July 2011


Adult intraosseous access

Experiences in a remote emergency department

Volume 40, No.7, July 2011 Pages 510-511

Donald A Howarth

Difficult intravenous access can be a very stressful experience, especially in a remote emergency department. Adult intraosseous access can provide rapid access for fluids and drugs in a critically ill patient in whom intravenous access is difficult or impossible. This article presents two case reports of patients in whom rapid intraosseous access was lifesaving.

Intravenous (IV) access is a key component in the management of emergencies and significantly unwell patients. At a remote local hospital, two experienced general practice anaesthetists had difficulty securing an adequate IV site in a severely shocked obstetric patient with a major haemorrhage and disseminated intravascular coagulation. On that occasion IV access was eventually achieved using the external jugular vein with the patient in a 45 degree head down tilt. Apart from the threat to the patient’s life caused by delayed IV access, the situation was very stressful for the doctors concerned.

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