Accident & Emergency OSCE
Pediatric Resuscitation
Answer
a) Intraosseous cannula
b) Temporary measure for rapid vascular access in critically ill or injured pediatric patient (3-4 hours only)
c) Contraindication
i. Absolute contraindication
- fracture of the tibia or long bones which are potential site for IO insertion
ii. Relative contraindication
- cellulutis overlying the insertion site
- Inferior vena cava injury
- Previous attempt on the same leg bone
- Osteogenis imperfecta
- Osteopetrosis
- children ages more than 6 years
d) where to insert the instrument
i. preferably tibia bone (2-3 cm inferior to proximal tibia tuberosity and 2-3 cm medial to it with needle being advanced inferiorly)
ii. Distal femur (anterior midline, above the external epicondyles, 1-3 cm above the femoral plateau)
iii. Anterior superior iliac spine
iv. Sternum
v. Ulnar bone
e) Complication
i. Extravasation of fluid
ii. Compartment syndrome
iii. Necrosis of the muscle due to extravasation of hypertonic or caustic medications like sodium bicarbonate, dopamine, or calcium chloride
iv. Infection and osteomyelitis
v. local hematoma, pain, growth plate injuries and fat microemboli