Last posts on intraosseux2024-03-29T03:12:51+01:00All Rights Reserved blogSpirithttps://www.hautetfort.com/https://www.hautetfort.com/explore/posts/tag/intraosseux/atom.xmlMédecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPlyo intraosseux ? Pas si simpletag:citerahiadesgenettes.hautetfort.com,2022-10-21:64077372022-10-21T21:52:00+02:002022-10-21T21:52:00+02:00 Intraosseous administration of freeze-dried plasma in the prehospital...
<p style="text-align: center;"><span style="font-size: 14pt;"><strong><span style="font-family: arial, helvetica, sans-serif;">Intraosseous administration of freeze-dried plasma in the prehospital setting</span></strong></span><br /><a href="https://ima-files.s3.amazonaws.com/410614_88ead92e-cfda-4f2c-a036-cf9f88b0f239.pdf" target="_blank" rel="noopener"><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;">Rittblat M et Al. Isr Med Assoc J. 2022 Sep;24(9):591-595.</span></a></p><p> </p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Background:</strong> </span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Freeze dried plasma (FDP) is a commonly used replacement fluid in the prehospital setting when blood products are unavailable. It is normally administered via a peripheral intravenous (PIV) line. However, in severe casualties, when establishing a PIV is difficult, administration via intraosseous vascular access is a practical alternative, particularly under field conditions.</span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Objectives:</strong> </span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">To evaluate the indications and success rate of intraosseous administration of FDP in casualties treated by the Israel Defense Forces (IDF).</span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Methods:</strong> </span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">A retrospective analysis of data from the IDF-Trauma Registry was conducted. It included all casualties treated with FDP via intraosseous from 2013 to 2019 with additional data on the technical aspects of deployment collected from the caregivers of each case.</span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Results:</strong> </span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Of 7223 casualties treated during the study period, intravascular access was attempted in 1744; intraosseous in 87 of those. <span style="background-color: #ffff99;"><strong>FDP via intraosseous was attempted in 15 (0.86% of all casualties requiring intravascular access). The complication rate was 73% (11/15 of casualties).</strong></span> </span></p><p style="text-align: center;"><img id="media-6396105" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/00/2532589634.png" alt="Plyo_IO.png" /></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">"<span style="font-size: 10pt;"><em>According to the manufacturer’s specifications, the reconstituted lyophilized plasma product is delivered from a glass bottle with the rate of infusion determined primarily by gravity. This procedure precludes the care providers from applying external pressure to increase the plasma infusion rate. Therefore, the pressure gradient is determined primarily by gravity with respect to height of the bottle</em></span>." </span></p><p> </p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Complications were more frequent when the event included multiple casualties or when the injury included multiple organs. <strong><span style="background-color: #ffff99;">Of the 11 failed attempts, 5 were reported as due to slow flow of the FDP through the intraosseous apparatus</span></strong>. Complications in the remaining six were associated with deployment of the intraosseous device.</span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Conclusions:</strong> </span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Administration of FDP via intraosseous access in the field requires a high skill level.</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlIO: Attention Embolie graisseuse ?tag:citerahiadesgenettes.hautetfort.com,2022-02-14:63661802022-02-14T23:40:06+01:002022-02-14T23:40:06+01:00 Intraosseous fluid resuscitation causes systemic fat emboli in a porcine...
<p style="text-align: center;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model</span></strong><br /><a href="https://sjtrem.biomedcentral.com/track/pdf/10.1186/s13049-021-00986-z.pdf" target="_blank" rel="noopener"><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;">Kristiansen S. et Al. Scand J Trauma Resusc Emerg Med . 2021 Dec 20;29(1):172. </span></a></p><p> </p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Background:</strong> Intraosseous cannulation can be life-saving when intravenous access cannot be readily achieved. However, it has been shown that the procedure may cause fat emboli to the lungs and brain. Fat embolization may cause serious respiratory failure and fat embolism syndrome. We investigated whether intraosseous fluid resuscitation in pigs in hemorrhagic shock caused pulmonary or systemic embolization to the heart, brain, or kidneys and if this was enhanced by open chest conditions.</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Methods:</strong> We induced hemorrhagic shock in anesthetized pigs followed by fluid-resuscitation through bilaterally placed tibial (hind leg) intraosseous cannulas. The fluid-resuscitation was limited to intraosseous or i.v. fluid therapy, and did not involve cardiopulmonary resuscitation or other interventions. A subgroup underwent median sternotomy with pericardiectomy and pleurotomy before hemorrhagic shock was induced. We used invasive hemodynamic and respiratory monitoring including Swan Ganz pulmonary artery catheter and transesophageal echocardiography and obtained biopsies from the lungs, heart, brain, and left kidney postmortem.</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Results:</strong> <span style="background-color: #ffff99;"><strong>All pigs exposed to intraosseous infusion had pulmonary fat emboli in postmortem biopsies.</strong></span> Additionally, seven of twenty-one pigs had coronary fat emboli. None of the pigs with open chest had fat emboli in postmortem lung, heart, or kidney biopsies. During intraosseous fluid-resuscitation, three pigs developed significant ST-elevations on ECG; all of these animals had coronary fat emboli on postmortem biopsies.</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Conclusions:<span style="background-color: #ffff99;"> Systemic fat embolism occurred in the form of coronary fat emboli in a third of the animals who underwent intraosseous fluid resuscitation.</span></strong> Open chest conditions did not increase the incidence of systemic fat embolization.</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlLe SAM IOtag:citerahiadesgenettes.hautetfort.com,2020-03-11:62193352020-03-11T23:13:00+01:002020-03-11T23:13:00+01:00 SAM medical propose un nouveau dispositif d'abord intraosseux. Peut être un...
<p style="text-align: center;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">SAM medical propose un nouveau dispositif d'abord intraosseux. Peut être un concurrent à l'EZ_IO </span></p><p style="text-align: center;"> </p><p style="text-align: center;"><iframe width="560" height="315" src="https://www.youtube.com/embed/MwZb6f_dHD4?autoplay=1" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="allowfullscreen"></iframe></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlIntra-Osseux: En 1er ? Chez les plus gravestag:citerahiadesgenettes.hautetfort.com,2018-04-12:60428142018-04-12T10:37:00+02:002018-04-12T10:37:00+02:00 The intraosseous have it : A prospective ...
