Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Vascular Access in Children: Intraosseous Procedure Update: “The Reasons Why” Maryland Medical Protocol and Continuing Education Maryland EMSC Program Objectives Discuss the indications and contraindications for the use of Intraosseous Access Discuss fluids and medications that can be administered via an IO line Demonstrate proper site selection per Maryland Medical Protocol Demonstrate proper technique for insertion and stabilization Maryland EMSC Program Topics of Discussion This program will discuss/demonstrate the following: Indications Contraindications Complications Technique Medication and Fluid Administration Case Studies Maryland EMSC Program At the end of the course the provider will have a better understanding of pediatric vascular access and the use of IO access. Maryland EMSC Program Vascular Access IV : 2 large bore catheters Upper extremity or Lower extremity IO: Maryland Protocol : Tibia sites < 6 years proximal tibia > 6 years distal tibia upper lower anatomy Maryland EMSC Program Keys to IV Success in Children Have all equipment ready. Have 2 (3) pairs of extra hands. TELL THE TRUTH - IVs hurt. Distract young children. * Involve older children . 2 attempts or 90 seconds * If child is awake and stable, ask another provider to attempt IV insertion. * If child is unconscious and/or unstable go to IO. Maryland EMSC Program IO Indications Unavailability of vascular access or following 2 unsuccessful IV attempts for a patient in the following categories Cardiac arrest Profound hypovolemia Life-threatening illness/injury requiring immediate fluid or medication Maryland EMSC Program IO Contraindications Conscious patient with stable vital signs Peripheral vascular access readily available Fracture of the extremity Previous IO attempts in the same extremity Cellulitis at the intended IO site Osteogenesis Imperfecta (OI) or other bone disorder Maryland EMSC Program Potential Complications of IO Infusion Infection Extravasation of fluid Fat embolism Compartment syndrome Maryland EMSC Program Tissue Extravasation Maryland EMSC Program What Can Be Administered Through an IO Fluids Medications D5W Normal saline D5 1/4 NSS D5 1/2 NSS D10W Ringer’s Lactate D5/Ringer’s Blood/ volume expanders Atropine Bretylium Adenosine Calcium D50* Dopamine Epinephrine Dobutamine Lidocaine Furosemide Naloxone Sodium Bicarbonate Maryland EMSC Program Equipment Required IO/bone aspirating needle Betadine/alcohol to cleanse site Fluid Administration set Stopcock/T connector (if available) 10 cc syringe Tape and 4x4s to secure line Pressure device Board splint Maryland EMSC Program NEVER cover an extremity that has an IO needle placed in it. Maryland EMSC Program Volume Resuscitation for Patients in Shock 20 cc/kg Ringer’s Lactate Bolus PUSH REASSESS Vascular Status Repeat 20 cc/kg Bolus RL Radio report should include the number and volume of boluses. Maryland EMSC Program “C” is for Circulation SHOCK : Inadequate tissue perfusion to meet the metabolic demands of the body Maryland EMSC Program Pediatric Circulation Estimates for Resuscitation Blood Volume = 80 cc/kg of body Weight Weight in kg = 8 + (2 x Age in years ) Systolic BP = 80 + (2 x Age in years) Maryland EMSC Program “C” is for Circulation Early signs of SHOCK in Children: LOC : Anxious, Irritable, and Lethargic Respiratory Rate : Increased (Tachypnea) Heart Rate : Increased (Tachycardia) Central Pulse : Normal Peripheral Pulse : Weak Skin : Pale and Cool Capillary Refill : 3 - 5 seconds (normal = 2) BP : Normal for Age Maryland EMSC Program Capillary Refill Maryland EMSC Program “C” is for Circulation LATE signs of SHOCK in Children: LOC : Unresponsive Respiratory Rate : Very fast and then slow or none Heart Rate : Very fast Central Pulse : Weak Peripheral Pulse : Absent Skin : Very Pale, Mottled, Blue Capillary Refill : greater than 5 seconds BP : Low for Age (hypotension is a very late sign) Maryland EMSC Program Management of Shock Airway Breathing - 100 % oxygen Vascular Access IV IO Volume resuscitation Initiate warming measures Maryland EMSC Program Maryland IO Protocol as of 7/2000 Over 6 years: distal tibia Under 6 years: proximal tibia Maryland EMSC Program Lower Leg X-ray With an IO Maryland EMSC Program IO Placement in a Toddler Maryland EMSC Program Intraosseous Infusion: Distal Tibia Site Maryland EMSC Program IO Placement in a School-Age Child Maryland EMSC Program IO with a Stop-cock The stop-cock is OFF to the syringe Maryland EMSC Program IO with a Stop-cock The stop-cock is OFF to the IV tubing Maryland EMSC Program Securing an IO Maryland EMSC Program Case Study 1 A previously well 3 - year-old has tonic clonic jerks separated by about 3 seconds. ETA: 3 minutes after dispatch from the 911 center EMS observes the child is in a postictal state. RR is 44, pulse is 140, Temperature is 40 0 C/ 1040 by report, BP is 120/76. What would you do next???? Does this child need an IO?? Maryland EMSC Program Case Study 2 EMS is dispatched to a pediatric call for seizures. A 4 -year- old child is having a seizure, and the family reports 12 minutes of seizure activity. The child has a history of seizures since birth. RR is 12, pulse is 90, BP is 80/40, temperature is 37 0 C/ 98.6 0. What would you do next???? Does this child need an IO?? Maryland EMSC Program Case Study 3 5 -year-old male is struck by an auto while riding his bike. He is thrown 15 feet and lands on his head. He has a hematoma to the right side of his head and is unconscious and unresponsive to verbal and painful stimuli. He has a RR 8, Pulse 160, BP of 150/60. What would you do next???? Does this child need an IO?? Maryland EMSC Program IO Frequently Asked Questions Can a patient receive blood through an IO? Yes, blood can be administered through an IO. Can blood be drawn from an IO? Yes, lab work can be drawn from an IO. Maryland EMSC Program Maryland EMSC Program Upper Extremity Vascular Access Site Maryland EMSC Program Lower Extremity Vascular Access Site Maryland EMSC Program Veins of the upper and lower extremities Maryland EMSC Program