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[PMID]:28562239
[Au] Autor:Whitney R; Langhan M
[Ad] Endereço:Clinical Fellow, Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
[Ti] Título:Vascular Access in Pediatric Patients in the Emergency Department: Types of Access, Indications, and Complications.
[So] Source:Pediatr Emerg Med Pract;14(6):1-20, 2017 Jun.
[Is] ISSN:1549-9650
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Vascular access is a potentially life-saving procedure that is a mainstay of emergency medicine practice. There are a number of challenges associated with obtaining and maintaining vascular access, and the choice of the route of access and equipment used will depend on patient- and provider-specific factors. In this issue, the indications and complications of peripheral intravenous access, intraosseous access, and central venous access are reviewed. Timely and effective assessment and management of difficult-access patients, pain control techniques that can assist vascular access, and contraindications to each type of vascular access are also discussed.
[Mh] Termos MeSH primário: Cateterismo Venoso Central/métodos
Cateterismo Periférico/métodos
Infusões Intraósseas/métodos
Medicina de Emergência Pediátrica
Dispositivos de Acesso Vascular
Venostomia/métodos
[Mh] Termos MeSH secundário: Anestésicos Locais/uso terapêutico
Derivação Arteriovenosa Cirúrgica
Cateterismo Venoso Central/instrumentação
Cateterismo Periférico/instrumentação
Cateteres Venosos Centrais
Criança
Pré-Escolar
Serviço Hospitalar de Emergência
Seres Humanos
Lactente
Recém-Nascido
Infusões Intraósseas/instrumentação
Infusões Intravenosas/instrumentação
Infusões Intravenosas/métodos
Manejo da Dor
Cirurgia Assistida por Computador
Ultrassonografia
Venostomia/instrumentação
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anesthetics, Local)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170721
[Lr] Data última revisão:
170721
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170601
[St] Status:MEDLINE


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[PMID]:28288774
[Au] Autor:Clemency B; Tanaka K; May P; Innes J; Zagroba S; Blaszak J; Hostler D; Cooney D; McGee K; Lindstrom H
[Ad] Endereço:Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA; American Medical Response (AMR), 481 William L. Gaiter Pkwy, Buffalo, NY 14215, USA. Electronic address: bc34@buffalo.edu.
[Ti] Título:Intravenous vs. intraosseous access and return of spontaneous circulation during out of hospital cardiac arrest.
[So] Source:Am J Emerg Med;35(2):222-226, 2017 Feb.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Guidelines endorse intravenous (IV) and intraosseous (IO) medication administration for cardiac arrest treatment. Limited clinical evidence supports this recommendation. A multiagency, retrospective study was performed to determine the association between parenteral access type and return of spontaneous circulation (ROSC) in out of hospital cardiac arrest. METHODS: This was a structured, retrospective chart review of emergency medical services (EMS) records from three agencies. Data was analyzed from adults who suffered OHCA and received epinephrine through EMS established IV or IO access during the 18-month study period. Per regional EMS protocols, choice of parenteral access type was at the provider's discretion. Non-inferiority analysis was performed comparing the association between first access type attempted and ROSC at time of emergency department arrival. RESULTS: 1310 subjects met inclusion criteria and were included in the analysis. Providers first attempted parenteral access via IV route in 788 (60.15%) subjects. Providers first attempted parenteral access via IO route in 552 (39.85%) subjects. Rates of ROSC at time of ED arrival were 19.67% when IV access was attempted first and 19.92% when IO access was attempted first. An IO first approach was non-inferior to an IV first approach based on the primary end point ROSC at time of emergency department arrival (p=0.01). CONCLUSION: An IO first approach was non-inferior to an IV first approach based on the end point ROSC at time of emergency department arrival.
[Mh] Termos MeSH primário: Epinefrina/administração & dosagem
Infusões Intraósseas
Infusões Intravenosas
Parada Cardíaca Extra-Hospitalar/tratamento farmacológico
Vasoconstritores/administração & dosagem
[Mh] Termos MeSH secundário: Protocolos Clínicos
Seres Humanos
Parada Cardíaca Extra-Hospitalar/mortalidade
Estudos Retrospectivos
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Vasoconstrictor Agents); YKH834O4BH (Epinephrine)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170414
[Lr] Data última revisão:
170414
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170315
[St] Status:MEDLINE