<h1 class="cit" style="text-align: center;"><span style="font-size: 14pt; font-family: arial, helvetica, sans-serif;">The <span class="highlight">intraosseous </span>have it : A <span class="highlight">prospective</span> <span class="highlight">observational</span> <span class="highlight">study</span> of <span class="highlight">vascular</span> <span class="highlight">access</span> <span class="highlight">success</span> <span class="highlight">rates</span> in <span class="highlight">patients</span> in <span class="highlight">extremis</span> using <span class="highlight">video</span> <span class="highlight">review</span>.</span></h1><p class="auths" style="text-align: center;"><span style="font-size: 12pt;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/29300281" target="_blank" rel="noopener noreferrer"><span style="font-family: arial, helvetica, sans-serif;">Chreiman KM et Al. J Trauma Acute Care Surg. 2018 Apr;84(4):558-563.</span></a></span></p><p class="auths" style="text-align: center;"><span style="font-size: 12pt;"><span style="font-family: arial, helvetica, sans-serif;">-------------</span></span></p><p class="auths" style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">Attention dans cette étude les abords vasculaires ne sont pas réalisés par les mêmes personnels. Ainsi les VVP sont posées en grande majorité par des infirmiers dont la pratique pour ce geste est grande. Ceci pour dire que l'intérêt de l'intra-osseux est majeur, tout particulièrement quand on emploie un dispositif motorisé tel que l'EZ-IO dont l'apprentissage est simplissime pour qui sait employer une perceuse.</span></p><div class="afflist"><h3 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif;">------------- </span></h3></div><div class="abstr"><div class=""><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;"><strong>BACKGROUND:</strong></span></p><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">Quick and successful <span class="highlight">vascular</span> <span class="highlight">access</span> in injured <span class="highlight">patients</span> arriving in <span class="highlight">extremis</span> is crucial to enable early resuscitation and rapid OR transport for definitive repair. <span style="background-color: #ffff99;"><strong>We hypothesized that <span class="highlight">intraosseous</span> (IO) <span class="highlight">access</span> would be faster and have higher <span class="highlight">success</span> </strong></span><span class="highlight">rates</span> than peripheral intravenous (PIV) or central venous catheters (CVCs).</span></p><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;"><strong>METHODS:</strong></span></p><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;"><span style="background-color: #ffff99;">H<strong><span style="background-color: #ffff99;">ig</span>h-definition <span class="highlight">video</span> recordings of resuscitations for all <span class="highlight">patients</span> undergoing emergency department thoracotomy</strong></span> from April 2016 to July 2017 were reviewed as part of a quality improvement initiative. Demographics, mechanism of injury, <span class="highlight">access</span> type, <span class="highlight">access</span> location, start and stop time, and <span class="highlight">success</span> of each <span class="highlight">vascular</span> <span class="highlight">access</span> attempt were recorded. Times to completion for <span class="highlight">access</span> types (PIV, IO, CVC) were compared using Kruskal-Wallis test adjusted for multiple comparisons, while categorical outcomes, such as <span class="highlight">success</span> <span class="highlight">rates</span> by <span class="highlight">access</span> type, were compared using χ test or Fisher's exact test.</span></p><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;"><strong>RESULTS:</strong></span></p><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;"><span class="highlight">Study</span> <span class="highlight">patients</span> had a median age of 30 years (interquartile range [IQR], 25-38 years), 92% were male, 92% were African American, and <span style="background-color: #ffff99;"><strong>93% sustained penetrating trauma</strong></span>. A tota<span style="background-color: #ffff99;"><strong>l of 145 <span class="highlight">access</span> attempts in 38 <span class="highlight">patients</span> occurred (median, 3.8; SD, 1.4 attempts per patient). There was no difference between duration of PIV and IO attempts</strong></span> (0.63; IQR, 0.35-0.96 vs. 0.39 IQR, 0.13-0.65 minutes, adjusted p = 0.03), but both PIV and IO were faster than CVC attempts (3.2; IQR, 1.72-5.23 minutes; adjusted p < 0.001 for both comparisons).<span style="background-color: #ffff99;"><strong> <span class="highlight">Intraosseous</span> lines had higher <span class="highlight">success</span> <span class="highlight">rates</span> than PIVs or CVCs (95% vs. 42% vs. 46%, p < 0.001)</strong></span>.</span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif;"><img style="margin: 0.7em 0;" src="http://ovidsp.tx.ovid.com/sp-3.28.0a/ovidweb.cgi?S=NDHAFPHPDPDDADPBNCFKOHJCBDCFAA00&Graphic=01586154-201804000-00002%7cFF2%7cM%7cjpg" alt="ovidweb.cgi?S=NDHAFPHPDPDDADPBNCFKOHJCBDCFAA00&Graphic=01586154-201804000-00002%7cFF2%7cM%7cjpg" width="350" height="252" /></span></p><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;"><strong>CONCLUSION:</strong></span></p><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;"><span style="background-color: #ffff99;"><strong><span class="highlight">Access</span> attempts using IO are as fast as PIV attempts but are more than twice as likely to be successful.</strong> </span>Attempts at CVC <span class="highlight">access</span> in <span class="highlight">patients</span> in <span class="highlight">extremis</span> have high <span class="highlight">rates</span> of failure and take a median of over 3 minutes. While IO <span class="highlight">access</span> may not completely supplant PIVs and CVCs, <span style="background-color: #ffff99;"><strong>IO <span class="highlight">access</span> should be considered as a first-line therapy for trauma <span class="highlight">patients</span> in <span class="highlight">extremis</span>.</strong></span></span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlIntra-osseux: Pas un gadgettag:citerahiadesgenettes.hautetfort.com,2017-06-30:59588622017-06-30T08:19:41+02:002017-06-30T08:19:41+02:00 En route intraosseous access performed in the combat setting Savell...
<h1 class="cit" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">En route intraosseous access performed in the combat setting</span></h1><div class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28140436" target="_blank" rel="noopener noreferrer">Savell S et all. Am J Disaster Med. 2016 Fall;11(4):225-231</a></div><div class="auths" style="text-align: center;"> </div><div class="auths" style="text-align: center;"> </div><div class="auths" style="text-align: center;">-----------------------------------</div><div class="auths" style="text-align: justify;">Dans cette étude 2 blessés sur 3 font l'objet d'une tentative d'abord vasculaire, réussie dans 93% des cas. L'abord intra-osseux est fait dans près de 12% des cas et représente le seul accès dans près de 6% des blessés pris en charge avec un taux de succès de 88%. </div><div class="auths" style="text-align: center;">----------------------------------- </div><div class="afflist"> </div><div class="abstr"><div class=""><h4 style="text-align: justify;">OBJECTIVE:</h4><p style="text-align: justify;">To describe and compare vascular access practices used by en route care providers during medical evacuation (MEDEVAC).</p><h4 style="text-align: justify;">DESIGN:</h4><p style="text-align: justify;">This was a retrospective cohort study. Medical records of US military personnel injured in combat and transported by MEDEVAC teams were queried.</p><h4 style="text-align: justify;">PATIENTS:</h4><p style="text-align: justify;">The subjects were transported by military en route care providers, in the combat theater during Operation Enduring Freedom (OEF) between January 2011 and March 2014. The authors reviewed 1,267 MEDEVAC records of US casualties and included 832 subjects that had vascular access attempts.