A child in a motor vehicle accident with prolonged extraction is confused, crying, agitated, and hypotensive. Multiple attempts at placing an intravenous line are unsuccessful. A nurse asks you if you can place an internal jugular central line. The child needs fluid resuscitation, antibiotics for open fractures, and analgesia.
Challenge: What's the most appropriate intervention here?
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I put together these medical challenges. The cases are hypothetical and do not necessarily represent actual or typical presentations of medical diseases. Disclaimer is at the bottom of this page.
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2 comments:
So this is a PHTLS question ! Hypotensive patients can be difficult to treat with IV lines as the preload and venous pressure can be very low. Therefore it is recommended, especially in children, not to try more than 3 times or 90 seconds for the IV placement. The next step should be to take the intraosseus drill and place a line through the tibia (usually). It has been recommended. To flush the IO line with diluted Lidocain to prevent the pain from volume therapy. IO is very safe and does not need teaching to use, drill until the corticalis in pearced and place the line. It is very unlikely to fail.
yes! great explanation of the IO - it's definitely come into favor since the time I started medical training.
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Access I
Intraosseous cannulation is most appropriate here. IO access can be obtained quickly and easily and is appropriate in emergent or urgent situations where reliable venous access cannot be achieved quickly or by other means despite multiple attempts. Fluids, drugs, and blood can all be administered through an IO.
Source: UpToDate.
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