BIG - BONE INJECTION GUN INSERVICE LIBERTY AMBULANCE

Bone Injection Gun Inservice
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Adult Injection Site

Pediatric Injection Site

Bone Injection Gun
Liberty Ambulance Service Jacksonville, Florida

	X-ray of Injection Site

Literature The BIG- Bone Injection Gun, has been used in emrgencies, trauma and on the military field for more than 6 years. During those years and during the pre-market of the BIG as well, many articles have been written on IntraOsseous (IO) in general and on the BIG device in particular. The BIG is a life saving device when time is crucial and an when Intravascular line is essential. The Intraosseous Principle The fundamental principle behind any Intraosseous technique is based on this unique complex of blood vessels. A system that penetrates into the Trabecular space and introduces liquids at a positive pressure will cause increased diffusion "with the current" and in fact pass on quantities of water into the blood system, which drain the Trabecular cavities. In simple terms, we are introducing material into a filtering system with adaptable permeability. Why the adaptable permeability? For the simple reason that, as the pressure of the flow into the system increases, the molecules that make up the cell membranes of the Trabecular canals, the Haverisan canals and the Volkman canals expand, causing larger drainage spaces for permeability. The result, naturally, is a higher flow volume. Once the introduction of fluid at high pressure is stopped, the system immediately returns to its original size, and will continue to enable transmission of fluids, although at a slower rate, as long as the external pressure created by the fluid is higher than the pressure inside the bone. These two configurations enable the healthcare provider to supply the rate of flow according to the patient's condition. For example, a patient requiring medication through a drip counter will not need a high-pressure flow. However, a patient who is in hypovolemic shock can receive the necessary quantities of fluids through high-pressure infusion. This short overview can be summarized by the importance of the channeled structure of the bone interior through which accelerated diffusion allows fluids and medications to be introduced into the blood system. Intraosseous Physiology Vascular physiology of bone and intraosseal infusions (IOI; bone-marrow, intramarrow infusion) were first described by Drinker et al. in 1922.1 In 1941, the method was introduced for clinical use by Tocantis et al.2, 3 mainly in children. Bone-marrow transfusion was practiced in Great Britain4-6 and in South America for emergency cases in the 1940s.7 In the Former Soviet Union, the intraosseous route was used in the 1960s for injection of local anesthetics.8-9 Intraosseal regional anesthesia is a tested and efficient method originally described by Thorn-Alquist10 and further developed at the Carmel Medical Center.11 The need for minimum time spent in the field, and the benefit of rapid transportation to the trauma center without time wasted by multiple attempts to place an IV line, is extensively discussed in the current literature.12-14 In emergency situations such as air and road transports of severely compromised patients and mass casualties from accidents, fires, or explosions, it may be difficult, even for experienced physicians, to gain IV access. In these situations where the establishment of an effective vascular access is imperative, the intraosseous (IO) route is indicated. Vascular access via the IO route is recommended for use in emergency situations in children by the American Heart Association, the American Academy of Pediatrics,15 and The American College of Surgeons16 when venous access is not immediately possible. It is also suitable for use in premature babies, term neonates, infants, children, and adults.11, 13, 14, 17-25 The advantages of using the IO route have been studied in acutely ill children and adults in the prehospital seting.13, 22, 23, 26 Highest rates of success were demonstrated in children younger then 3 years old (85%) and the lowest rates in children over 10 years old and in adults (50%). The main causes for failure in this series were errors in landmark identification and bending of needles.23 Refrences Long Bones Physiology As we all know, bones are living, functioning organs, just like the other organs of the body. Bones require oxygen and glucose in order to produce energy and the metabolic products (red blood cells, endogenous factors of the immune system, etc.) unique to this system. The supply of oxygen and glucose is derived through blood vessels, which are distributed from the hard structure of the bone cortex through the softer skeletal centers. In each of the long bones (tibia, femur) there are a number of openings through which arteries enter the bone, as well as a number of openings where veins exit the bone, which serve to drain the blood back into the vascular system. Most of these openings are concentrated in the area called the Epiphysis, located in the upper part or endpoint of the bone (the joint area). Another feature of the Epiphysis is that the cortex tissue in this area is usually thinner than in the main part of the bone.