</p><h4 style="text-align: justify;">MAIN OUTCOME MEASURES:</h4><p style="text-align: justify;"><span style="color: #000000; background-color: #ffff99;"><strong>The outcome measures for this study were vascular access success rates, including intravenous (IV) and intraosseous (IO) attempts</strong></span>. Subjects were grouped by type of vascular access: None, peripheral intravenous (PIV), IO, and PIV + IO (combination of PIV and IO) and by vascular access (PIV or IO) success (No versus Yes). Survival rate, in-flight events, ventilator, intensive care and in hospital days, and 30-day outcomes were compared among groups.</p><h4 style="text-align: justify;">STATISTICAL ANALYSIS:</h4><p style="text-align: justify;">The authors used chisquare or Fisher's exact tests to evaluate categorical variables. Analysis of variance (ANOVA) or Kruskal-Wallis tests were used for continuous variables.</p><h4 style="text-align: justify;">RESULTS:</h4><p style="text-align: justify;"><span style="background-color: #ffff99;"><strong>Vascular access was attempted in 832 (66 percent) of the 1,267 subjects transported by MEDEVAC</strong></span> during this study period. The majority (n = 758) of the access attempts were PIV of which 93 percent (706/758) were successful. In 74 subjects, IO was the only access attempted with an 85 percent (n = 63) success rate. The overall success rate with IO placement was 88 percent.</p><h4 style="text-align: justify;">CONCLUSIONS:</h4><p style="text-align: justify;">Intraosseous access has been used successfully in the combat setting and accounts for approximately 12 percent of vascular access in the MEDEVAC population the authors studied.</p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlIntraosseux ? Ne pas aller trop profondtag:citerahiadesgenettes.hautetfort.com,2017-05-01:59390892017-05-01T22:21:00+02:002017-05-01T22:21:00+02:00 Intramedullary placement of intraosseous cannulas inserted in the...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Intramedullary placement of <span class="highlight">intraosseous</span> cannulas inserted in the preclinical treatment of polytrauma patients : A retrospective, computed tomography-assisted evaluation</span></h1><p class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28233040" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Jansen Get Al. Anaesthesist. 2017 Mar;66(3):168-176</span></a></p><p class="auths" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">-------------------------------</span></p><p class="auths" style="text-align: justify;">Le recours à la voie intra-osseuse trouve a sa place lors de la prise en charge de traumatisé sévère. Il faut néanmoins s'assurer du bon positionnement intra-médullaire de l'aiguille. Ce travail appelle à de la prudence car il met en évidence la fréquence de positionnements non optimaux notamment un peu trop profond. Une vérification régulière s'impose dans le contexte de la traumatologie sévère.</p><p class="auths" style="text-align: center;">-------------------------------</p><div class="afflist"> </div><div class="abstr"><div class=""><h4>BACKGROUND:</h4><p>Use of <span class="highlight">intraosseous</span> <span class="highlight">access</span> to the vascular system is rare in the pre-hospital setting (<1%). However, as patients for which the use of an <span class="highlight">intraosseous</span> device is indicated are usually in a critical condition, awareness of possible application errors is vital. A survey was performed to evaluate intramedullary needle placement by means of computed axial tomography.</p><h4>METHODS:</h4><p>In the period of 01/01/2011 to 31/12/2015 all multislice-CT trauma scans performed in a trauma center were monitored for <span class="highlight">intraosseous</span> devices in situ. The placement site, type of <span class="highlight">intraosseous</span> device and needle deployed, thickness of bone and soft tissues, site for optimum needle placement, and both deviation from gold standard placement and visible complications were also recorded.</p><h4>RESULTS:</h4><p>In 11 out of 982 patients with suspected polytrauma that were studied during the observation period, 13 <span class="highlight">intraosseous</span> cannulas were found (<span style="background-color: #ffff99;"><strong>1.12%)</strong></span>. In all cases, the EZ-IO® (Teleflex, P.O. Box 12600, Research Triangle Park, NC 27709, USA) <span class="highlight">intraosseous</span> vascular <span class="highlight">access</span> system was used. <span style="background-color: #ffff99;"><strong>All applications were placed correctly in the medullary cavity</strong></span>, but none concurred with the current guidelines: The site of the puncture deviated laterally in seven cases, medially in two cases, cranially in four cases, and caudally in two cases.</p><p style="text-align: center;"><img id="media-5616124" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/00/3573642336.jpg" alt="IO position.jpg" /></p><p>T<span style="background-color: #ffff99;"><strong>he most common error in all 13 cases was overshooting during needle introduction.</strong></span></p><h4>CONCLUSION:</h4><p><span style="background-color: #ffff99;"><strong>Even though clinical criteria may suggest correct placement of an <span class="highlight">intraosseous</span> device, the results of this survey provide evidence that deviations in positioning are common.</strong></span> Placement of the needle too deep can cause complications within the soft tissues or potentially impede <span class="highlight">intraosseous</span> infusion.</p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlAiguille Intraosseuse: Pour trépaner ?tag:citerahiadesgenettes.hautetfort.com,2017-03-09:59193442017-03-09T08:36:00+01:002017-03-09T08:36:00+01:00 Temporising extradural haematoma by craniostomy using an intraosseous...
<h1 class="cit" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Temporising extradural haematoma by craniostomy using an <span class="highlight">intraosseous</span> needle.</span></h1><div class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28238447" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Bulstrode Het Al. Injury. 2017 Feb 20. pii: S0020-1383(17)30082-7. </span></a></div><div class="afflist"><div class="ui-helper-reset"> </div></div><div class="abstr"><h3 style="text-align: center;">---------------------------</h3><p style="text-align: justify;">Le contrôle de l'hypertension intracrânienne fait souvent appel à l'évacuation chirurgical des hématomes intra-crâniens, notamment les hématomes extra-duraux. Il peut être nécessaire avant création d'un volet osseux de mettre en oeuvre des interventions comme la trépanation. Ce geste est un des plus anciens de la chirurgie. On rapporte son emploi au <a href="http://www.pourlascience.fr/ewb_pages/a/article-le-neolithique-age-d-or-de-la-trepanation-21063.php" target="_blank">néolithique</a>. La soustraction d'un faible volume de sang peut en effet réduire de manière très importante la pression intracrânienne, améliorant du coup la perfusion intracérébrale (<a href="http://www.sfmu.org/upload/consensus/rfe_tcg_2016.pdf" target="_blank">rfe Prise en charge des TC</a>). Un simple fraise boule permet ce geste qui peut être fait manuellement ou avec un moteur. Cet article rapporte l'emploi d'un kit de perfusion intra-osseuse pour réaliser une telle évacuation partielle. Petite précision: Ceci est fait après un TDM. En environnement extrême pourquoi pas , mais avec une fraise boule plutôt?</p><h3 style="text-align: center;">---------------------------</h3><div class=""><p>We report a novel application of <span class="highlight">intraosseous</span> needle drainage, alleviating raised intracranial pressure due to extradural haematoma. The potential application of this technique in preventing secondary brain injury and herniation during transfer to a neurosurgical unit is discussed.</p><p style="text-align: center;"><img style="margin: 0.7em 0;" src="http://ars.els-cdn.com/content/thumbimage/1-s2.0-S0020138317300827-gr2.sml" alt="1-s2.0-S0020138317300827-gr2.sml" /></p><p style="text-align: center;"> </p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlIntraosseux: Oui, INTRAtag:citerahiadesgenettes.hautetfort.com,2017-03-09:59193382017-03-09T08:15:13+01:002017-03-09T08:15:13+01:00 Deltoid Compartment Syndrome: A Rare Complication after Humeral...
