Is a suspected pelvic fracture a contraindication to IO in the tibia?
Ideally, IO insertion into the tibia should be avoided in the setting of a pelvic fracture if there are other sites that can be utilized (humeral IO). Fluids given through the proximal humerus reach the central circulation via the superior vena cava, thereby bypassing pelvic and abdominal vasculature. This is important in trauma where there may be abdominal and pelvic injuries resulting in extravasation of administered fluid. In some trauma patients who have sustained multiple orthopedic injuries (pelvic fracture, humerus fractures), the proximal tibia may be the best choice in terms of potential complications that could occur from utilizing that site.
It is important to note that as per the medical directive, indications for IO placement require the patient to be in a pre-arrest or arrested state. As such, in trauma patients, the utility of an IO would be for fluid administration in a hypotensive patient whereby IV access was unattainable. In traumatic cardiac arrest patients, an IO is not required as a fluid bolus is not indicated. In the setting of an arrest, expedient transfer to hospital is the best possible treatment you can provide. With that in mind, in both traumatic pre-arrest and arrest situations, the focus should be upon minimizing scene time.
Note that: Analgesic agents such as morphine and fentanyl can be administered by alternative routes other than IV or IO, thus an IO is not indicated for the delivery of these medications. In the rare occurrence whereby the IO route is the only feasible route for delivery of analgesic agents, a patch would be required for this order.