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骨髓内针的置入
原作者: Ashley Strobel,葛赟译,肖 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2015-03-03

Title: IO placement
题目:骨髓内针的置入
Author 作者: Ashley Strobel
翻译:葛赟 校对:肖锋

Are you comfortable with Intraosseous Catheter Placement in Children during a code?
你会在抢救儿童时有信心放置骨髓内针吗?
A pediatric code or child in distress is also distressing to care providers.
儿童抢救或一个在痛苦中的儿童对医务人员来说也是有压力的。
Your staff may not feel comfortable with IO access in children, especially the chubby toddlers. .
你的受同事可能对儿童放置骨髓内针不会感觉很有把握,尤其是肥胖的小孩。
The basics for a patient in distress are "IV, O2, Monitor". Access is vital to giving resuscitation medications.
对一个重症患者的最基本的处理是:静脉,氧气,和监测。开通静脉通道对复苏药物治疗是非常重要的。
Indications for IO access: Any child in whom IV access cannot readily be obtained, but is necessary.
骨髓内针通道的适应症:任何无法但又有必要建立静脉通道的儿童。
All IOs are 15G for infusion equal to central vascular access.
所有骨髓内针都是15g,相当于中心静脉通道。
Different colors indicate different sizes:
不同的颜色代表不同的长度:
1 Pink=15 mm
粉红=15mm
2 Blue=25 mm
蓝色=25mm
3 Yellow=45 mm
黄色=45mm

Preferred sites:
首选位置:

• Proximal tibial (place a towel in popliteal fossa to bend the leg, Identify the tibial tuberosity, just below the knee, by palpation, locate a consistent flat area of bone 2 cm distal and slightly medial to the tibial tuberosity)
• 胫骨近端(将腿弯曲在腘窝处放置一块毛巾,找到胫骨粗隆,在其远端2cm偏内侧摸到一个平的地方)
• Distal tibia (proximal to medial malleolus by 1 finger width)—preferred in older children
• 胫骨远端 (内踝近端1指宽度的地方) — — 年纪大的孩子的首选
Proximal Humerus (internally rotate humerus and 1 finger width below surgical neck)
• 肱骨近端 (将肱骨向内侧旋转,在肱骨外科颈下 1 指宽的地方)
• Distal Femoral (1-2 finger widths superior to femoral epicondyles)
• 股骨远端 (股骨髁上1-2 指宽的地方)

Kids-do NOT use the sternum or distal radius
小孩——不要用胸骨或桡骨远端

References 参考文献
Joshua Nagler, M.D., and Baruch Krauss, M.D., Ed.M. Intraosseous Catheter Placement in Children. N Engl J Med 2011; 364:e14.

http://www.ncbi.nlm.nih.gov/pubmed/21631349

文章来源:《中华急诊医学杂志》编辑部