495:
hypodermic, butterfly, spinal, trephine, sternal, and standard bone marrow needles are used." Needles that have a short shaft are preferred and safe. For infants up to 6 to 8 months old, 18-gauge needles are used and for children more than 8 months old, 15- or 16- gauge needles are used. A study by
Glaeser et al., concluded that individuals who received IO vs. peripheral and central intravenous access were able to obtain much faster and more successful IO access. Another study, by Fiorito et al., observed the safety of IO use during the transportation of critically ill pediatric individuals. Based on the results, they concluded that the use of IO was safe, based on 78% successful placement of the IO needle and complications that occurred in only 12% of the cases.
361:
training in the methods of intraosseous marrow access for infusion. Extravasation can lead to the more serious complication of compartment syndrome. The risk of developing compartment syndrome can be reduced by medical personnel checking the infusion site regularly for any signs of swelling. Swelling could indicate misplacement of the catheter. Avoiding puncturing the same bone in 48 hours can also lessen the risk of developing this complication. The risk of osteomyelitis, while very low ( <1%), can be further lessened by using sterile, hygienic practices and modern devices to make the puncture. Damage to the epiphyseal plate can be avoided by training medical personnel about proper landmarks to be used for determining puncture sites.
2471:
491:, are difficult to use or cannot be used. When individuals are severely ill and need "rapid, efficient, and safe delivery of drugs", IO is used. When inserting the intraosseous needle into a conscious individual, this can be very painful. For children, anesthesia is not recommended before this procedure for non-emergency situations. Instead, distracting and holding the child is preferred. Intraosseous infusion is used in instances such as, "immediate indication/life-threatening emergency, cardiac/respiratory arrest, acute shock, hypothermia, obesity, edema, thermal injury, etc."
152:
deaths via hemorrhagic shock. While popular in the field during WWII, the use of IO was not seen as a standard for emergencies until the 1980s, and only so for children. With the rise of technology allowing the ease of technique of IO, and a lower risk of complications like bloodstream infections than when using peripheral access, the alternative of IO access has increased throughout the years for adults, as well. IO is now recommended in
Advanced Cardiac and Pediatric Advanced Life Support treatment protocols, in cases where access via IV cannot be established on time.
461:
2105:
261:
2578:
370:
1967:
40:
2818:
2099:
1979:
2640:
382:
2344:
265:
263:
268:
267:
262:
269:
266:
252:
An IO infusion can be used on adult or pediatric populations when traditional methods of vascular access are difficult or otherwise cause unwanted delayed management of the administration of medications. The IO site can be used for 24 hours and should be removed as soon as intravenous access has been
319:
can be administered IO during a cardiac arrest when IV access is unavailable. High flow rates are attainable with an IO infusion, up to 125 milliliters per minute. This high rate of flow is achieved using a pressure bag to administer the infusion directly into the bone. Large volume IO infusions are
282:
and into the soft marrow interior, which allows immediate access to the vascular system. The IO needle is positioned at a 90-degree angle to the injection site, and is advanced through manual traction, impact driven force, or power driven. Each IO device has different designated insertion locations.
179:
In addition to the emergency clinical scenario that can call for an IO route to be used, IO access is only indicated when access to peripheral veins is either not possible or delayed. When IV access is either not possible or delayed, other indications for utilizing the IO route include administering
151:
and others then continued to advocate, research, and make advances on behalf of the IO administration. Once Papper showed that the bone marrow space could be used with comparable success to administer IV fluids and drugs, intraosseous infusion was popularized during World War II to prevent soldiers'
377:
Intraosseous devices allow quick and safe access to the vascular system for fluid and drug administration. After proper education and training, medical professionals can obtain vascular access via the IO route of administration by using one of the multiple devices that have been approved by the FDA
184:
if needed for radiology scans and drawing blood for laboratory testing and analysis. Situations that can result in decreased or delayed access to peripheral veins, and thus necessitate the use of an IO route to infuse medications and fluids include circumstances such as burns, fluid accumulation
360:
Many of these potential complications can be prevented with simple measures like using good technique and keeping the period of IO infusion short by switching to IV as soon as it becomes feasible. Bone fracture complications can be decreased by using modern techniques and requiring more regular
134:
et al. saw that bone, specifically the sternum, could also be used as a route of administration for emergency purposes. To continue the expansion of knowledge regarding IO administration, a successful blood transfusion took place in 1940 using the sternum, and afterward, in 1941, Tocantins and
494:
For children, the preferred sites of IO are the distal tibia, proximal tibia, and distal femur. The distal end of the tibia is the preferred site because it is easy to access and the most reliable. Depending on the procedure, a variety of needles are used for IO. For example, "standard steel
401:, consisting of a reusable, battery-powered driver and disposable, hollow IO needle. A trigger allows for the IO needle to enter the bone marrow space at a preset length without any pressure being applied. In the United States, the FDA has approved the use of the EZ-IO device in the proximal
270:
176:. IO access can provide the quickest way to rapidly infuse needed medications and fluids in an emergency situation. In people who experience critical trauma and who do not have adequate blood pressure, the IO route doubles the success rate of the peripheral IV route.
328:
Like any medical procedure, intraosseous infusion has some potential complications. In a review by Tyler et al., an analysis across the included studies found the overall complication rate associated with IO infusions to be less than 1% (0.9%).
116:
is not available or not feasible. Intraosseous infusions allow for the administered medications and fluids to go directly into the vascular system. The IO route of fluid and medication administration is an alternative to the preferred
431:
to aid in the insertion of the needle. Dense adult bone limits its use, but manual devices are commonly used in children because of their safety profile and ease of use, once training has taken place. The three most widely used are:
498:
Similarly to adults, contraindications for IO infusion use in pediatrics include bone diseases such as osteogenesis imperfecta and osteopetrosis, and fractures. Others include cellulitis, burns, and infections at the access site.
