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Prehospital intraosseous access
Intraosseous (IO) needles are commonly used to obtain vascular access in children rapidly. Recent studies have shown that IO needles can also be used as a rapid method for obtaining vascular access in adults. A randomised controlled trial attempted to establish whether there was a difference in the frequency of first attempt success between humeral IO, tibial IO and peripheral intravenous access in adult patients experiencing non-traumatic out-of-hospital cardiac arrest. The study found that tibial IO needles had the highest first attempt success and the most rapid time to vascular access. Perhaps IO access should be adopted more widely in the adult population (Annals of Emerg Med 2011;58:509–16).
Pigtails for chest trauma
There is an increasing trend towards using pigtail catheters (rather than traditional large bore drains) in patients who are found to have a traumatic pneumothorax. A retrospective study from the USA found that pigtail catheters not only had similar efficacy to wide bore chest drains in patients with traumatic pneumothorax, but also were safe and easily inserted …