External jugular

emschick1985

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How many would rather IO someone or would you rather hit the jugular? I prefer external juge and feel as if the IO isn't as good for med administration. Any take on this?
 

NomadicMedic

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In cases where I need fast access and an IV isn't immediately screaming, "stick me", I always drill an IO.

Why do you "feel" an EJ is superior to an IO? Any evidence you'd care to share?
 
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emschick1985

emschick1985

Medic
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M
In cases where I need fast access and an IV isn't immediately screaming, "stick me", I always drill an IO.

Why do you "feel" an EJ is superior to an IO? Any evidence you'd care to share?

Most I've seen done in the leg, which is farther from the heart, and going thru the bone it just seems like it'd be a slower route... I have seen a video on contrast dye being flushed thru a humeral IO and it got to the heart very rapidly!! I don't have a scientific evidence to back up my theory, just seems like and external jugular would infuse more rapidly. Anyone else have any input??
 

chaz90

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Like you said, medication and fluid administration through tibial IO placement has been proven to be rapid and effective. With low complication rates, ease of access, and rapid placement, who wouldn't like using EZ-IO?

I'm with DEmedic. Critical patients who don't have immediately obvious veins conducive to IV placement are getting an IO. I have nothing against EJ placement in many patients, but they have a higher complication rate and can interfere with someone working on the airway as well.
 

TransportJockey

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I have set the record for most EZ-IOs used in a given month at two different services... what does that say about how I feel about them? Lol
 

Burritomedic1127

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Pressure bags help with tibia IOs and the rapid flush following placement (or lidocaine if conscious). Humeral IOs can something run better than peripheral IVs. Got to echo everyone else, IOs are fast, relatively easy, and don't impede simultaneous airway management.
 

Handsome Robb

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The problem with lidocaine for conscious IOs is you have to give it slowly then let it sit for a while for it to be effective otherwise it doesn't do a whole lot.
 

Burritomedic1127

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The problem with lidocaine for conscious IOs is you have to give it slowly then let it sit for a while for it to be effective otherwise it doesn't do a whole lot.

Agree 100%. The key is the SLOW administration over 2 mins. Which isn't too long unless your patient needs an intervention immediately, but if that's the case they're prob closer to the unconscious side anyways. EZIO recently doubled the recommended lidocaine does to 40mg
 

NomadicMedic

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If I can wait a few minutes for lidocaine to sit there, I can spend a few more minutes looking for a good vein.

But status seizure, unstable tachycardia, cardiac arrest, RSI… I go right to the IO after a cursory look for a suitable vein.
 

NomadicMedic

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Fair enough. I've stuck a dialysis patient in the neck. She yelled at me and said, "just stick the shunt". Uhhh, No. It's less damaging to get a 16 gauge in your neck.
 
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emschick1985

emschick1985

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Most I've seen done in the leg, which is farther from the heart, and going thru the bone it just seems like it'd be a slower route... I have seen a video on IO being flushed thru a humeral IO and it got to the heart very rapidly!! I don't have a scientific evidence to back up my theory, just seems like and external jugular would infuse more rapidly. Anyone else have any input??[/QUOTE
Like you said, medication and fluid administration through tibial IO placement has been proven to be rapid and effective. With low complication rates, ease of access, and rapid placement, who wouldn't like using EZ-IO?

I'm with DEmedic. Critical patients who don't have immediately obvious veins conducive to IV placement are getting an IO. I have nothing against EJ placement in many patients, but they have a higher complication rate and can interfere with someone working on the airway as well.
If I can wait a few minutes for lidocaine to sit there, I can spend a few more minutes looking for a good vein.

But status seizure, unstable tachycardia, cardiac arrest, RSI… I go right to the IO after a cursory look for a suitable vein.

I wish we had RSI capabilities at my service
 

STXmedic

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I've started two EJs recently, both on hypotensive GI bleeds. They were both alert and we don't have the ability to use lidocaine for the IO- that, and the EJs were easily visible on both patients. I can't remember the last time I started an EJ before that, though. If the EJs of those two weren't so blatantly visible, I'd have no problem with an IO. From what I've been told, the humeral IOs aren't nearly as painful as the tibial IOs. Medication administration isn't really a consideration, though. CaCl is the only med I'd prefer an IV for, but in a cardiac arrest where it's a bolus anyway, I'm fine with an IO.
 

EMTinNEPA

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At least for a cardiac arrest in the field, always EJ. You can kneel at the head, turn it to the side, stick the EJ, straighten the head out, place your advanced airway, and voila, everything ALS is from the neck up. No worrying about compressors on either side getting caught up in your tubing and pulling your line.
 

johnrsemt

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I used to do EJ's quite often (before the IO drill); 2 weeks ago I was comtemplating an EZ IO on a concious pt who is paralyzed. Like he said, he wasn't going to ffeel anything
 

NomadicMedic

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At least for a cardiac arrest in the field, always EJ. You can kneel at the head, turn it to the side, stick the EJ, straighten the head out, place your advanced airway, and voila, everything ALS is from the neck up. No worrying about compressors on either side getting caught up in your tubing and pulling your line.

I may have to go back to the Code EJ, since I'll be the only medic on codes at my new job. At the old place, we (almost) always had two medics on a code, so one would manage the airway and pause the LUCAS when asked, the other would drill an IO, push meds and run the show.
 

Burritomedic1127

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At least for a cardiac arrest in the field, always EJ. You can kneel at the head, turn it to the side, stick the EJ, straighten the head out, place your advanced airway, and voila, everything ALS is from the neck up. No worrying about compressors on either side getting caught up in your tubing and pulling your line.

There's always a humeral IO then a tube from there person at the head during the code. Then whoever can do compressions and putting the monitor on etc. Pretty simple and fast
 

DesertMedic66

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This is one of the things that makes having 2 medics on scene wonderful. The patient can get intubated/King at the same time as an IV/IO.
 

Ensihoitaja

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I generally prefer to have an EJ. We don't have lidocaine for IOs, so it's really difficulty to administer meds in someone not completely unconscious. It also seems like it takes a LOT of pressure to infuse meds through the IO.
 

Summit

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Humeral Head!

In my experience, urgent need for IV access doesn't seem to occur in concious patients who are a state where the becomes their chief complaint.
 
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