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[PMID]:28253870
[Au] Autor:Afzali M; Kvisselgaard AD; Lyngeraa TS; Viggers S
[Ad] Endereço:Department of Anaesthesiology, University Hospital of Copenhagen, Herlev, Denmark. monika.afzali@regionh.dk.
[Ti] Título:Intraosseous access can be taught to medical students using the four-step approach.
[So] Source:BMC Med Educ;17(1):50, 2017 Mar 02.
[Is] ISSN:1472-6920
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The intraosseous (IO) access is an alternative route for vascular access when peripheral intravascular catheterization cannot be obtained. In Denmark the IO access is reported as infrequently trained and used. The aim of this pilot study was to investigate if medical students can obtain competencies in IO access when taught by a modified Walker and Peyton's four-step approach. METHODS: Nineteen students attended a human cadaver course in emergency procedures. A lecture was followed by a workshop. Fifteen students were presented with a case where IO access was indicated and their performance was evaluated by an objective structured clinical examination (OSCE) and rated using a weighted checklist. To evaluate the validity of the checklist, three raters rated performance and Cohen's kappa was performed to assess inter-rater reliability (IRR). To examine the strength of the overall IRR, Randolph's free-marginal multi rater kappa was used. RESULTS: A maximum score of 15 points was obtained by nine (60%) of the participants and two participants (13%) scored 13 points with all three raters. Only one participant failed more than one item on the checklist. The expert rater rated lower with a mean score of 14.2 versus the non-expert raters with mean 14.6 and 14.3. The overall IRR calculated with Randolph's free-marginal multi rater kappa was 0.71. CONCLUSION: The essentials of the IO access procedure can be taught to medical students using a modified version of the Walker and Peyton's four-step approach and the checklist used was found reliable.
[Mh] Termos MeSH primário: Competência Clínica/normas
Medicina de Emergência/educação
Medicina de Emergência/métodos
Infusões Intraósseas/métodos
Estudantes de Medicina
[Mh] Termos MeSH secundário: Cadáver
Lista de Checagem/normas
Dinamarca
Seres Humanos
Projetos Piloto
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170330
[Lr] Data última revisão:
170330
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170304
[St] Status:MEDLINE
[do] DOI:10.1186/s12909-017-0882-7


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[PMID]:28249956
[Au] Autor:Hodgetts JM; Johnston A; Kendrew J
[Ad] Endereço:Department of Trauma and Orthopaedics, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, UK.
[Ti] Título:Long-term follow-up of two patients with retained intraosseous sternal needles.
[So] Source:J R Army Med Corps;163(3):221-222, 2017 Jun.
[Is] ISSN:0035-8665
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Sternal intraosseous devices are widely used in both civilian and military trauma when vascular access is difficult to establish. We discuss a rare complication of intraosseous needle insertion in two patients where the needle tip remained in the sternum after the device had been removed. Neither patient had evidence of any complication of the retained intraosseous needle tip after >6 years of follow-up.
[Mh] Termos MeSH primário: Corpos Estranhos/diagnóstico por imagem
Infusões Intraósseas/instrumentação
Agulhas
Esterno/diagnóstico por imagem
Lesões Relacionadas à Guerra/terapia
[Mh] Termos MeSH secundário: Serviços Médicos de Emergência
Seguimentos
Corpos Estranhos/etiologia
Seres Humanos
Infusões Intraósseas/efeitos adversos
Masculino
Militares
Radiografia Torácica
Ressuscitação
Tomografia Computadorizada por Raios X
Reino Unido
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170829
[Lr] Data última revisão:
170829
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170303
[St] Status:MEDLINE
[do] DOI:10.1136/jramc-2016-000699


