV access > immediately in both adults and children. It is the > paramedics decision which is used. IV is used more often, > but if one can not be obtained, IO access is utilized. > > D. Stone > > > > From the trauma list: > > > > Does anyone have experience of adult intraosseous > infusion systems? Do they > > add significantly to the management of adult trauma > > patients? The manufacturers are trying to get us to buy > them and I'd like to get some > > inputs before recommending them in the field. > > > > Thanks > > > > Rangraj Setlur > > > > Department of Anaesthesiology > > > > Armed Forces Medical College > > > > Pune > > > > India > > > > > > > > In my view, ANY interosseous system for trauma care is > an instrument of the > > devil. I know of NO indication for such use. First, > there is no need to > > > > give excessive fluids or raise the BP. Second, > interosseous devices have > > their own set of side effects, up to and including fat > emboli syndrome. In > > my > > > > view, interosseous gadgets are a device in search of an > indication. So far, > > such indications have not been discovered. > > > > Mattox, MD, FACS > > > > Chair of Surgery at Baylor > > > > > > > > Just out of curiosity, are many EMS systems placing IOs > in adults as a > > matter of routine? I have not really reviewed the > > science on these. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 Dr Bledsoe are you a D.O. ? -------------------------------------------------------------------------------- Re: Adult IO > > > > I am sure that Dr. Mattox has never had an issue with IV > access because physicians have the availibility to use > central lines. In the EMS setting, we also need something > to fall back on. I don't see central lines on ambulances > in the near future, so IO access seems to be the next in > line. > > In the service that I work for, we have the FAST1, EZ IO, > and the Jamshidi IO needle. For example, in the case of > cardiac arrest, we are to obtain either IO or IV access > immediately in both adults and children. It is the > paramedics decision which is used. IV is used more often, > but if one can not be obtained, IO access is utilized. > > D. Stone > > > > From the trauma list: > > > > Does anyone have experience of adult intraosseous > infusion systems? Do they > > add significantly to the management of adult trauma > > patients? The manufacturers are trying to get us to buy > them and I'd like to get some > > inputs before recommending them in the field. > > > > Thanks > > > > Rangraj Setlur > > > > Department of Anaesthesiology > > > > Armed Forces Medical College > > > > Pune > > > > India > > > > > > > > In my view, ANY interosseous system for trauma care is > an instrument of the > > devil. I know of NO indication for such use. First, > there is no need to > > > > give excessive fluids or raise the BP. Second, > interosseous devices have > > their own set of side effects, up to and including fat > emboli syndrome. In > > my > > > > view, interosseous gadgets are a device in search of an > indication. So far, > > such indications have not been discovered. > > > > Mattox, MD, FACS > > > > Chair of Surgery at Baylor > > > > > > > > Just out of curiosity, are many EMS systems placing IOs > in adults as a > > matter of routine? I have not really reviewed the > > science on these. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 What about starting IV/IO while transporting? Would that alleviate your concerns regarding transport times? The Bickell study does not define immediate fluid resuscitation, were the IV attempts done on scene or during transport? The Sampalis study states " on-site intravenous fluid replacement " . Do you know of any studies that looked at IV/IO attempts done while transporting vs on scene attempts? RE: Re: Adult IO Obviously, you have not ben following the science. The prehospital administration of IV fluids is almost a thing of the past. There is minimal benefit and the time it takes to start an IV or IO increases the length of time to definitive care and disadvantageous. Thus, Mattox' point is there is no indication in any setting. BEB E. Bledsoe, DO, FACEP Midlothian, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 What about starting IV/IO while transporting? Would that alleviate your concerns regarding transport times? The Bickell study does not define immediate fluid resuscitation, were the IV attempts done on scene or during transport? The Sampalis study states " on-site intravenous fluid replacement " . Do you know of any studies that looked at IV/IO attempts done while transporting vs on scene attempts? RE: Re: Adult IO Obviously, you have not ben following the science. The prehospital administration of IV fluids is almost a thing of the past. There is minimal benefit and the time it takes to start an IV or IO increases the length of time to definitive care and disadvantageous. Thus, Mattox' point is there is no indication in any setting. BEB E. Bledsoe, DO, FACEP Midlothian, TX Quote Link to comment Share on other sites More sharing options...
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