307:
drugs, except as a last resort when IV or IO access cannot be gained. ET absorption of medications is poor, and optimal ET drug dosings are unknown. IO administration is becoming more common in civilian and military pre-hospital
295:, proximal tibia, distal tibia and the sternum (manubrium). Although intravascular access is still the preferred method for medication delivery in the prehospital area, IO access for adults has become more common. As of 2010, the
417:
The First Access for Shock and Trauma (FAST 1) spring-loaded device is designed for use in the sternum of an adult. The FAST 1 device consists of multiple needles in a probe that penetrates the manubrium once manual pressure is
121:
route when the latter cannot be established promptly in emergent situations. Intraosseous infusions are used when people have compromised intravenous access and need immediate delivery of life-saving fluids and medications.
264:
421:
The Bone
Injection Gun (BIG) device is a small, plastic, disposable, spring-loaded device that has a trigger that shoots the IO needle into the IO insertion site, which is more than likely in the proximal
480:
concluded that the intraosseous (IO) route is the preferred method versus intramuscular (IM) and comparable to intravenous (IV) administration in delivering pediatric anaesthetic drugs.
2016:
2862:
447:
Each device is capable of achieving rapid vascular access, despite the mechanism of action, with insertion times comparable to the IV administration route.
2009:
833:"Recommendations for the Use of Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Health Care Settings: A Consensus Paper"
139:
in rabbits. Because of
Tocantins and O'Neill's success in their experiments with rabbits, human clinical trials were established using mainly the
2088:
2002:
1803:
1807:
427:
Manual / Hand
Powered: Hollow steel manually inserted needles have been around since the inception of IO administration, and use a removable
1823:
1567:
1929:
1818:
832:
1795:
1813:
1357:
Moore GP, Pace SA, Busby W (1989). "Comparison of intraosseous, intramuscular, and intravenous administration of succinylcholine".
1833:
1843:
1683:
2971:
1838:
1655:
160:
Intraosseous access is indicated in emergency situations, such as when a person experiences some type of major trauma like
320:
known to be painful. 1% lidocaine is used to ease the pain associated with large volume IO infusions in conscious people.
2373:
1923:
1853:
1828:
315:
Intraosseous access has roughly the same absorption rate as IV access, and allows for fluid resuscitation. For example,
287:
as this site lies just under the skin and is easily located. Other insertion sites include the anterior aspect of the
2961:
1678:
1620:
1560:
826:
824:
822:
820:
818:
1917:
1857:
1630:
2454:
1905:
1899:
815:
2551:
2394:
1982:
1887:
1870:
483:
Intraosseous infusion (IO) is used in pediatric populations during anesthesia when other intravenous access,
304:
2925:
2887:
2230:
2046:
1911:
1893:
1876:
1625:
17:
2956:
2839:
1970:
1553:
2867:
2436:
1595:
309:
296:
198:
Having adequate and timely peripheral venous access is a major contraindication to obtaining IO access.
2915:
2844:
2431:
2378:
2212:
1535:
830:
378:
for 24-hour use. There are several FDA approved IO devices, categorized by their mechanism of action:
173:
2470:
2834:
2208:
1539:
50:
2905:
2872:
2826:
2671:
2503:
2235:
2156:
2083:
2025:
1495:
484:
477:
473:
213:
672:
2900:
2854:
2796:
2702:
2569:
2176:
2050:
1610:
109:
1441:"Intraosseous Drug Administration in Children and Adults During Cardiopulmonary Resuscitation"
1144:"Intraosseous infusion in elective and emergency pediatric anesthesia: when should we use it?"
2966:
2791:
2204:
1951:
1722:
570:
130:
The use of the IV route to administer fluids has been around since the 1830s, and, in 1922,
2755:
2600:
2518:
2463:
2383:
2368:
2171:
1728:
1605:
1590:
776:
345:
98:
8:
2808:
2545:
2426:
2421:
2141:
2037:
1994:
1707:
1701:
1689:
571:"Intraosseous infusions: a review for the anesthesiologist with a focus on pediatric use"
469:
161:
140:
113:
1261:
70:
2882:
2676:
2631:
2328:
2073:
1881:
1785:
1576:
1476:
1382:
1339:
1179:
1121:
989:
929:
894:
868:
804:
752:
727:
708:
600:
316:
238:
131:
1401:
1245:
414:
Spring-Loaded: the Bone
Injection Gun (BIG) and the Pyng Medical Corporation FAST 1
253:
gained. Prolonged use of an IO site, lasting longer than 24 hours, is associated with
44:
The tibia IO insertion site is just below the medial condyle, labeled in this picture.
2732:
2727:
2565:
2306:
2068:
1780:
1615:
1600:
1515:
1468:
1460:
1421:
1417:
1374:
1370:
1331:
1323:
1273:
1265:
1226:
1218:
1214:
1171:
1163:
1125:
1113:
1105:
1063:
1019:
993:
981:
973:
934:
916:
860:
852:
796:
757:
700:
692:
648:
592:
551:
543:
300:
283:
The most common site of insertion is the antero-medial aspect of the upper, proximal
1480:
1386:
1343:
1183:
808:
712:
604:
112:. The intraosseous infusion technique is used to provide fluids and medication when
2666:
1507:
1452:
1413:
1366:
1315:
1303:
1257:
1210:
1155:
1097:
1055:
1043:
965:
924:
906:
893:
Petitpas, F.; Guenezan, J.; Vendeuvre, T.; Scepi, M.; Oriot, D.; Mimoz, O. (2016).
