Board Review: Critical Care
A 56 year old male presents to your ED in respiratory distress requiring intubation. During the resuscitation you obtain blood work from his intraosseous device. His K is 6.5. What do you do next?
Give him calcium
Give him calcium, IV insulin and lasix
Obtain an ECG and redraw blood work from peripheral line
Start IV fluids
Answer C. While you can obtain some diagnostics tests from samples taken from an IO, typically potassium will be falsely elevated. In this situation, an ECG should be obtained to assess for changes associated with hyperkalemia (peaked T waves with narrow base, short QT, ST segment depression, widening of QRS) See below table as to what diagnostic test can/can not be drawn from an IO.
Jousi M, Saikko S, Nurmi J. Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses. Scand J Trauma Resusc Emerg Med. 2017;25(1):92. Published 2017 Sep 11. doi:10.1186/s13049-017-0435-4
Bradburn S, Gill S: Understanding and Establishing Intraosseous Access. ATOTW 317. June 2015
Hansen M: Intravenous and Intraosseous Access. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw Hill Education; 2016:(Ch) 112;722–727.