Six Mistakes of Awake Intraosseous Infusion

I’ve been inserting and teaching how to insert an intraosseous (IO) needle for several decades. Like most of you, however, almost all of the IO needle insertions that I have performed were on obtunded or cardiac arrest patients (mostly pediatric and a few adult). Several years ago I did my first intraosseous needle insertion on an altered but awake adult. Much to my chagrin, I quickly learned that I really didn’t know what I was doing. I even documented my ineptness with a video so that others could learn from my mistakes. Most emergency physicians are comfortable with using IO needles during resuscitation, but their skills and experience in using IO needles in awake patients are not quite as sharp. Intraosseous access provides fast, safe, and effective access during CPR. Central venous access can be reliably obtained via the IO needle in less than 20 seconds, and medications administered intraosseously work just as fast as medications given through a central line. (Int J Emerg Med 2009;2[3]:155; Ann Emerg Med 1985;14[12]:1135; Pediatr Clin North Am 1994;41[6]:1183; Am J Dis Child 1990;144[1]:112; (J Trauma 1993;34[3]:422.) It is also suitable for blood transfusion, hyperalimental solutions for overdose management, and chilled fluids for therapeutic hypothermia following resuscitation from a sudden cardiac death. (Am J Dis Child 1984;138[9]:810; Am J Emerg Med 1986;4[1]:34; Am J Emerg Med 1988;6[4]:353; N Engl J Med 1990;322[22]:1579; J Emerg Med 1987;5[2]:97; Ann Emerg M...
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