872:
844:
788:
747:
739:
684:
638:
582:
539:
535:
460:
353:
1086:"Intraosseous access in the resuscitation of trauma patients: a literature review"
135:
O'Neill demonstrated successful vascular access using the bone marrow cavity of a
2556:
2240:
2104:
1319:
1159:
587:
373:
Axial CT with left humeral head EZ-IO (power driver device) infusion of contrast.
342:
Bone and tissue damage from the puncturing device needle breaking off in the bone
56:
1059:
2617:
2250:
1712:
1674:
1663:
1101:
1011:
488:
181:
165:
148:
1511:
969:
911:
831:
The
Consortium on Intraosseous Vascular Access in Healthcare Practice (2010).
688:
2950:
2760:
2682:
2651:
2416:
2245:
1640:
1464:
1425:
1327:
1269:
1222:
1167:
1109:
1044:"Proximal Humerus Intraosseous Infusion: A Preferred Emergency Venous Access"
977:
920:
856:
800:
792:
696:
547:
279:
254:
229:
224:
118:
2801:
2737:
2722:
2697:
2535:
2255:
1635:
1519:
1472:
1335:
1277:
1175:
1143:
1117:
1085:
1067:
1023:
985:
953:
938:
864:
761:
704:
652:
596:
555:
523:
219:
1378:
1230:
1198:
2895:
2783:
2656:
2612:
2590:
2577:
2508:
2478:
2412:
2261:
2200:
2029:
1770:
1734:
743:
169:
105:
627:"Intraosseous Devices for Intravascular Access in Adult Trauma Patients"
369:
2817:
2779:
2750:
2310:
2284:
2146:
1946:
1755:
1669:
848:
643:
626:
207:
101:
39:
2098:
1456:
1244:
Weiser, Giora; Hoffmann, Yoav; Galbraith, Roger; Shavit, Itai (2012).
80:
2389:
2279:
2131:
2121:
1865:
1750:
1717:
1545:
398:
144:
136:
64:
1440:
2931:
2920:
2712:
2692:
2687:
2661:
2605:
2498:
2488:
2483:
2186:
2151:
2136:
2078:
1775:
1765:
1760:
1496:"Intraosseous Access for Administration of Medications in Neonates"
1084:
Tyler, Joseph Antony; Perkins, Zane; De'Ath, Henry Dudley (2021).
2717:
2646:
2585:
2530:
2525:
2493:
2333:
2289:
2166:
1246:"Current advances in intraosseous infusion – A systematic review"
406:
393:
The EZ-IO device is a small device that works like a traditional
292:
2639:
1439:
Buck, Marcia L; Wiggins, Barbara S; Sesler, Jefferson M (2007).
1042:
Paxton, James H.; Knuth, Thomas E.; Klausner, Howard A. (2009).
2707:
2627:
2540:
2360:
2271:
2161:
2126:
2113:
1645:
522:
Luck, Raemma P.; Haines, Christopher; Mull, Colette C. (2010).
428:
210:
or other type of skin infection at the site of device insertion
1304:"Intraosseous Infusion: A Review of Methods and Novel Devices"
892:
728:"Discovery of the intraosseous route for fluid administration"
204:
Burn damage to the tissues around the site of device insertion
2595:
2320:
2222:
2181:
2060:
1302:
Blumberg, Stephen M.; Gorn, Michael; Crain, Ellen F. (2008).
1243:
402:
394:
288:
284:
243:
A recent failed attempt at device insertion in the same bone
186:
895:"Use of intra-osseous access in adults: a systematic review"
381:
274:
Intraosseous infusion-- needle insertion into anterior tibia
189:), past IV drug use, obesity, and very low blood pressure.
2343:
2024:
1199:"Tibial fracture: a complication of intraosseous infusion"
2459:
2404:
108:; this provides a non-collapsible entry point into the
1297:
1295:
1293:
1291:
1289:
1287:
1083:
1048:
Journal of Trauma-Injury
Infection & Critical Care
951:
666:
664:
662:
339:
Catheter misplacement which can lead to extravasation
201:
Fractures in the bone at the site of device insertion
1284:
1041:
659:
1438:
1301:
2948:
1090:European Journal of Trauma and Emergency Surgery
1804:International Federation for Emergency Medicine
1018:, Treasure Island (FL): StatPearls Publishing,
1009:
278:The needle is inserted through the bone's hard
1808:International Conference on Emergency Medicine
1356:
521:
104:, fluids, or blood products directly into the
2010:
1561:
1196:
952:D'Amore, Katrina; Swaminathan, Anand (2020).
1824:Canadian Association of Emergency Physicians
1930:Care of the Critically Ill Surgical Patient
1819:Australasian College for Emergency Medicine
1400:Peck, Karen Rowe; Altieri, Michael (1989).
1399:
1010:Dornhofer, Peter; Kellar, Jesse Z. (2021),
958:Emergency Medicine Clinics of North America
670:
441:Cook Critical Care Dieckman modified needle
438:Cook Critical Care threaded Sur-Fast needle
390:Power Driver: EZ-IO By Arrow Teleflex.
2017:
2003:
1568:
1554:
1203:The American Journal of Emergency Medicine
671:LaRocco, Brian G.; Wang, Henry E. (2003).