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[PMID]:28233040
[Au] Autor:Jansen G; Leimkühler K; Mertzlufft F
[Ad] Endereço:Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus, Bielefeld, Deutschland. jansen-ge@khdf.de.
[Ti] Título:[Intramedullary placement of intraosseous cannulas inserted in the preclinical treatment of polytrauma patients : A retrospective, computed tomography-assisted evaluation].
[Ti] Título:Intramedulläre Lage von präklinisch angelegten intraossären Zugängen bei polytraumatisierten Patienten : Retrospektive, computertomographisch gestützte Evaluation..
[So] Source:Anaesthesist;66(3):168-176, 2017 Mar.
[Is] ISSN:1432-055X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:BACKGROUND: Use of intraosseous access to the vascular system is rare in the pre-hospital setting (<1%). However, as patients for which the use of an intraosseous device is indicated are usually in a critical condition, awareness of possible application errors is vital. A survey was performed to evaluate intramedullary needle placement by means of computed axial tomography. METHODS: In the period of 01/01/2011 to 31/12/2015 all multislice-CT trauma scans performed in a trauma center were monitored for intraosseous devices in situ. The placement site, type of intraosseous device and needle deployed, thickness of bone and soft tissues, site for optimum needle placement, and both deviation from gold standard placement and visible complications were also recorded. RESULTS: In 11 out of 982 patients with suspected polytrauma that were studied during the observation period, 13 intraosseous cannulas were found (1.12%). In all cases, the EZ-IO® (Teleflex, P.O. Box 12600, Research Triangle Park, NC 27709, USA) intraosseous vascular access system was used. All applications were placed correctly in the medullary cavity, but none concurred with the current guidelines: The site of the puncture deviated laterally in seven cases, medially in two cases, cranially in four cases, and caudally in two cases. The most common error in all 13 cases was overshooting during needle introduction. CONCLUSION: Even though clinical criteria may suggest correct placement of an intraosseous device, the results of this survey provide evidence that deviations in positioning are common. Placement of the needle too deep can cause complications within the soft tissues or potentially impede intraosseous infusion.
[Mh] Termos MeSH primário: Cateterismo/métodos
Infusões Intraósseas/métodos
Traumatismo Múltiplo/diagnóstico por imagem
Traumatismo Múltiplo/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Osso e Ossos/diagnóstico por imagem
Serviços Médicos de Emergência
Feminino
Seres Humanos
Infusões Intraósseas/efeitos adversos
Masculino
Erros Médicos
Meia-Idade
Agulhas
Estudos Retrospectivos
Tomografia Computadorizada por Raios X
Centros de Traumatologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170916
[Lr] Data última revisão:
170916
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170225
[St] Status:MEDLINE
[do] DOI:10.1007/s00101-016-0257-1


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[PMID]:28076874
[Au] Autor:Yamamoto T; Schindler E
[Ti] Título:Notfälle im Rettungsdienst und in der Klinik: Gefäßzugänge bei Kindern..
[So] Source:Anasthesiol Intensivmed Notfallmed Schmerzther;52(1):55-64, 2017 Jan.
[Is] ISSN:1439-1074
[Cp] País de publicação:Germany
[La] Idioma:ger
[Mh] Termos MeSH primário: Cateterismo Periférico/instrumentação
Cateterismo Periférico/métodos
Serviços Médicos de Emergência/métodos
Infusões Intraósseas/métodos
Ressuscitação/métodos
Dispositivos de Acesso Vascular
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Desenho de Equipamento
Feminino
Seres Humanos
Lactente
Recém-Nascido
Infusões Intraósseas/instrumentação
Masculino
Ressuscitação/instrumentação
Ultrassonografia de Intervenção/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170126
[Lr] Data última revisão:
170126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170112
[St] Status:MEDLINE
[do] DOI:10.1055/s-0042-104853


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[PMID]:28045841
[Au] Autor:Helleman K; Kirpalani A; Lim R
[Ad] Endereço:From the Departments of Paediatrics and Medicine, Schulich School of Medicine at Western University, Children's Hospital at London Health Sciences Centre, London, Ontario, Canada.
[Ti] Título:A Novel Method of Intraosseous Infusion of Adenosine for the Treatment of Supraventricular Tachycardia in an Infant.
[So] Source:Pediatr Emerg Care;33(1):47-48, 2017 Jan.
[Is] ISSN:1535-1815
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Supraventricular tachycardia is a common arrhythmia faced by emergency physicians in the pediatric population. In most cases, antecubital intravenous access can be established, and adenosine can be administered in a rapid and timely fashion. The role and administration of intraosseous adenosine are poorly established. We describe a case where the administration of adenosine was successful via a mixed method administration.
[Mh] Termos MeSH primário: Adenosina/administração & dosagem
Antiarrítmicos/administração & dosagem
Taquicardia Supraventricular/tratamento farmacológico
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Eletrocardiografia
Seres Humanos
Recém-Nascido
Infusões Intraósseas
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Arrhythmia Agents); K72T3FS567 (Adenosine)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170424
[Lr] Data última revisão:
170424
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170104
[St] Status:MEDLINE
[do] DOI:10.1097/PEC.0000000000000966


