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        Don't knock drumsticks, Mike.  They do an excellent job at
simulating infant long bones despite the lack of appropriate landmarks,
and just about *nobody* skeeves at knocking intraosseous needles into
'em.  I ran through a PHTLS (PreHospital Trauma Life Support) course for
the local EMT's a couple of years ago, and the IO needle training went
like a charm with them damned Perdue Simulators.
 
        Come to think of it, why not use the PHTLS curriculum as a base
from which to begin the course for RN's and RRT's?  Manuals for
participants and instructors are readily available, and the format is
certainly solid enough.  It's something very basic upon which one might
build.
 
        As for finding the landmarks....  Well, long before I put in my
first IO needle, I was directed by my preceptors to use every infant
examination as an opportunity to locate those landmarks.  Without mom
twigging, my instructor would glance at me, and I'd indicate with a
fingertip the likely locus, repeating this until each of the preceptors
in the ED was satisfied with my ability to target the spot, and I've
*never* stuck the anterior or posterior compartment on any of the few
(thank ghod) occasions on which I've been unable to secure venous
access.
 
                                        -- Rich Bartucci, D.O.
                                           Williamstown, N.J.
 
> ----------
> From:         Michael G. Tunik
> Sent:         Thursday, August 13, 1998 5:09 PM
> To:   Multiple recipients of list PED-EM-L
> Subject:      Re: procedures lab
>
> >We are planning a procedures lab for training our RN's and RRT's in
> advance-
> >directed pediatric transport. .....Similarly, are chicken legs still
> the"best" for simulating IO's?
> >Clearly $$, time, and availability are all factors being
> considered...
> >Thank you in advance for your assistance.
> >Scott Freedman MD
> Scott,
> The chicken leg is the best simulation of an infants tibia for IO
> placement, in terms of ease of insertion, thickness of cortex etc.  I
> strongly believe that a manikin that has *correct lower leg anatomy
> and
> landmarks* is a must.  One of the more common errors I see is a
> failure to
> place the needle in the tibia when residents and medics try this in
> live
> children (they hit the anterior or posterior compartment).  One
> possible
> explanation is training only with a chicken leg that has no landmarks
> and
> no flat bony surface.
>
> Older children have thicker tibial cortex and are more difficult to
> insert
> the IO needle in (No clear simulation winner for the older child,
> although
> beef ribs have been used).
>
> Michael Tunik, MD
> Associate Director
> Pediatric Emergency Medicine
> Bellevue Hospital Center/NYU School of Medicine
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html