Trauma skills - IO, Decompress, pressure infusers, decompression, hemorrhage control

Question 1

IO indications

Answer 1

Cardiac arrest, difficult IV in hypovolemia, needs fluid or drugs within 5 minutes, two IV attempts or 90 seconds

Question 2

Equipment

Answer 2

Gun, needle, IV solutions tubing fluid, stopcock 60cc and 10cc syringe, gauze, extension tubing and tape

Question 3

Landmarks for proximal tibia

Answer 3

2cm below patella 2 cm medial to tibial tuberosity

Question 4

Landmarks for distial tibia

Answer 4

3cm proximal to most prominent aspect of medial malleolous. Palpate anterior and posterior borders of tibia to ensure your insertion site is on flat central aspect

Question 5

Once you’ve drilled

Answer 5

Slowly inject 10mL of NS and attempt to aspirate marrow/blood. Check for increased resistance, extravasation, bleeding, occlusion, dislodgement.
Attach infuser, labels EZ-IO wristband on pt, reasses pt

Question 6

Complications of IO

Answer 6

Extravasation, compartment syndrome, dislodgement, fracture, failure, pain, ,infection

Question 7

Contras to IO

Answer 7

Infection, fractures, prosthesis, IO within 24 hours, don’t do two IOs in same extremity, osteogenesis imperfecta, excessive tissue or unable to landmark

Question 8

Indications for decompression

Answer 8

Poor compliance, decrease/loss of consciousness, hypotension, hyper-resonance, absent breath sounds, respiratory distress, JVD, tracheal deviation

Question 9

Oxygenation for tension pneumo

Answer 9

Supplemental high flow oxygen to patient and/or ventilation support NRB/BVM

Question 10

Equipment for decompression

Answer 10

10-14G IV catheter optimum length 5cm 10mL syringe
Iodine/betadine/alcohol swabs
Tape/securing device and heimlich valve with connection tubing or other type of flutter valve

Question 11

Landmarking

Answer 11

Explain procedure to pt, landmark 2nd or 3rd intercostal space midclavicular or 4th or 5th intercostal midaxillary

Question 12

Decompression procedure

Answer 12

Swab, take cap off and attach 10mL syringe with 5mL. Stick it in then tape, avoid kinking/bending. Reassess lung sounds, attach heimlich valve. Constant monitoring

Question 13

Bleeding control procedure

Answer 13

Direct constant pressure, compress as much as possible
Maintain pressure, only move once to identify correct spot if needed
Horizontal or slightly head down positioning.
CAT
Wound packing dressing with hemostatic agent

Question 14

Bleeding control others

Answer 14

Support airway/oxygenation and ventilation

Question 15

Fluids

Answer 15

Lactated ringers increase cytokine which contributes to lactic acidosis
NS can cause hyperchloremia
Both can cause neutrophil release

Question 16

Bleeding control

Answer 16

Constant monitoring
Large bore IVs, MAP 65 or SBP 80-90
TXA infusion (hypotension tachycardia over 16) 1g in 250mL over 10mL (4 drops per second)

Question 17

Lido IO amount

Answer 17

2-4mL of 2% in adults which is 20-40mg of Lido if pt complains of pain

Question 18

IO sizse

Answer 18

15mm 3-39kg
25mm 40kg and greater
45mm for 40kg and greater with excessive tissue

Question 19

Pressure infuser

Answer 19

300mmHg will get 150mL/minute through an IO

Question 20

More on pressure infuser

Answer 20

Adjusts volume of air as needed to maintain flow

Monitors IV site for patency

Question 21

First six deadly dozen

TCFOAM

Answer 21

Tension pneumo
Cardiac tamponade 
Flail chest
Open pneumo
Airway obstruction 
Massive hemo

Question 22

Deadly dozen second six

DAMPTB

Answer 22

Diaphragmatic tear
Aortic rupture 
Myocardial contusion
Pulmonary contusion
Tracheal/bronchial tree injury 
Blast injuries