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[PMID]:27998615
[Au] Autor:Tallman CI; Darracq M; Young M
[Ad] Endereço:Emergency Medicine, UCSF Fresno, United States. Electronic address: civestallman@fresno.ucsf.edu.
[Ti] Título:Analysis of intraosseous blood samples using an EPOC point of care analyzer during resuscitation.
[So] Source:Am J Emerg Med;35(3):499-501, 2017 Mar.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In the early phases of resuscitation in a critically ill patient, especially those in cardiac arrest, intravenous (IV) access can be difficult to obtain. Intraosseous (IO) access is often used in these critical situations to allow medication administration. When no IV access is available, it is difficult to obtain blood for point of care analysis, yet this information can be crucial in directing the resuscitation. We hypothesized that IO samples may be used with a point of care device to obtain useful information when seconds really do matter. METHODS: Patients presenting to the emergency department requiring resuscitation and IO placement were prospectively enrolled in a convenience sample. 17 patients were enrolled. IO and IV samples obtained within five minutes of one another were analyzed using separate EPOC® point of care analyzers. Analytes were compared using Bland Altman Plots and intraclass correlation coefficients. RESULTS: In this analysis of convenience sampled critically ill patients, the EPOC® point of care analyzer provided results from IO samples. IO and IV samples were most comparable for pH, bicarbonate, sodium and base excess, and potentially for lactic acid; single outliers for bicarbonate, sodium and base excess were observed. Intraclass correlation coefficients were excellent for sodium and reasonable for pH, pO2, bicarbonate, and glucose. Correlations for other variables measured by the EPOC® analyzer were not as robust. CONCLUSION: IO samples can be used with a bedside point of care analyzer to rapidly obtain certain laboratory information during resuscitations when IV access is difficult.
[Mh] Termos MeSH primário: Análise Química do Sangue/métodos
Osso e Ossos/química
Parada Cardíaca/sangue
Parada Cardíaca/terapia
Infusões Intraósseas/métodos
Sistemas Automatizados de Assistência Junto ao Leito
Ressuscitação/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Análise Química do Sangue/instrumentação
Criança
Serviço Hospitalar de Emergência
Feminino
Seres Humanos
Infusões Intraósseas/instrumentação
Masculino
Meia-Idade
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170503
[Lr] Data última revisão:
170503
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161222
[St] Status:MEDLINE