568:
216:, also referred to as Brittle Bone Disease
38:
1538:at the U.S. National Library of Medicine
928:
910:
751:
642:
586:
435:Cardinal Health Jamishidi/Illinois needle
1814:American College of Emergency Physicians
777:"Intraosseous vascular access: A review"
459:
380:
368:
336:Bone fractures from the puncture devices
259:
1834:European Society for Emergency Medicine
1141:
476: (IM), and intraosseous (IO)
14:
2949:
1844:American Academy of Emergency Medicine
1575:
1197:Katz, D. S.; Wojtowycz, A. R. (1994).
774:
450:
27:Medication injections into bone marrow
1998:
1549:
1493:
1137:
1135:
1079:
1077:
1005:
1003:
954:"Massive Gastrointestinal Hemorrhage"
291:, the superior iliac crest, proximal
1839:Asian Society for Emergency Medicine
888:
886:
884:
882:
725:
620:
618:
616:
614:
517:
515:
513:
511:
192:
2374:Heated humidified high-flow therapy
1924:Advanced Life Support in Obstetrics
1829:Royal College of Emergency Medicine
1262:10.1016/j.resuscitation.2011.07.020
624:
24:
2638:
2576:
2469:
1132:
1074:
1000:
25:
2983:
1529:
1148:Current Opinion in Anesthesiology
879:
611:
528:The Journal of Emergency Medicine
508:
2816:
2342:
2103:
2097:
1977:
1966:
1965:
1621:International emergency medicine
1418:10.1097/00006416-198905000-00013
1371:10.1097/00006565-198912000-00001
464:Intraosseous infusion, pediatric
323:
1978:
1918:Pediatric Advanced Life Support
1631:Pre-hospital emergency medicine
1487:
1432:
1393:
1350:
1237:
1190:
1035:
356:injury in pediatric populations
299:no longer recommends using the
1906:Acute Care of at-Risk Newborns
1900:Neonatal Resuscitation Program
1012:"Intraosseous Vascular Access"
945:
768:
719:
562:
540:10.1016/j.jemermed.2009.04.054
385:BIG IO devices (spring-loaded)
155:
13:
1:
2142:Effervescent powder or tablet
1888:Advanced cardiac life support
1871:Cardiopulmonary resuscitation
502:
455:
125:
2972:Emergency medical procedures
2926:Patient-controlled analgesia
2231:Orally disintegrating tablet
1912:Pediatric basic life support
1894:Advanced trauma life support
1877:Mouth-to-mouth resuscitation
1626:Pediatric emergency medicine
1320:10.1097/pec.0b013e31815f727b
1215:10.1016/0735-6757(94)90261-5
1160:10.1097/ACO.0000000000000069
588:10.1213/ane.0b013e3181c03c7f
485:central venous catherization
257:(an infection in the bone).
247:
7:
1060:10.1097/ta.0b013e3181b16f42
569:Tobias JD, Ross AK (2010).
174:gastrointestinal hemorrhage
10:
2988:
2437:Relative analgesia machine
1596:Emergency medical services
1494:Engle, William A. (2006).
1102:10.1007/s00068-020-01327-y
732:Emergency Medicine Journal
677:Prehospital Emergency Care
575:Anesthesia & Analgesia
364:
310:emergency medical services
297:American Heart Association
2881:
2853:
2825:
2814:
2778:
2745:
2626:
2564:
2517:
2453:
2403:
2359:
2340:
2319:
2305:
2270:
2221:
2199:
2112:
2095:
2059:
2045:
2036:
1960:
1939:
1852:
1794:
1743:
1654:
1583:
1512:10.1016/j.clp.2005.11.006
1445:Annals of Pharmacotherapy
970:10.1016/j.emc.2020.06.008
912:10.1186/s13054-016-1277-6
689:10.1080/10903120390936950
77:
63:
49:
37:
32:
2962:Routes of administration
2026:Routes of administration
1771:Epinephrine / Adrenaline
1540:Medical Subject Headings
1402:"Intraosseous Infusions"
1359:Pediatric Emergency Care
1308:Pediatric Emergency Care
793:10.1177/1460408611430175
775:Paxton, James H (2012).
625:Day, Michael W. (2011).
478:routes of administration
312:(EMS) systems globally.
2552:Extra-amniotic infusion
2157:Molecular encapsulation
2089:Osmotic delivery system
2084:Time release technology
1536:Infusions, Intraosseous
1500:Clinics in Perinatology
1142:Neuhaus, Diego (2014).
673:"Intraosseous Infusion"
655:– via EBSCO Host.
332:Complications include:
214:Osteogenesis imperfecta
2855:Central nervous system
2643:
2581:
2509:Mucoadhesive microdisc
2474:
465:
386:
374:
275:
110:systemic venous system
2698:Transfersome vesicles
2642:
2580:
2557:Intravesical infusion
2473:
1952:Injury Severity Score
1723:Nasopharyngeal airway
1696:Intraosseous infusion
524:"Intraosseous access"
463:
384:
372:
273:
91:Intraosseous infusion
33:Intraosseous infusion
2384:Metered-dose inhaler
2369:Anesthetic vaporizer
1729:Oropharyngeal airway
1606:Emergency psychiatry
1591:Emergency department
744:10.1136/emj.17.2.136
405:and the head of the
346:Compartment syndrome
97:) is the process of
2809:Transdermal implant
2769:(into tissue/blood)
2546:Intrauterine device
2427:Anaesthetic machine
2422:Oxygen concentrator
1708:Tracheal intubation
1702:Intravenous therapy
1406:Orthopaedic Nursing
837:Critical Care Nurse
726:Foex, B. A (2000).
631:Critical Care Nurse
451:Special Populations
141:body of the sternum
2957:Medical treatments
2921:Nanocell injection
2644:
2582:
2475:
2329:Dry-powder inhaler
1882:Basic life support
1786:Sodium bicarbonate
1584:Emergency medicine
1577:Emergency medicine
849:10.4037/ccn2010632
644:10.4037/ccn2011615
466:
387:
375:
317:sodium bicarbonate
276:
239:orthopedic surgery
114:intravenous access
2944:
2943:
2940:
2939:
2771:
2733:Transdermal spray
2728:Transdermal patch
2718:Medicated shampoo
2449:
2448:
2445:
2444:
2432:Medical inhalants
2379:Medical inhalants
2307:Respiratory tract
2301:
2300:
2195:
2194:
1992:
1991:
1781:Magnesium sulfate
1690:Electrocardiogram
1616:Medical emergency
1601:Emergency nursing
1457:10.1345/aph.1K168
1451:(10): 1679–1686.
301:endotracheal tube
271:
193:Contraindications
88:
87:
16:(Redirected from
2979:
2820:
2776:
2775:
2767:
2354:
2350:
2346:
2317:
2316:
2246:Sublingual drops
2219:
2218:
2107:
2101:
2057:
2056:
2043:
2042:
2019:
2012:
2005:
1996:
1995:
1981:
1980:
1969:
1968:
1570:
1563:
1556:
1547:
1546:
1524:
1523:
1491:
1485:
1484:
1436:
1430:
1429:
1397:
1391:
1390:
1354:
1348:
1347:
1299:
1282:
1281:
1241:
1235:
1234:
1194:
1188:
1187:
1139:
1130:
1129:
1081:
1072:
1071:
1039:
1033:
1032:
1031:
1030:
1007:
998:
997:
949:
943:
942:
932:
914:
890:
877:
876:
828:
813:
812:
772:
766:
765:
755:
723:
717:
716:
668:
657:
656:
646:
622:
609:
608:
590:
566:
560:
559:
519:
468:A comparison of
354:Epiphyseal plate
272:
132:Cecil K. Drinker
81:edit on Wikidata
73:
59:
42:
30:
29:
21:
2987:
2986:
2982:
2981:
2980:
2978:
2977:
2976:
2947:
2946:
2945:
2936:
2916:Intraperitoneal
2888:musculoskeletal
2886:
2877:
2849:
2845:Intra-articular
2821:
2812:
2772:
2766:
2765:
2741:
2622:
2560:
2513:
2458:
2441:
2399:
2355:
2352:
2351:
2348:
2347:
2338:
2297:
2266:
2191:
2108:
2102:
2093:
2047:Digestive tract
2032:
2023:
1993:
1988:
1956:
1940:Scoring systems
1935:
1848:
1790:
1739:
1650:
1579:
1574:
1532:
1527:
1492:
1488:
1437:
1433:
1398:
1394:
1355:
1351:
1300:
1285:
1242:
1238:
1195:
1191:
1140:
1133:
1082:
1075:
1040:
1036:
1028:
1026:
1008:
1001:
950:
946:
891:
880:
829:
816:
773:
769:
724:
720:
669:
660:
623:
612:
567:
563:
520:
509:
505:
458:
453:
367:
326:
260:
250:
195:
158:
128:
84:
69:
55:
45:
28:
23:
22:
15:
12:
11:
5:
2985:
2975:
2974:
2969:
2964:
2959:
2942:
2941:
2938:
2937:
2935:
2934:
2929:
2923:
2918:
2913:
2908:
2903:
2898:
2892:
2890:
2879:
2878:
2876:
2875:
2870:
2865:
2859:
2857:
2851:
2850:
2848:
2847:
2842:
2837:
2835:Intracavernous
2831:
2829:
2823:
2822:
2815:
2813:
2811:
2806:
2805:
2804:
2794:
2789:
2787:
2773:
2764:
2763:
2758:
2753:
2747:
2746:
2743:
2742:
2740:
2735:
2730:
2725:
2720:
2715:
2710:
2705:
2700:
2695:
2690:
2685:
2680:
2674:
2669:
2664:
2659:
2654:
2649:
2637:
2635:
2624:
2623:
2621:
2620:
2618:Nutrient enema
2615:
2610:
2609:
2608:
2603:
2593:
2588:
2575:
2573:
2562:
2561:
2559:
2554:
2549:
2543:
2538:
2533:
2528:
2523:
2521:
2515:
2514:
2512:
2511:
2506:
2501:
2496:
2491:
2486:
2481:
2468:
2466:
2451:
2450:
2447:
2446:
2443:
2442:
2440:
2439:
2434:
2429:
2424:
2419:
2409:
2407:
2401:
2400:
2398:
2397:
2392:
2387:
2381:
2376:
2371:
2365:
2363:
2357:
2356:
2341:
2339:
2337:
2336:
2331:
2325:
2323:
2314:
2303:
2302:
2299:
2298:
2296:
2295:
2292:
2287:
2282:
2276:
2274:
2268:
2267:
2265:
2264:
2259:
2253:
2248:
2243:
2238:
2233:
2227:
2225:
2216:
2197:
2196:
2193:
2192:
2190:
2189:
2184:
2179:
2174:
2169:
2164:
2159:
2154:
2149:
2144:
2139:
2134:
2129:
2124:
2118:
2116:
2110:
2109:
2096:
2094:
2092:
2091:
2086:
2081:
2076:
2071:
2065:
2063:
2054:
2040:
2034:
2033:
2022:
2021:
2014:
2007:
1999:
1990:
1989:
1987:
1986:
1974:
1961:
1958:
1957:
1955:
1954:
1949:
1943:
1941:
1937:
1936:
1934:
1933:
1927:
1921:
1915:
1909:
1903:
1897:
1891:
1885:
1879:
1874:
1868:
1862:
1860:
1850:
1849:
1847:
1846:
1841:
1836:
1831:
1826:
1821:
1816:
1811:
1800:
1798:
1792:
1791:
1789:
1788:
1783:
1778:
1773:
1768:
1763:
1758:
1753:
1747:
1745:
1741:
1740:
1738:
1737:
1732:
1726:
1720:
1715:
1713:Laryngeal tube
1710:
1705:
1699:
1693:
1687:
1681:
1675:Defibrillation
1672:
1667:
1664:Bag valve mask
1660:
1658:
1652:
1651:
1649:
1648:
1643:
1638:
1633:
1628:
1623:
1618:
1613:
1608:
1603:
1598:
1593:
1587:
1585:
1581:
1580:
1573:
1572:
1565:
1558:
1550:
1544:
1543:
1531:
1530:External links
1528:
1526:
1525:
1506:(1): 161–168.
1486:
1431:
1392:
1365:(4): 209–210.
1349:
1283:
1236:
1209:(2): 258–259.
1189:
1154:(3): 282–287.
1131:
1073:
1054:(3): 606–611.
1034:
999:
964:(4): 871–889.
944:
878:
814:
787:(3): 195–232.
767:
738:(2): 136–137.
718:
683:(2): 280–285.
658:
610:
581:(2): 391–401.
561:
534:(4): 468–475.
506:
504:
501:
489:venous cutdown
457:
454:
452:
449:
445:
444:
443:
442:
439:
436:
425:
424:
423:
419:
412:
411:
410:
366:
363:
358:
357:
351:
348:
343:
340:
337:
325:
322:
249:
246:
245:
244:
241:
235:
232:
227:
222:
217:
211:
205:
202:
199:
194:
191:
166:cardiac arrest
157:
154:
149:Emanuel Papper
127:
124:
86:
85:
78:
75:
74:
67:
61:
60:
53:
47:
46:
43:
35:
34:
26:
9:
6:
4:
3:
2:
2984:
2973:
2970:
2968:
2965:
2963:
2960:
2958:
2955:
2954:
2952:
2933:
2930:
2927:
2924:
2922:
2919:
2917:
2914:
2912:
2909:
2907:
2906:Intramuscular
2904:
2902:
2899:
2897:
2894:
2893:
2891:
2889:
2884:
2880:
2874:
2871:
2869:
2866:
2864:
2863:Intracerebral
2861:
2860:
2858:
2856:
2852:
2846:
2843:
2841:
2838:
2836:
2833:
2832:
2830:
2828:
2824:
2819:
2810:
2807:
2803:
2800:
2799:
2798:
2795:
2793:
2790:
2788:
2785:
2781:
2777:
2774:
2770:
2762:
2759:
2757:
2754:
2752:
2749:
2748:
2744:
2739:
2736:
2734:
2731:
2729:
2726:
2724:
2721:
2719:
2716:
2714:
2711:
2709:
2706:
2704:
2701:
2699:
2696:
2694:
2691:
2689:
2686:
2684:
2683:Iontophoresis
2681:
2678:
2675:
2673:
2670:
2668:
2665:
2663:
2660:
2658:
2655:
2653:
2652:Topical cream
2650:
2648:
2645:
2641:
2636:
2633:
2629:
2625:
2619:
2616:
2614:
2611:
2607:
2604:
2602:
2599:
2598:
2597:
2594:
2592:
2589:
2587:
2584:
2583:
2579:
2574:
2571:
2567:
2563:
2558:
2555:
2553:
2550:
2547:
2544:
2542:
2539:
2537:
2534:
2532:
2529:
2527:
2524:
2522:
2520:
2516:
2510:
2507:
2505:
2502:
2500:
2497:
2495:
2492:
2490:
2487:
2485:
2482:
2480:
2477:
2476:
2472:
2467:
2465:
2461:
2456:
2452:
2438:
2435:
2433:
2430:
2428:
2425:
2423:
2420:
2418:
2417:Nasal cannula
2414:
2411:
2410:
2408:
2406:
2402:
2396:
2393:
2391:
2388:
2385:
2382:
2380:
2377:
2375:
2372:
2370:
2367:
2366:
2364:
2362:
2358:
2345:
2335:
2332:
2330:
2327:
2326:
2324:
2322:
2318:
2315:
2312:
2308:
2304:
2293:
2291:
2288:
2286:
2283:
2281:
2278:
2277:
2275:
2273:
2269:
2263:
2260:
2257:
2254:
2252:
2249:
2247:
2244:
2242:
2239:
2237:
2234:
2232:
2229:
2228:
2226:
2224:
2220:
2217:
2214:
2210:
2206:
2202:
2198:
2188:
2185:
2183:
2180:
2178:
2175:
2173:
2170:
2168:
2165:
2163:
2160:
2158:
2155:
2153:
2150:
2148:
2145:
2143:
2140:
2138:
2135:
2133:
2130:
2128:
2125:
2123:
2120:
2119:
2117:
2115:
2111:
2106:
2100:
2090:
2087:
2085:
2082:
2080:
2077:
2075:
2072:
2070:
2067:
2066:
2064:
2062:
2058:
2055:
2052:
2048:
2044:
2041:
2039:
2035:
2031:
2027:
2020:
2015:
2013:
2008:
2006:
2001:
2000:
1997:
1985:
1984:
1975:
1973:
1972:
1963:
1962:
1959:
1953:
1950:
1948:
1945:
1944:
1942:
1938:
1931:
1928:
1925:
1922:
1919:
1916:
1913:
1910:
1907:
1904:
1901:
1898:
1895:
1892:
1889:
1886:
1883:
1880:
1878:
1875:
1872:
1869:
1867:
1864:
1863:
1861:
1859:
1855:
1851:
1845:
1842:
1840:
1837:
1835:
1832:
1830:
1827:
1825:
1822:
1820:
1817:
1815:
1812:
1809:
1805:
1802:
1801:
1799:
1797:
1796:Organisations
1793:
1787:
1784:
1782:
1779:
1777:
1774:
1772:
1769:
1767:
1764:
1762:
1759:
1757:
1754:
1752:
1749:
1748:
1746:
1742:
1736:
1733:
1730:
1727:
1724:
1721:
1719:
1716:
1714:
1711:
1709:
1706:
1703:
1700:
1697:
1694:
1691:
1688:
1685:
1682:
1680:
1676:
1673:
1671:
1668:
1665:
1662:
1661:
1659:
1657:
1653:
1647:
1644:
1642:
1641:Trauma center
1639:
1637:
1634:
1632:
1629:
1627:
1624:
1622:
1619:
1617:
1614:
1612:
1609:
1607:
1604:
1602:
1599:
1597:
1594:
1592:
1589:
1588:
1586:
1582:
1578:
1571:
1566:
1564:
1559:
1557:
1552:
1551:
1548:
1541:
1537:
1534:
1533:
1521:
1517:
1513:
1509:
1505:
1501:
1497:
1490:
1482:
1478:
1474:
1470:
1466:
1462:
1458:
1454:
1450:
1446:
1442:
1435:
1427:
1423:
1419:
1415:
1411:
1407:
1403:
1396:
1388:
1384:
1380:
1376:
1372:
1368:
1364:
1360:
1353:
1345:
1341:
1337:
1333:
1329:
1325:
1321:
1317:
1313:
1309:
1305:
1298:
1296:
1294:
1292:
1290:
1288:
1279:
1275:
1271:
1267:
1263:
1259:
1255:
1251:
1250:Resuscitation
1247:
1240:
1232:
1228:
1224:
1220:
1216:
1212:
1208:
1204:
1200:
1193:
1185:
1181:
1177:
1173:
1169:
1165:
1161:
1157:
1153:
1149:
1145:
1138:
1136:
1127:
1123:
1119:
1115:
1111:
1107:
1103:
1099:
1095:
1091:
1087:
1080:
1078:
1069:
1065:
1061:
1057:
1053:
1049:
1045:
1038:
1025:
1021:
1017:
1013:
1006:
1004:
995:
991:
987:
983:
979:
975:
971:
967:
963:
959:
955:
948:
940:
936:
931:
926:
922:
918:
913:
908:
904:
900:
899:Critical Care
896:
889:
887:
885:
883:
874:
870:
866:
862:
858:
854:
850:
846:
842:
838:
834:
827:
825:
823:
821:
819:
810:
806:
802:
798:
794:
790:
786:
782:
778:
771:
763:
759:
754:
749:
745:
741:
737:
733:
729:
722:
714:
710:
706:
702:
698:
694:
690:
686:
682:
678:
674:
667:
665:
663:
654:
650:
645:
640:
636:
632:
628:
621:
619:
617:
615:
606:
602:
598:
594:
589:
584:
580:
576:
572:
565:
557:
553:
549:
545:
541:
537:
533:
529:
525:
518:
516:
514:
512:
507:
500:
496:
492:
490:
486:
481:
479:
475:
474:intramuscular
471:
462:
448:
440:
437:
434:
433:
430:
426:
420:
416:
415:
413:
408:
404:
400:
396:
392:
391:
389:
388:
383:
379:
371:
362:
355:
352:
350:Osteomyelitis
349:
347:
344:
341:
338:
335:
334:
333:
330:
324:Complications
321:
318:
313:
311:
306:
305:resuscitation
302:
298:
294:
290:
286:
281:
258:
256:
255:osteomyelitis
242:
240:
236:
233:
231:
230:Osteopetrosis
228:
226:
225:Osteomyelitis
223:
221:
218:
215:
212:
209:
206:
203:
200:
197:
196:
190:
188:
183:
177:
175:
171:
167:
163:
153:
150:
146:
142:
138:
133:
123:
120:
119:intravascular
115:
111:
107:
103:
100:
96:
92:
82:
76:
72:
68:
66:
62:
58:
54:
52:
48:
41:
36:
31:
19:
2967:Dosage forms
2911:Intraosseous
2910:
2901:Intracardiac
2840:Intravitreal
2802:Injector pen
2797:Subcutaneous
2768:
2738:Jet injector
2723:Dermal patch
2536:Vaginal ring
2504:Insufflation
2256:Effervescent
2030:dosage forms
1976:
1964:
1858:Life support
1695:
1636:Major trauma
1503:
1499:
1489:
1448:
1444:
1434:
1412:(3): 46–48.
1409:
1405:
1395:
1362:
1358:
1352:
1314:(1): 50–56.
1311:
1307:
1256:(1): 20–26.
1253:
1249:
1239:
1206:
1202:
1192:
1151:
1147:
1096:(1): 47–55.
1093:
1089:
1051:
1047:
1037:
1027:, retrieved
1015:
961:
957:
947:
902:
898:
843:(6): e1–e7.
840:
836:
784:
780:
770:
735:
731:
721:
680:
676:
637:(2): 76–89.
634:
630:
578:
574:
564:
531:
527:
497:
493:
482:
472: (IV),
467:
446:
376:
359:
331:
327:
314:
277:
251:
220:Osteoporosis
178:
172:, or severe
159:
147:for access.
