急危重症抢救给药途径2讲课文档.pptVIP

* Proximal Tibia Insertion Site Identification – Adult Extend the leg. Insertion site is approximately 2 cm medial to the tibial tuberosity, or approximately 3 cm below the patella and approximately 2 cm medial, along the flat aspect of the tibia. * * Proximal Tibia Insertion Site Identification – Adult Extend the leg. Insertion site is approximately 2 cm medial to the tibial tuberosity, or approximately 3 cm below the patella and approximately 2 cm medial, along the flat aspect of the tibia. * * Proximal Tibia Insertion Site Identification – Adult Extend the leg. Insertion site is approximately 2 cm medial to the tibial tuberosity, or approximately 3 cm below the patella and approximately 2 cm medial, along the flat aspect of the tibia. * * 解剖 在骨髓腔的骨骺（近端和远端）存在着广泛的血管系统，包括垂直的（Haversian管）和水平的（Volksmann管）血流。通过这个广泛的系统，血液和液体能够快速地通过这个血管系统的组成部分进入中央循环。 A common misperception is that it takes a long time for fluids, medications, or blood infused into the intraosseous space to reach the central circulation, when in fact medications and fluids instilled into the intraosseous space gain access to the central circulation within seconds. A preclinical study measuring peak serum concentrations found that epinephrine infused via IO access has the identical peak serum concentration as central line administration.1 This video of real-time fluoroscopy in a caprine subject demonstrates how quickly IV contrast infused into the medullary space is disseminated into the central circulation. Watch how quickly the dye reaches the vasculature when instilled via the proximal tibia. Under pressure, typical fluid volumes of 1L/hr are achieved using the proximal tibia3 1 Hoskins SL, Kramer GC, Stephens CT, Zachariah BS. Efficacy of epinephrine delivery via the intraosseous humeral head route during CPR. Circulation 2006;114:II_1204.* 2 Philbeck TE, Miller LJ, Montez D, Puga T. Hurt so good; easing IO pain and pressure. JEMS 2010;35(9):58-69.* *Teleflex Incorporated (Vidacare