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[PMID]:27906869
[Au] Autor:Gazmuri RJ; Whitehouse K; Whittinghill K; Baetiong A; Shah K; Radhakrishnan J
[Ad] Endereço:From the Resuscitation Institute at Rosalind Franklin University of Medicine and Science (R.J.G., K. Whitehouse, K.S., K. Whittinghill, A.B., J.R.), Chicago, Illinois; and the Division of Critical Care Medicine (R.J.G.), Captain James A. Lovell Federal Health Care Center, Chicago, Illinois.
[Ti] Título:Early and sustained vasopressin infusion augments the hemodynamic efficacy of restrictive fluid resuscitation and improves survival in a liver laceration model of hemorrhagic shock.
[So] Source:J Trauma Acute Care Surg;82(2):317-327, 2017 Feb.
[Is] ISSN:2163-0763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Current management of hemorrhagic shock favors restrictive fluid resuscitation before control of the bleeding source. We investigated the additional effects of early and sustained vasopressin infusion in a swine model of hemorrhagic shock produced by liver laceration. METHODS: Forty male domestic pigs (32-40 kg) had a liver laceration inflicted with an X-shaped blade clamp, 32 received a second laceration at minute 7.5, and 24 received two additional lacerations at minute 15. Using a two-by-two factorial design, animals were randomized 1:1 to receive vasopressin infusion (0.04 U/kg per minute) or vehicle intraosseously from minute 7 until minute 240 and 1:1 to receive isotonic sodium chloride solution (12 mL/kg) intravenously at minute 30 or no fluids. RESULTS: Kaplan-Meier curves showed greater survival after vasopressin with isotonic sodium chloride solution (8/10) compared to vasopressin without isotonic sodium chloride solution (4/10), vehicle with isotonic sodium chloride solution (3/10), or vehicle without isotonic sodium chloride solution (3/10), but the differences were not statistically significant (p = 0.095 by log-rank test). However, logistic regression showed vasopressin to elicit a statistically significant benefit on survival (p = 0.042). Vasopressin augmented mean aortic pressure between 10 and 20 mm Hg without intensifying the rate of bleeding from liver laceration, which was virtually identical to that of vehicle-treated animals (33.9 ± 5.1 and 33.8 ± 4.8 mL/kg). Vasopressin increased systemic vascular resistance and reduced transcapillary fluid extravasation, augmenting the volume of isotonic sodium chloride solution retained (6.5 ± 2.7 vs 2.4 ± 2.0 mL/kg by minute 60). The cardiac output and blood flow to the myocardium, liver, spleen, kidney, small bowel, and skeletal muscle at minute 120 and minute 180 were comparable or higher in the vasopressin group. CONCLUSIONS: Early and sustained vasopressin infusion provided critical hemodynamic stability during hemorrhagic shock induced by liver laceration and increased the hemodynamic efficacy of restrictive fluid resuscitation without intensifying bleeding or compromising organ blood flow resulting in improved 240-minute survival.
[Mh] Termos MeSH primário: Hidratação/métodos
Hemodinâmica/efeitos dos fármacos
Fígado/lesões
Ressuscitação/métodos
Choque Hemorrágico/tratamento farmacológico
Vasopressinas/farmacologia
[Mh] Termos MeSH secundário: Animais
Débito Cardíaco
Infusões Intraósseas
Lacerações
Masculino
Distribuição Aleatória
Cloreto de Sódio/farmacologia
Suínos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
11000-17-2 (Vasopressins); 451W47IQ8X (Sodium Chloride)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161202
[St] Status:MEDLINE
[do] DOI:10.1097/TA.0000000000001318


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[PMID]:27870553
[Au] Autor:Shina A; Baruch EN; Shlaifer A; Shovali A; Levi M; Yosefy O; Segal D; Bader T; Shavit I; Yitzhak A
[Ti] Título:Comparison of Two Intraosseous Devices: The NIO Versus the EZ-IO by Novice Users-A Randomized Cross Over Trial.
[So] Source:Prehosp Emerg Care;21(3):315-321, 2017 May-Jun.
[Is] ISSN:1545-0066
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: During resuscitation in the field, intraosseous (IO) access may be achieved using a variety of available devices, often attempted by inexperienced users. AIM: We sought to examine the success rate and ease-of-use ratings of an IO device, the NIO® (New Intraosseous Persys Medical, Houston, TX, USA) in comparison to the Arrow® EZ-IO® (Teleflex Medical Research Triangle Park, NC, USA) by novice users. METHODS: We performed a randomized crossover trial. The study model was a porcine hind leg which was cut distally in order to expose the marrow. The Study population was composed of pre-graduate medical students without prior experience in IO use, all designated future field physicians. The students underwent instruction and practiced the use of both devices. After practice completion, each student attempted a single IO insertion with both devices sequentially in randomized fashion. Success was defined as a flow of fluid through the bone marrow after a single IO attempt. Investigators which determined the success rate were blinded to the used device. RESULTS: 50 users (33 males, 17 females) participated in the trial, mean age of 21.7 years (±1). NIO users were successful in 92% (46/50) attempts while EZ-IO user success rate was 88% (44/50). NIO success rates were comparable to those of EZ-IO (p = NS). Results were similar when examining only the initial device used. Median score of ease of use was 4 (5 point Likert scale) in both devices (p = NS). 54% (27/50) of the participants preferred using the EZ-IO over the NIO (p = NS). CONCLUSION: Novice users were equally successful in establishing IO access with the NIO® in comparison to the EZ-IO® in a porcine model.
[Mh] Termos MeSH primário: Hidratação/instrumentação
Infusões Intraósseas/instrumentação
[Mh] Termos MeSH secundário: Animais
Estudos Cross-Over
Serviços Médicos de Emergência
Feminino
Membro Posterior
Seres Humanos
Masculino
Ressuscitação/educação
Ressuscitação/métodos
Método Simples-Cego
Suínos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170628
[Lr] Data última revisão:
170628
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161122
[St] Status:MEDLINE
[do] DOI:10.1080/10903127.2016.1247201



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BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde