Quiz-398-Section 4

A patient in profound hemorrhagic shock requires rapid volume resuscitation via intraosseous access. Which of the following strategies will most effectively maximise the flow rate of crystalloid fluids?

Flow rate optimisation

Select the proximal tibia and rely on gravity infusion to avoid pressure-related complications

Select the proximal humerus and apply a pressure bag inflated to 300 mmHg

Select the distal tibia and use a manual push-pull technique with a 10 mL syringe

Select the proximal tibia and use a mechanical rapid infuser without a pressure bag

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A paramedic administers 1 mg of epinephrine via an established IO line during cardiac arrest but forgets to administer the subsequent saline flush. What is the most likely pharmacokinetic consequence of this omission?

The mandatory flush protocol

The epinephrine will be rapidly metabolised in the medullary space before reaching the heart

The epinephrine will pool in the medullary cavity, resulting in subtherapeutic plasma concentrations

The epinephrine will cause immediate extravasation due to lack of a carrier fluid

The epinephrine will precipitate within the needle lumen, causing occlusion

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A conscious patient is receiving intraosseous lidocaine for pain management prior to fluid infusion. What is the critical procedural step that must be followed immediately after injecting the lidocaine?

Pain management

Flush the line with 10 mL of normal saline to ensure the drug enters the circulation

Wait 60–90 seconds before initiating any infusion or flushing the line

Administer a second dose of lidocaine immediately to ensure adequate anaesthesia

Begin the fluid infusion at a slow rate to test the effectiveness of the anaesthetic

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A patient in traumatic hemorrhagic shock requires a transfusion of packed red blood cells (pRBCs) via the intraosseous route. Which of the following statements regarding this procedure is correct?

Blood product administration

Blood products are incompatible with the IO route and must be given via central line only

Blood products can be administered via IO, but gravity infusion is sufficient for resuscitation

Blood products are compatible with IO, but pressure augmentation is mandatory to achieve meaningful flow rates

Blood products must be warmed to 41°C before IO infusion to prevent haemolysis

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How does the bioavailability of medications administered via the intraosseous route compare to peripheral intravenous access during a state of severe hypovolemic shock?

Bioavailability comparison

IO bioavailability is significantly lower than peripheral IV due to marrow resistance

IO bioavailability is comparable to central venous access and superior to peripheral IV

IO bioavailability is equivalent to peripheral IV in all hemodynamic states

bioavailability is unpredictable and requires dose doubling compared to IV

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