<div class="fm-citation half_rhythm no_top_margin clearfix"><div class="small"><div class="inline_block eight_col va_top"><h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Deltoid Compartment Syndrome: A Rare Complication after Humeral Intraosseous Access</span></h1></div></div></div><div class="half_rhythm"><div class="contrib-group fm-author" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Thadikonda%20KM%5BAuthor%5D&cauthor=true&cauthor_uid=28203508">Thadikonda</a> KM et Al. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293306/" data-vivaldi-spatnav-clickable="1">Plast Reconstr Surg Glob Open</a>. 2017 Jan; 5(1): e1208.</div><div class="contrib-group fm-author" style="text-align: center;"> </div><div class="contrib-group fm-author" style="text-align: center;">--------------------------------</div><div class="contrib-group fm-author" style="text-align: center;">La voie intraosseuse est un alternative majeure à la voie intraveineuse. Sa mise en oeuvre fait appel à certaines spécificités. Il est fondamental que l'aiguille soit bien en intraosseux, ce qui n'est pas toujours simple. Un test d'aspiration, la surveillance du site clinique et pour certains échographique sont requis. L'observation présentée rapporte une complication lors d'un accès huméral. </div><div class="contrib-group fm-author" style="text-align: center;">--------------------------------</div><div class="contrib-group fm-author" style="text-align: center;"> </div><div class="contrib-group fm-author" style="text-align: justify;"> </div><div class="contrib-group fm-author" style="text-align: justify;">We present a case of a 65-year-old woman who developed a delayed deltoid compartment syndrome after resuscitation via humeral <span class="highlight">intraosseous</span> <span class="highlight">access</span>.</div><div class="contrib-group fm-author" style="text-align: justify;"><br /><img style="float: left; margin: 0.2em 1.4em 0.7em 0;" src="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293306/bin/gox-5-e1208-g001.jpg" alt="gox-5-e1208-g001.jpg" width="194" height="106" />Initially she was treated conservatively but then was taken emergently for a fasciotomy. After confirming the diagnosis with compartment pressures, a 2-incision approach was employed and a large hematoma was evacuated from the inferior margin of the anterior deltoid. The rest of the deltoid was inspected and debrided to healthy bleeding tissue. Her fasciotomy wounds were left open to heal on their own due to her tenuous clinical condition. At most recent follow-up, she had full range of motion in her shoulder and no residual pain. Our unique case study is the first documented incidence of upper extremity compartment syndrome after <span class="highlight">intraosseous</span> <span class="highlight">access</span>. Additionally, our case supports using humeral <span class="highlight">access</span> only as a second-line option if lower extremity <span class="highlight">access</span> is not available and prolonged vigilant monitoring after discontinuing <span class="highlight">intraosseous</span> <span class="highlight">access</span> to prevent disastrous late complications.</div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPlyo: En intraosseux aussitag:citerahiadesgenettes.hautetfort.com,2017-01-02:58935652017-01-02T09:02:57+01:002017-01-02T09:02:57+01:00 Pre-hospital intra-osseous freeze dried plasma transfusion: a case report...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Pre-hospital intra-osseous freeze dried plasma transfusion: a case report </span></h1><p style="text-align: center;"><a href="https://disastermilitarymedicine.biomedcentral.com/track/pdf/10.1186/2054-314X-1-8?site=disastermilitarymedicine.biomedcentral.com" target="_blank">Rottenstreich et al. Disaster and Military Medicine 2015, 1:8</a></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Background:</strong> <span style="background-color: #ffff99;"><strong>Hemorrhage and coagulopathy are among the leading causes of death in combat</strong></span> and are considered the leading causes of preventable deaths. Plasma, in the form of Fresh Frozen Plasma (FFP) is considered a key component in the Damage Control Resuscitation performed within hospitals. Freeze-Dried Plasma (FDP) can be stored at room temperature and therefore is potentially useful in pre-hospital conditions. Our case report join to few cases where FDP was administered at the point of injury. It is also unique as <span style="background-color: #ffff99;"><strong>it describes an intra- osseous administration</strong></span> given to pediatric patient. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Case report:</strong> M.S. otherwise healthy 13 year old girl was injured due to gunshots and grenade blast. On the first triage by the IDF medical teams she suffered from: Severe hemorrhagic shock, (Blood pressure could not be measured, Heart rate 163), superficial wounds to her face, (forehead and Rt. Eye), gunshot wounds with active bleeding from her Lt. Arm and her RT. Knee (Mangled Extremity Severity Score (MESS) 8) and open fractures of left elbow and right thigh. A peripheral intravenous catheter was established and 1 g tranexamic acid in 500 ml of Hartman fluid were administered. D<span style="background-color: #ffff99;"><strong>ue to difficulties in establishing a functioning intra-venous line, an intra-osseous catheter was established and one unit of FDP (250 ml) was given in the field</strong></span>. She was transferred by a military medical team to a regional civilian hospital for further treatment. Upon arrival to the hospital her blood pressure and heart rate were significantly improved. After three weeks of hospitalization M.S. was discharged and she was returned to her homeland.</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Conclusion:</strong> We have described the successful use of FDP for pre hospital resuscitation of a 13 year old girl suffering from severe hemorrhagic shock as a result of gunshots and grenade blast. <span style="background-color: #ffff99;"><strong>This case report demonstrates that intra-osseous FDP administration for as part pre hospital resuscitation of children has a favorable outcome.</strong></span></span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPosition intraosseuse ? Echographiez !tag:citerahiadesgenettes.hautetfort.com,2016-09-15:58479582016-09-15T07:28:00+02:002016-09-15T07:28:00+02:00 A Serious Adult Intraosseous Catheter Complication and...
<p style="text-align: center;"><strong> <span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">A <span class="highlight">Serious</span> <span class="highlight">Adult</span> <span class="highlight">Intraosseous</span> <span class="highlight">Catheter</span> <span class="highlight">Complication</span> and <span class="highlight">Review</span> of the <span class="highlight">Literature</span>.</span></strong></p><div class="auths" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/27058467" target="_blank">Greenstein YY et Al. Crit Care Med. 2016 Sep;44(9):e904-9 </a></span></div><div class="auths" style="text-align: center;"> </div><div class="auths" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">----------------------------------</span></div><div class="auths" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Cette observation rapporte une extravasation d'amines pressives responsable d'une ischémie aiguë sévère de membre. Ceci est connu. Ce qui est intéressant c'est la proposition de recours à l'échographie pour confirmer la bonne position de l'aiguille.</span></div><div class="auths" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">----------------------------------</span></div><div class="abstr"><div class=""><h4>OBJECTIVE:</h4><p>Current guidelines recommend the use of <span class="highlight">intraosseous</span> access when IV access is not readily attainable. The pediatric <span class="highlight">literature</span>re ports an excellent safety profile, whereas only small prospective studies exist in the <span class="highlight">adult</span> <span class="highlight">literature</span>. We report a case of vasopressor extravasation and threatened limb perfusion related to <span class="highlight">intraosseous</span> access use and our management of the <span class="highlight">complication</span>. We further report our subsequent systematic <span class="highlight">review</span> of <span class="highlight">intraosseous</span> access in the <span class="highlight">adult</span> population.