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Central Venous Access in Trauma Bay
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Anjuman Chander, Ashish Aditya, Tanvir Samra, Harshit Singla
Establishment of adequate vascular access is challenging, but of utmost importance for the management of patients with traumatic injuries. As recent as the 20th century, peripheral intravenous (PIV) access complemented by venous cutdown was the standard of care for vascular access in the trauma bay. These intravascular access techniques were revolutionized by the development of central venous catheterization (CVC), which was first attempted in 1929 by Dr Werner Forssmann and has now gained popularity in emergent and elective situations. Intraosseous (IO) access is another underutilized technique for vascular access of adult patients. But IO access has recently gained popularity in light of the American Heart Association (AHA) guidelines that call for prompt administration of resuscitation agents and minimal interruption of chest compressions for patients in cardiac arrest.
Pre-Hospital Care
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Patient assessment follows the standard <C>ABCDE discussed in detail elsewhere in this manual, beginning with control of catastrophic external haemorrhage. Advanced airway skills are increasingly available, as a result, often but not always, provided by consultants in emergency medicine or anaesthesia. Advanced techniques for intravenous access may also be available as may thoracostomy, thoracotomy and intrathoracic techniques for haemorrhage control. Intraosseous access is increasingly used in patients of all ages.
Recognition and management of cardiopulmonary arrest
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
In both shockable and non-shockable sides of the algorithm, there is much to be done to improve the patient’s chances of survival.The most important task is maintenance of high-quality CPR.The gold standard for protecting the airway is tracheal intubation but this can only be performed by someone expert in the technique. Until this point, ensure ventilation is achieved by whichever means you are competent to perform.Once tracheal intubation is achieved, ventilations can be administered at a rate of 10 per minute without stopping compressions.Once tracheal intubation has been undertaken, waveform capnography should be used.Intravenous access should be obtained as soon as possible.If it is not possible to achieve intravenous access, intraosseous access may be considered, using either the tibia or the humerus. Either drugs or fluids can be administered via this route.
Titanium surface polyethylene glycol hydrogel and gentamicin-loaded cross-linked starch microspheres release system for anti-infective drugs
Published in Journal of Drug Targeting, 2023
Yunfeng Wu, Fanqi Hu, Xiaoqing Yang, Shaofu Zhang, Chengqi Jia, Xiaole Liu, Xuesong Zhang
Intraosseous implant-related infection is one of the most serious complications of orthopaedic implant surgery [1]. The metallic implant is an independent risk factor for infections [2]. The weakening of macrophages and the blunting of the local immune system create the conditions for pathogen colonisation [3, 4]. Once the bacteria form a bacterial film on the implant surface, it will lead to the failure of antimicrobial drugs [5]. Most of the previous studies focussed on intraoperative environment and systemic antibiotic application. However, the systemic use of antibiotics has many drawbacks such as increasing the burden on liver and kidney, which easily leading to the dysbiosis of body flora [6]. It is difficult to achieve high local drug concentration while avoiding systemic toxicity; moreover, the systemic application of antibiotics easily leads to bacterial resistance. To overcome the above problems, researchers have explored implantable anti-infective drug delivery systems (DDSs) to continuously release antibiotics at implant sites, locally inhibit bacterial growth on the implant surface, and prevent bacterial biofilm formation [7].
A Four-Year-Old with History of Kawasaki Disease Presenting in Acute Shock
Published in Prehospital Emergency Care, 2021
Katherine Staats, Adriana H. Tremoulet, Helen Harvey, Jane C. Burns, J. Joelle Donofrio-Odmann
Initial resuscitation of shock is directed toward maintaining oxygenation, ventilation, and perfusion (Table 2) (1–3). Vascular access is a critical step in shock management. If intravenous access is not successful, early intervention using intraosseous access is advised. Pediatric advanced life support (PALS) and advanced trauma life support (ATLS) recommend IO attempt if access is unsuccessful with three IV attempts or an IV takes > 90 seconds. Notably, in our patient, there was success with a humeral IO, after failure of tibial and femoral IOs. The proximal tibia, distal tibia, proximal humerus, and the distal femur are the main IO sites for pediatric patients. While no large studies evaluating flow rates in pediatrics have been published at this time, proximal tibia and proximal humerus have shown high flow rates in adults, which is significantly improved with the use of pressure bags to increase infusion rates (12).
Tibial Intraosseous Insertion in Pediatric Emergency Care: A Review Based upon Postmortem Computed Tomography
Published in Prehospital Emergency Care, 2020
H. Theodore Harcke, Riley N. Curtin, M. Patricia Harty, Sharon W. Gould, Jennie Vershvovsky, Gary L. Collins, Stephen Murphy
Insertion of intraosseous (IO) needles has become a popular technique used by first responders and emergency departments to rapidly establish vascular access in pediatric patients (1–4). It can be used for patients in extremis or who require rapid administration of fluid or medications and for whom intravenous access is not readily obtainable. The proximal tibia is one of the preferred sites and is commonly used (1–3,5). Needle insertion may take place at the scene of an emergency, during transport, and upon arrival at an emergency care facility. It is expected that personnel performing insertions will have varying levels of experience with IO placement in infants and children and that a postmortem review of placement of IO needles in this population will aid in further selection and use of IO devices. Findings could have implications for selection and use of devices as well as the training of personnel performing insertions.