Muhamad Na'im B Ab Razak (jacknaim) is a fresh graduate Muslim Doctor from Universiti Sains Malaysia and waiting for the enrollment into the housemanship program. Ambitious in pursuing master program in emergency and traumatology medicine and loves to spent his free time joining humanitarian missions, writing and speaks as an amateur public speaker in motivation and comparative religion. [HOME]

Osce A&E Pediatric instrument


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