</p><h4>DATA SOURCES:</h4><p>Ovid Medline was searched from 1946 to January 2015.</p><h4>STUDY SELECTION:</h4><p>Articles pertaining to <span class="highlight">intraosseous</span> access in the <span class="highlight">adult</span> population (age greater than or equal to 14 years) were selected. Search terms were "infusion, <span class="highlight">intraosseous</span>" (all subfields included), and <span class="highlight">intraosseous</span> access" as key words.</p><h4>DATA EXTRACTION:</h4><p>One author conducted the initial <span class="highlight">literature</span> <span class="highlight">review</span>. All authors assessed the methodological quality of the studies and consensus was used to ensure studies met inclusion criteria.</p><h4>DATA SYNTHESIS:</h4><p style="text-align: justify;">The case of vasopressor extravasation was successfully treated with pharmacologic interventions, which reversed the effects of the extravasated vasopressors: <span class="highlight">intraosseous</span> phentolamine, topical nitroglycerin ointment, and intraarterial verapamil and nitroglycerin. Our systematic <span class="highlight">review</span> of the <span class="highlight">adult</span> <span class="highlight">literature</span> found 2,332 instances of <span class="highlight">intraosseous</span> insertion. A total of 2,106 <span class="highlight">intraosseous</span> insertion attempts were made into either the tibia or the humerus; 192 were unsuccessful, with an overall success rate of 91%. Five insertions were associated with<span class="highlight">serious</span> complications. A total of 226 insertion attempts were made into the sternum; 54 were unsuccessful, with an overall success rate of 76%.</p><p style="text-align: justify;"> ----</p><p style="text-align: justify;">Color Doppler ultrasonography has been described as a method to verify placement of an intraosseous catheter. A high-frequency linear array transducer is placed near the intraosseous insertion site in either transverse or longitudinal axis. The color Doppler sample box is adjusted to include the subcutaneous compartment, the periosteum, and the intraosseous space, with the tomographic plane oriented to intersect the axis of the intraosseous needle . A 10-mL syringe filled with normal saline is attached to the intraosseous catheter and is rapidly infused with real-time ultrasonography imaging. If the intraosseous catheter is properly placed, color Doppler signal is seen in the subperiosteal (intraosseous) compartment. The presence of color Doppler signal in the extraosseous compartment indicates improper intraosseous catheter placement with extravasation.</p><p style="text-align: justify;"> ----</p><p style="text-align: center;"><img style="margin: 0.7em 0;" src="https://ovidsp-tx-ovid-com.bibliopam-evdg.org/sp-3.21.1b/ovidweb.cgi?S=NCKAFPLNJKDDFCAMNCIKPBFBHJCGAA00&Graphic=00003246-201609000-00047%7cFF3%7cM%7cjpg" alt="ovidweb.cgi?S=NCKAFPLNJKDDFCAMNCIKPBFBHJCGAA00&Graphic=00003246-201609000-00047%7cFF3%7cM%7cjpg" width="225" height="169" /></p><p> </p><h4>CONCLUSIONS:</h4><p><span class="highlight">Intraosseous</span> <span class="highlight">catheter</span> insertion provides a means for rapid delivery of medications to the vascular compartment with a favorable safety profile. Our systematic <span class="highlight">literature</span> <span class="highlight">review</span> of <span class="highlight">adult</span> <span class="highlight">intraosseous</span> access demonstrates an excellent safety profile with <span class="highlight">serious</span> complications occurring in 0.3% of attempts. We report an event of vasopressor extravasation that was potentially limb threatening. Therapy included local treatment and injection of intraarterial vasodilators. <span class="highlight">Intraosseous</span> access complications should continue to be reported, so that the medical community will be better equipped to treat them as they arise.</p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlIntraosseux tibial: Pas l'idéal !tag:citerahiadesgenettes.hautetfort.com,2015-08-07:56678112015-08-07T20:36:00+02:002015-08-07T20:36:00+02:00 Intraosseous infusion rates under high pressure: a cadaveric comparison of...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Intraosseous infusion rates under high pressure: a cadaveric comparison of anatomic sites</span></h1><p style="text-align: center;"><a href="http://www.dtic.mil/get-tr-doc/pdf?AD=ADA597324" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Pasley J et al. J Trauma Acute Care Surg 2015;78(2):295-9.</span></a></p><p style="text-align: center;">-------------------------------------------------</p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Dans notre pratique le choix d'un abord tibial est le plus fréquent mais certainement pas le plus pertinent chez l'adulte. Le taux de succès de 1ère pose, le débit atteint les les aléas de perfusion font qu'un abord huméral ou sternal sont un meilleur choix. C'est ce laisse supposer ce document.</span></p><p style="text-align: center;"><span style="text-align: center;">-------------------------------------------------</span></p><div><p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">BACKGROUND:</span></strong></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: small;">When traditional vascular access methods fail, emergency access through the intraosseous (IO) route can be lifesaving. Fluids, medications, and blood components have all been delivered through these devices. We sought to compare the performance of IO devices placed in the sternum, humeral head, and proximal tibia using a fresh human cadaver model.</span></p><p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">METHODS:</span></strong></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Commercially available IO infusion devices were placed into fresh human cadavers: sternum (FAST-1), humeral head (EZ-IO), and proximal tibia (EZ-IO). Sequentially, the volume of 0.9% saline infused into each site under 300 mm Hg pressure over 5 minutes was measured. Rates of successful initial IO device placement and subjective observations related to the devices were also recorded.</span></p><p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">RESULTS:</span></strong></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: small;">For 16 cadavers over a 5-minute bolus infusion, t<span style="background-color: #ffff99;"><strong>he total volume of fluid infused at the three IO access sites was 469 (190) mL for the sternum, 286 (218) mL for the humerus, and 154 (94) mL for the tibia.</strong></span> Thus, t<span style="background-color: #ffff99;"><strong>he mean (SD) flow rate infused at each site was as follows: (1) sternum, 93.7 (37.9) mL/min; (2) humerus, 57.1 (43.5) mL/min; and (3) tibia, 30.7 (18.7) mL/min</strong></span>. <span style="background-color: #ffff99;"><strong>The tibial site had the greatest number of insertion difficulties.</strong></span></span></p><p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">CONCLUSION:</span></strong></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: small;">This is the first study comparing the rate of flow at the three most clinically used adult IO infusion sites in an adult human cadaver model.<span style="background-color: #ffff99;"><strong> Our results showed that the sternal site for IO access provided the most consistent and highest flow rate compared with the humeral and tibial insertion sites</strong></span>. The average flow rate in the sternum was 1.6 times greater than in the humerus and 3.1 times greater than in the tibia.</span></p></div><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlIntraosseux = Embolie graisseusetag:citerahiadesgenettes.hautetfort.com,2015-08-07:56678072015-08-07T20:04:00+02:002015-08-07T20:04:00+02:00 Fat Intravasation from Intraosseous Flush and Infusion Procedures...
