Quiz-398-Section 2

Which of the following accurately describes a key difference between pediatric and geriatric bone that affects IO insertion technique?

Pediatric vs. geriatric bone characteristics

Pediatric cortex is thicker and requires greater insertion force than geriatric bone

Geriatric yellow marrow is more vascular than pediatric red marrow, improving aspiration reliability

Pediatric bone has a thinner cortex and lower mineralisation, requiring less insertion force

Geriatric patients have proportionally larger medullary cavities relative to bone diameter

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Where is the standard insertion point for proximal tibial IO access located?

Proximal tibia landmarking

1–2 cm lateral and 1–2 cm proximal to the tibial tuberosity

1–2 cm medial and 1–2 cm distal to the tibial tuberosity

Directly over the tibial tuberosity at the patellar tendon insertion

3–4 cm distal to the tibial tuberosity on the lateral tibial shaft

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What is the correct arm position for proximal humerus IO landmarking and insertion?

Proximal humerus positioning

Abducted to 90° with external rotation of the forearm

Adducted against the thorax with internal rotation (hand on abdomen)

Extended overhead with the palm facing posteriorly

Flexed at the elbow with the arm resting across the chest

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Which of the following represents the most significant risk specific to proximal humerus IO access in pediatric patients under 10 years of age?

Growth plate injury prevention in pediatrics

Disruption of the proximal humeral physis, which contributes approximately 80% of humeral longitudinal growth

Damage to the radial nerve, which courses through the surgical neck of the humerus

Compartment syndrome of the forearm due to extravasation tracking along fascial planes

Osteomyelitis from the higher bacterial load in pediatric marrow compared to adult marrow

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A geriatric patient has a proximal tibia IO needle that stands upright without support, but marrow aspiration yields no return. What is the most appropriate next step?

Multimodal confirmation

Immediately remove the needle and attempt insertion at the proximal humerus

Perform a 10 mL normal saline flush to assess resistance and check for extravasation

Advance the needle an additional 5 mm to ensure deeper medullary penetration

Request ultrasound guidance before proceeding with any further assessment

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For which pediatric population is the distal femur frequently preferred over the proximal tibia for IO access?

Distal femur indications in pediatric patients

Children aged 6–12 years with suspected septic shock

Neonates and infants under 6 months

Adolescents aged 13–17 years with trauma

All pediatric patients regardless of age

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