129:
94:
90:
89:
18:Intraosseous
2896:Intravenous
2883:Circulatory
2868:Intrathecal
2792:Intradermal
2784:transdermal
2751:Parenterals
2657:Topical gel
2613:Murphy drip
2591:Suppository
2479:Nasal spray
2413:Oxygen mask
2262:Chewing gum
2201:Oral mucosa
1735:Pocket mask
1611:Golden hour
470:intravenous
170:dehydration
156:Indications
106:bone marrow
2951:Categories
2756:Injections
2519:Urogenital
2455:Ophthalmic
2311:inhalation
2285:Toothpaste
2213:sublingual
2177:Suspension
2147:Herbal tea
1947:NACA score
1756:Amiodarone
1670:Chest tube
1029:2021-07-27
1016:StatPearls
503:References
456:Pediatrics
234:Osteopenia
208:Cellulitis
126:Background
102:medication
2761:infusions
2693:Liposomes
2489:Eye drops
2484:Ear drops
2395:Vaporizer
2390:Nebulizer
2280:Mouthwash
2209:sublabial
2132:Electuary
2122:Decoction
1866:First aid
1751:Adenosine
1718:Combitube
1692:(ECG/EKG)
1656:Equipment
1465:1060-0280
1426:0744-6020
1328:0749-5161
1270:0300-9572
1223:0735-6757
1168:1473-6500
1126:211217544
1110:1863-9941
994:222151867
978:1558-0539
921:1466-609X
857:0279-5442
801:1460-4086
697:1090-3127
548:0736-4679
399:drill bit
303:(ET) for
248:Procedure
168:, severe
145:manubrium
137:long bone
99:injecting
65:eMedicine
2932:PIC line
2873:Epidural
2713:Lip balm
2688:Hydrogel
2679:solution
2662:Liniment
2647:Ointment
2606:Hydrogel
2601:Solution
2586:Ointment
2526:Ointment
2499:Hydrogel
2494:Ointment
2290:Ointment
2251:Lozenges
2241:Lollipop
2187:Tincture
2172:Solution
2152:Hydrogel
2137:Emulsion
2079:Pastille
1971:Category
1932:(CCrISP)
1776:Naloxone
1766:Dopamine
1761:Atropine
1520:16533642
1481:20835675
1473:17698894
1387:24125346
1344:36188009
1336:18212613
1278:21871243
1184:32076647
1176:24651308
1118:32078703
1068:19741408
1024:32119260
986:32981623
939:27075364
865:21123225
809:75480795
762:10718241
713:72638403
705:12710793
653:21459867
605:22669421
597:19897801
556:19545966
418:applied.
182:contrast
2632:topical
2570:enteral
2531:Pessary
2361:Liquids
2334:Smoking
2272:Liquids
2167:Softgel
2114:Liquids
2074:Capsule
2051:enteral
1983:Outline
1908:(ACoRN)
1854:Courses
1379:2602189
1231:8161406
930:4831096
905:: 102.
873:9445111
753:1725359
407:humerus
365:Devices
293:humerus
237:Recent
143:or the
57:D017148
2827:Organs
2708:Lotion
2628:Dermal
2566:Rectal
2541:Douche
2321:Solids
2258:tablet
2223:Solids
2205:buccal
2162:Powder
2127:Elixir
2069:Tablet
2061:Solids
1926:(ALSO)
1920:(PALS)
1914:(PBLS)
1896:(ATLS)
1890:(ACLS)
1646:Triage
1542:(MeSH)
1518:
1479:
1471:
1463:
1424:
1385:
1377:
1342:
1334:
1326:
1276:
1268:
1229:
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1166:
1124:
1116:
1108:
1066:
1022:
992:
984:
976:
937:
927:
919:
871:
863:
855:
807:
799:
781:Trauma
760:
750:
711:
703:
695:
651:
603:
595:
554:
546:
429:trocar
422:tibia.
280:cortex
2703:Cream
2667:Paste
2596:Enema
2548:(IUD)
2464:nasal
2386:(MDI)
2294:Spray
2182:Syrup
1902:(NRP)
1884:(BLS)
1873:(CPR)
1744:Drugs
1731:(OPA)
1725:(NPA)
1666:(BVM)
1477:S2CID
1383:S2CID
1340:S2CID
1180:S2CID
1122:S2CID
990:S2CID
869:S2CID
805:S2CID
709:S2CID
601:S2CID
403:tibia
395:drill
289:femur
285:tibia
187:edema
162:shock
79:[
71:80431
2928:pump
2780:Skin
2677:DMSO
2672:Film
2460:otic
2415:and
2236:Film
2038:Oral
1704:(IV)
1698:(IO)
1516:PMID
1469:PMID
1461:ISSN
1422:ISSN
1375:PMID
1332:PMID
1324:ISSN
1274:PMID
1266:ISSN
1227:PMID
1219:ISSN
1172:PMID
1164:ISSN
1114:PMID
1106:ISSN
1064:PMID
1020:PMID
982:PMID
974:ISSN
935:PMID
917:ISSN
861:PMID
853:ISSN
797:ISSN
758:PMID
701:PMID
693:ISSN
649:PMID
593:PMID
552:PMID
544:ISSN
397:and
51:MeSH
2405:Gas
1684:ICD
1679:AED
1508:doi
1453:doi
1414:doi
1367:doi
1316:doi
1258:doi
1211:doi
1156:doi
1098:doi
1056:doi
966:doi
925:PMC
907:doi
845:doi
789:doi
748:PMC
740:doi
685:doi
639:doi
583:doi
579:110
536:doi
487:or
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