<p style="text-align: center;"><strong><span style="color: #333333; font-family: arial, helvetica, sans-serif; font-size: medium; line-height: 18.7199993133545px;">Fat Intravasation from Intraosseous Flush and Infusion Procedures</span></strong><br style="color: #333333; font-family: arial, helvetica, sans-serif; font-size: 12.4799995422363px; line-height: 18.7199993133545px;" /><span style="color: #333333; font-family: arial, helvetica, sans-serif; font-size: 12.4799995422363px; line-height: 18.7199993133545px;"><br /><a href="http://informahealthcare.com/doi/abs/10.3109/10903127.2014.980475" target="_blank"><span style="font-size: small;">Rubal BJ et Al. </span></a></span><a href="http://informahealthcare.com/doi/abs/10.3109/10903127.2014.980475" target="_blank"><span style="font-size: small;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.9565258026123px; text-align: left;"><span style="color: #660066;">Prehosp Emerg Care.</span></span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.9565258026123px; text-align: left;"> 2015 Jul-Sep;19(3):376-90</span></span></a><span style="color: #333333; font-family: arial, helvetica, sans-serif; font-size: 12.4799995422363px; line-height: 18.7199993133545px;"><br /></span></p><p style="text-align: center;"><span style="color: #333333; font-family: arial, helvetica, sans-serif; font-size: 12.4799995422363px; line-height: 18.7199993133545px;">----------------------------------</span></p><p style="text-align: justify;"><span style="color: #333333; font-family: arial, helvetica, sans-serif; font-size: 12.4799995422363px; line-height: 18.7199993133545px;">On s'en doutait mais cela est objectivé: Le recours à la perfusion intraosseuse est responsable d'embolie graisseuse. La survenue d'une telle complication est moindre quand la procédure de flush ne dépasse pas 300mmHg et que le débit est lent. Dont acte au moins pour le flush.</span></p><p style="text-align: center;"><span style="color: #333333; font-family: arial, helvetica, sans-serif; font-size: 12.4799995422363px; line-height: 18.7199993133545px; text-align: center;">----------------------------------</span></p><p style="text-align: center;"> </p><div class="abstr"><div><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">STUDY HYPOTHESIS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">The primary study objective was to delineate the procedural aspects of intraosseous (IO) infusions responsible for fatintravasation by t<span style="background-color: #ffff99;"><strong>esting the hypothesis that the fat content of effluent blood increases during IO infusions.</strong></span></span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">METHODS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">IO cannulas were inserted into the proximal tibiae of 35 anesthetized swine (Sus scrofa, 50.1 ± 3.5 kg) and intravasated fat was assessed using a lipophilic fluoroprobe (Nile red) and by vascular ultrasound imaging. Effluent blood bone marrow fat was assessed at baseline, during flush, and with regimens of controlled infusion pressures (73-300 mmHg) and infusion flow rates (0.3-3.0 mL per second). Fat intravasation was also assessed with IO infusions at different tibial cannulation sites and in the distal femur. In 7 animals, the lipid uptake of alveolar macrophages and lung tissue assessed for fat embolic burden using oil red O stain 24 hours post infusion. Additionally, bone marrow shear-strain was assessed radiographically with IO infusions.</span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">RESULTS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="background-color: #ffff99;"><strong>Fat intravasation was observed during all IO infusion regimens, with subclinical pulmonary fat emboli persisting 24 hours post infusion.</strong></span> It was noted that <span style="background-color: #ffff99;"><strong>initial flush was a significant factor in fat intravasation</strong></span>, l<span style="background-color: #ffff99;"><strong>ow levels of intravasation occurred with infusions ≤300 mmHg, fat intravasationand bone marrow shear-strain increased with IO infusion rates, and intravasation was influenced by cannula insertion site</strong></span>. Ultrasound findings suggest that echogenic particles consistent with fat emboli are carried in fast and slow venous blood flow fields. Echo reflective densities were observed to rise to the nondependent endovascular margins and coalesce in accordance with Stoke's law. In addition, ultrasound findings suggested that intravasated bone marrow fat was thrombogenic.</span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">CONCLUSION:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Results suggest that in swine the intravasation of bone marrow fat is a common consequence of IO infusion procedures and that its magnitude is influenced by the site of cannulation and infusion forces. Although the efficacy and benefits of IO infusions for emergent care are well established, emergency care providers also should be cognizant that infusion procedures affect bone marrow fat intravasation.</span></p><div> </div></div></div><p style="text-align: center;"> </p><div class="aux"> </div><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlBIG et FAST: Evolutions récentestag:citerahiadesgenettes.hautetfort.com,2015-07-23:56613222015-07-23T08:47:00+02:002015-07-23T08:47:00+02:00 Le BIG et Le FAST1 sont les dispositifs historiques d'accès intraosseux par...
<p>Le BIG et Le FAST1 sont les dispositifs historiques d'accès intraosseux par impaction. Ils ont évolué. La nouvelle version du BIG est le<span style="font-size: medium;"><strong> <a href="http://www.nio-pm.com/" target="_blank">NIO</a></strong></span>, celle du FAST1 est le <span style="font-size: medium;"><strong><a href="http://www.pyng.com/wp/wp-content/uploads/PM-080c%20FASTx%20Trainer's%20PowerPoint.pdf" target="_blank">FASTX</a>.</strong></span> On rappelle que le BIG est en o dotation dans l'armée français et que différence fondamentale le BIG ne s'applique pas en sternal, alors qu'il s'agit du site de pose exclusif du FAST. On peut penser que ce dernier est moins polyvalent qu'un système permettant un abord huméral, tibial ou iliaque (<a href="http://citerahiadesgenettes.hautetfort.com/list/procedure/fiche-technique-perfusion-intra-osseuse.html" target="_blank">lire la fiche mémento</a>).</p><p style="text-align: center;"><img id="media-5107625" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/00/395687249.jpg" alt="New IO.jpg" /> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlCICO: Stratégies et équipementtag:citerahiadesgenettes.hautetfort.com,2015-05-07:56176402015-05-07T06:28:00+02:002015-05-07T06:28:00+02:00 Equipment and strategies for emergency tracheal access in the adult patient...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Equipment and strategies for emergency tracheal access in the adult patient</span></h1><p style="text-align: center;"><a href="http://emcrit.org/wp-content/uploads/2014/12/Cric-review-in-anesth-lit.pdf" target="_blank">Hamaekers A; et All. Anaesthesia, 2011, 66 (Suppl. 2), pages 65–80</a></p><p style="text-align: center;">-----------------------------------------------------------------------</p><p>Un document qui passe en revue les équipements à mettre en oeuvre lors de sutuation de CICO (Can't intubate can't oxygneate)</p><p style="text-align: center;">-----------------------------------------------------------------------</p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">The inability to maintain oxygenation by non-invasive means is one of the most pressing emergencies in anaesthesia and emergency care. To prevent hypoxic brain damage and death in a ‘cannot intubate, cannot oxygenate’ situation, emergency percutaneous airway access must be performed immediately. Even though this emergency is rare, every anaesthetist should be capable of performing an emergency percutaneous airway as the situation may arise unexpectedly. Clear knowledge of the anatomy and the insertion technique, and repeated skill training are essential to ensure completion of this procedure rapidly and successfully. Various techniques have been described for emergency oxygenation and several commercial emergency cricothyroidotomy sets are available. There is, however, no consensus on the best technique or device. As each has its limitations, it is recommended that all anaesthetists are skilled in more than one technique of emergency percutaneous airway. Avoiding delay in initiating rescue techniques is at least as important as choice of device in determining outcome</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlBIG: Pas si évident !tag:citerahiadesgenettes.hautetfort.com,2014-11-26:54975812014-11-26T08:01:00+01:002014-11-26T08:01:00+01:00 The israeli defense force experience with intraosseous access...
