Episode 61 Whistler’s Update in EM Conference 2015 Highlights Part 1

This EM Cases episode is Part 1 of The Highlights of The University of Toronto, Divisions of Emergency Medicine, Update in EM Conference from Whistler 2015 with Paul Hannam on Pearls and Pitfalls of Intraosseus Line Placement, Anil Chopra on who is at risk and how to prevent Contrast Induced Nephropathy, and Joel Yaphe on the Best of EM Literature from 2014, including reduction of TMJ dislocations, the TRISS trial (on transfusion threshold in sepsis), PEITHO study for thrombolysis in submassive PE, Co-trimoxazole and Sudden Death in Patients Receiving ACE inhibitors or ARBs, the effectiveness and safety of outpatient Tetracaine for corneal abraisons, chronic effects of shift work on cognition and much more...



Recorded February 2015. Written Summary & Blog Post Written by Keerat Grewal & Edited by Anton Helman, March 2015.

Cite this podcast as: Hannam, P, Chopra, A, Yaphe, J, Helman, A. Whistler's Update in EM Conference 2015 Highlights Part 1. Emergency Medicine Cases. March, 2015. https://emergencymedicinecases.com/episode-61-whistlers-update-in-em-conference-2015-highlights-part-1/. Accessed [date].

Go to part 2 of this 2-part podcast on Whistler's Update on EM Conference

Intraosseus (IO) Line Pearls – Dr. Paul Hannam

Choosing and Landmarking a Site for an Intraosseus Line

Proximal Tibia: Find the tibial tubercle, move 2cm inferiorly and 1 cm medially and insert the IO line 90 degrees to the bony plane

Proximal Humerus: Place your thumb on anterior humerus, feel for bicepital groove, the lateral “bump” is the greater tubricle – which is the site of a humeral IO.

Advantages of Humerus site: faster infusion rates and is easily landmarked.

Disadvantage of Humerus site: The arm must be immobilized in adduction, across the abdomen to prevent dislodging the needle. Requiring the arm to be immobilized may interfere with other resuscitative measures.



Avoid all bone sites where there is: a fracture, previous attempt, trauma or circulatory compromise proximal to the site

Choosing an IO Needle Length

 

EZ-IO kits have three needle lengths (15mm, 25mm and 45mm) and comes with weight-based recommendations for which needle to use for a given patient. Rather than using weight-based recommendations, our experts find it more useful to select the needle length according to the soft tissue thickness between the skin and bone of the patient at the given site. Estimate the soft tissue thickness and choose the needle that would accommodate that thickness. It is better to overestimate than underestimate the length of the needle required.

 Update 2015: The squeeze test is an additional method to confirm IO placement, check it out on ALiEM.

Stabilizing and Securing the IO Needle

Ensuring that the needle does not move once it is placed is vital to avoiding leaking from the si...