<h1 style="font-size: 1.231em; margin: 0.375em 0px; line-height: 1.125em; font-family: arial, helvetica, clean, sans-serif; text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">The israeli defense force experience with <span class="highlight">intraosseous</span> access</span></h1><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><strong>Nadler R.et All. </strong></span></span><span style="line-height: 15.9565258026123px;"><a style="color: #660066; border-bottom-width: 0px;" title="Military medicine." href="http://www.ncbi.nlm.nih.gov/pubmed/25373050">Mil Med.</a></span><span style="line-height: 15.9565258026123px;"> 2014 Nov;179(11):1254-7</span></span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="line-height: 15.9565258026123px;">----------------------------------------------------------------------</span></span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="line-height: 15.9565258026123px;">La réalisation d'un abord vasculaire peut faire appel à la voie intraosseuse. <a href="http://citerahiadesgenettes.hautetfort.com/list/procedure/fiche-technique-perfusion-intra-osseuse.html" target="_blank">Trois dispositifs</a> sont prévus par la procédure du sauvetage au combat: le trocard de mallarmé, le BIG et l'EZ_IO. Si les études expérimentales sont en faveur de cette pratique, la réalité ne semble pas suivre notamment pour le BIG. Relativement peu de dispositifs ont eu un emploi enregistré avec un taux de succès faible. Peut être un problème de stratégie d'emploi ?</span></span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; line-height: 15.9565267562866px; font-size: small;">----------------------------------------------------------------------</span></p><p style="text-align: justify;"><span style="font-family: Arial, sans-serif; font-size: small;"><strong>INTRODUCTION:</strong></span></p><p style="text-align: justify;"><span style="font-size: small;"><span style="font-family: arial, helvetica, clean, sans-serif;">Obtaining vascular access is of paramount importance in trauma care. When peripheral venous access is indicated but cannot be obtained, the intraosseous</span> <span style="font-family: arial, helvetica, clean, sans-serif;">route represents an alternative. The Bone Injection Gun (BIG) is the device used for intraosseous</span> <span style="font-family: arial, helvetica, clean, sans-serif;">access by the Israeli Defense Force (IDF). The purpose of this study is to assess the success rate of intraosseous</span> <span style="font-family: arial, helvetica, clean, sans-serif;">access using this device.</span></span></p><p style="text-align: justify;"><span style="font-size: small;"><strong>METHOD:</strong></span></p><p style="text-align: justify;"><span style="font-size: small;"><span style="font-family: arial, helvetica, clean, sans-serif;">The IDF Trauma Registry <span style="background-color: #ffff99;"><strong>from 1999 to 2012</strong></span> was searched for patients for whom at least 1 attempt at intraosseous</span> <span style="font-family: arial, helvetica, clean, sans-serif;">access was made.</span></span></p><p style="text-align: justify;"><span style="font-size: small;"><strong>RESULTS:</strong></span></p><p style="text-align: justify;"><span style="font-size: small;"><span style="background-color: #ffff99;"><strong><span style="font-family: arial, helvetica, clean, sans-serif;">37 attempts at intraosseous</span> </strong></span><span style="font-family: arial, helvetica, clean, sans-serif;"><span style="background-color: #ffff99;"><strong>access were identified in 30 patients</strong></span>. Overall <span style="background-color: #ffff99;"><strong>success rate was 50%</strong></span>. No differences in success rates were identified between different care givers. Overall mortality was 87%.</span></span></p><p style="text-align: justify;"><span style="font-size: small;"><strong>CONCLUSION:</strong></span></p><p style="text-align: justify;"><span style="font-size: small;"><span style="font-family: arial, helvetica, clean, sans-serif;">The use of BIG in the IDF was associated with a<span style="background-color: #ffff99;"><strong> low success rate at obtaining intraosseous</strong></span></span><span style="background-color: #ffff99;"><strong> </strong></span><span style="font-family: arial, helvetica, clean, sans-serif;"><span style="background-color: #ffff99;"><strong>access</strong></span>. Although inability to achieve peripheral venous access can be considered an indicator for poor prognosis, the high mortality rate for patients treated with BIG can also stand for the provider's low confidence in using this tool, making its usemaking its use a last resort. This study serves as an example to ongoing learning process that includes data collection, analysis, and improvement, constantly taking place in the IDF</span></span></p><p> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlL'intraosseux: La vraie vietag:citerahiadesgenettes.hautetfort.com,2014-02-04:52902272014-02-04T21:08:00+01:002014-02-04T21:08:00+01:00 Complication with Intraosseous Access: Scandinavian Users’ Experience...
<p style="text-align: center;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Complication with Intraosseous Access: Scandinavian Users’ Experience</span></strong></p><p style="text-align: center;"><em><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789903/pdf/wjem-14-440.pdf" target="_blank"><span style="font-size: small;"><span style="font-family: arial, helvetica, sans-serif;">Hallas P. et All. </span></span><span style="font-family: arial, helvetica, sans-serif; font-size: small;">West J Emerg Med. 2013;14(5):440–443</span></a></em></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Pas si idyllique que cela</span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/01/4258412700.jpg" target="_blank"><img id="media-4429542" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/01/3977106729.jpg" alt="intraosseux" /></a></p><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlBIG: Du nouveau et en MIEUXtag:citerahiadesgenettes.hautetfort.com,2013-05-23:50785022013-05-23T21:54:46+02:002013-05-23T21:54:46+02:00 La mise en place d'un abord intra-osseux peut faire appel à une aiguille de...
<p style="text-align: justify;"><span style="font-size: small;">La mise en place d'un abord intra-osseux peut faire appel à une aiguille de Jamshidi, le Bone Injection Gun ou BIG et l'EZ-IO. Le BIG est un dispositif à impaction dont l'efficacité est reconnue mais dont le maniement peut être délicat. La société PersysMedical propose une novelle version du BIG qui corrige certains défauts. La clavette de sécurité est remplacée par un dispositif de sécurité beaucoup plus pratique, il n'est pas possible d'initier la percussion tant que le dispositif n'est pas plaqué à 90° contre une surface plane. Enfin ce déclenchement nécessite une poussée important puis l'attraction du corps du dispositif évitant ainsi un déclenchement intempestif du système.</span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/02/2717780974.jpeg" target="_blank"><img id="media-4114909" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/02/237584686.jpeg" alt="NIO1.jpeg" /></a></p><p style="text-align: justify;"><span style="font-size: small;"><br /></span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPIO: Le Bone Injection Guntag:citerahiadesgenettes.hautetfort.com,2013-04-11:50420332013-04-11T06:33:00+02:002013-04-11T06:33:00+02:00
<p><iframe width="640" height="360" src="http://www.youtube.com/embed/a2nyIqoN1b0?feature=player_embedded" frameborder="0" allowfullscreen=""></iframe></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlAccès intraosseux: La voie huméraletag:citerahiadesgenettes.hautetfort.com,2012-02-11:45953982012-02-11T14:33:00+01:002012-02-11T14:33:00+01:00 La voie intra-osseuse à privilégier Lire // ...
<p style="text-align: center;">La voie intra-osseuse à privilégier</p><p style="text-align: center;"><a href="http://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1277-6#MOESM2" target="_blank"><img src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcRFr9k5tqoq8DF1X25ZIKp4fgH7o6Fg5JwtASFR6GN4ZtGQaEDMRQ" alt="images?q=tbn:ANd9GcRFr9k5tqoq8DF1X25ZIKp4fgH7o6Fg5JwtASFR6GN4ZtGQaEDMRQ" width="45" height="44" /></a></p><p style="text-align: center;"><a href="http://www.acep.org/WorkArea/DownloadAsset.aspx?id=48943" target="_blank">Lire</a></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/01/00/497892319.JPG" target="_blank"><img id="media-3433587" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/00/400568299.JPG" alt="HumeralIO 1.JPG" /></a></p><p style="text-align: center;"><img id="media-3433590" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/00/1346393403.JPG" alt="HumeralIO 2.JPG" /></p><div id="MOESM1" class="MediaObject"><div id="mijsvdiv1039156"><script type="text/javascript" src="http://www.edge-cdn.net/videojs_1039156?jsdiv=mijsvdiv1039156&playerskin=37016">// <![CDATA[// ]]></script></div><div class="Caption" lang="en"> </div></div><div id="MOESM3" class="MediaObject"> </div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlAccès intraosseux: Revuetag:citerahiadesgenettes.hautetfort.com,2012-02-11:45953932012-02-11T14:06:00+01:002012-02-11T14:06:00+01:00 http://ccn.aacnjournals.org/content/31/2/76.full.pdf
<p style="text-align: center;"><a href="http://ccn.aacnjournals.org/content/31/2/76.full.pdf">http://ccn.aacnjournals.org/content/31/2/76.full.pdf</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlBack to the field: La réalité de terrain US sur l'intra-osseusetag:citerahiadesgenettes.hautetfort.com,2011-12-10:39015592011-12-10T11:28:00+01:002011-12-10T11:28:00+01:00 La PIO sternale La PIO humérale...
<p><strong><a href="http://www.medicalsci.com/files/harcke_-_fb2tf_7_sternal_io_iv_110810.pdf" target="_blank">La PIO sternale</a></strong><br /><strong><a href="http://www.medicalscg.de/files/ft2f__9_humeral_io-iv_part_1-final__nxpowerlite_.pdf" target="_blank">La PIO humérale</a></strong><br /><strong><a href="http://www.jsomonline.org/Publications/2011123Harcke.pdf" target="_blank">http://www.jsomonline.org/Publications/2011123Harcke.pdf</a></strong></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPerfusion intraosseuse: Voie huméraletag:citerahiadesgenettes.hautetfort.com,2009-10-17:24232332009-10-17T11:26:00+02:002009-10-17T11:26:00+02:00 La voie humérale apparait ête l'alternative de choix à la voie tibiale...
<p style="text-align: left;">La voie humérale apparait ête l'alternative de choix à la voie tibiale</p> <h2 style="text-align: center;"><a target="_blank" title="Voie intraosseuse humérale" href="http://www.ncbi.nlm.nih.gov/pubmed/19741408?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum">Proximal humerus intraosseous infusion: a preferred emergency venous access. PAxton et all. <span class="ti"><span title="The Journal of trauma.">J Trauma.</span> 2009 Sep;67(3):606-11.</span></a></h2> <p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/00/00/996769616.PNG" target="_blank"></a></p> <div style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/00/440823020.GIF" target="_blank"></a> <div style="text-align: center"><a href="http://citerahiadesgenettes.hautetfort.com/media/01/01/440823020.GIF" target="_blank"></a><a href="http://citerahiadesgenettes.hautetfort.com/media/00/00/938842562.GIF" id="media-2046328" name="media-2046328">IO.GIF</a><br /></div> <br /></div> <p> </p> <p> </p> <p> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPerfusion intraosseusetag:citerahiadesgenettes.hautetfort.com,2009-10-17:24231922009-10-17T11:07:00+02:002009-10-17T11:07:00+02:00 Si la pose d'un cathéter intraosseux est associée à une douleur tolérable,...
<p>Si la pose d'un cathéter intraosseux est associée à une douleur tolérable, <b>ce n'est pas le cas de la perfusion de solutés par cette voie surtout si le blessé est conscient</b>. La douleur est atténuée mais pas calmée par l'administration de bolus de lidocaïne (Au moins 40 mg soit 4 ml de lidocaïne à 1%), suivie d'une injection <b>lente</b> de 1à ml de sérum physiologique. Des bolus sont ensuite nécessaire. Il semble que la douleur soit proportionnelle à la pression d'injection. Il semblerait que le recours à la voie humérale soit associée à une douleur moindre.</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlLa voie humérale pour la perfusion intraosseusetag:citerahiadesgenettes.hautetfort.com,2009-10-17:24231862009-10-17T10:49:37+02:002009-10-17T10:49:37+02:00 La tête humérale est probablement la voie de choix pour la pose d'un...
<p><a title="La voie humérale pour l'abord vasculaire intraosseux" href="http://www.ncbi.nlm.nih.gov/pubmed/19741408">La tête humérale est probablement la voie de choix pour la pose d'un cathéter intraosseux en condition de combat</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlLe BIG: Emploitag:citerahiadesgenettes.hautetfort.com,2009-10-17:24231612009-10-17T10:37:31+02:002009-10-17T10:37:31+02:00 Comment employer le BIG
<p><a title="Comment employer le BIG" href="http://www.waismed.com/Documents/Presentations/PresentationAdultBIG.pps">Comment employer le BIG</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlBIG et son maintientag:citerahiadesgenettes.hautetfort.com,2009-08-12:23236132009-08-12T11:13:00+02:002009-08-12T11:13:00+02:00 L'emploi du BIG est intéressant. Cependant il faut savoir que dans la "vrai...
<p>L'emploi du BIG est intéressant. Cependant il faut savoir que dans la "vrai vie", sa pose est effective dans moins de 70% des cas. Il est particulièrement important de maintenir très fermement le dispositif au moment de l'impact. En effet le ressort qui propulse l'aiguille est comprimé à environ 20kg. Il existe donc un "recul" potentiellement important lors de la mise en oeuvre. Il faut donc appuyer très fortement de façon à ce que l'impact se fasse bien perpendiculairement à l'os.</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlAu sujet de la perfusion intraosseusetag:citerahiadesgenettes.hautetfort.com,2008-12-07:19355402008-12-07T15:28:00+01:002008-12-07T15:28:00+01:00 La perfusion intraosseuse est une alternative majeure à la pose de VVP. On...
<p>La perfusion intraosseuse est une alternative majeure à la pose de VVP. On distingue trois types de dispositifs qui peuvent être mis en place sur les principaux sites suivants: Tibia, sternum, tête humérale, crête iliaque, poignet. Les dispositifs manuels sont dérivés des aiguilles de ponction sternale ( trocards de mallarm, aiguile de jamashidi,..). Il existe des aiguiles spécifiquement étudiées pour l'abord vasculaire intraosseux (aiguille COOK de divers modèles, aiguilles VIDACARE EZ-IO). Très employés en pédiatrie ces aiguilles, sont plus difficiles à mettre en place chez l'adulte du moins sur le site tibial à cause de l'épaisseur de la corticale osseuse. Il faut donc privilégier les sites sternaux, iliques et huméraux pour leur pose. Les dispositifs à impact sont censés pallier cet inconvénient. Il existe deux types de dispositifs de ce genre. Le FAST de la société PYNG qui n'est utilisable qu'en sternal. Il est en dotation dans l'armée américaine. Le BIG de la société WAISMED, qui ne doit JAMAIS être utilisé en sternal. Il est en dotation dans l'armée française. Ces deux matériels nécessitent une mise en oeuvre rigoureuse. Leur efficacité est comparable, avec environ moinsde 70% de pose effective en situation réelle. <b>Le BIG nécessite d'être très fortement maintenu</b> lors de la percussion de l'aiguille. Ces aiguilles ( au moins 1 aiguille manuelle type jamshidi et un BIG) sont la base de la technique et doivent être présentes dans le sac de tout personnel santé de role 1. Enfin les dispositifs motorisés, dont il n'existe actuellement qu'un exemplaire (la perceuse EZ-IO de la société VIDACARE). Ce sont les dispositifs les plus efficaces et de loin. Ils vont être mis en place dans chaque poste de secours. Ils sont relativement volumineux et lourds pour faire partie de la composition d'un sac à dos médical standard.</p>