A 43-year-old man comes to the hospital due to substernal chest pressure, dyspnea, and nausea that began an hour ago. He has a history of hypertension, hypercholesterolemia, and type 2 diabetes mellitus. He takes aspirin, lisinopril, rosuvastatin, metformin, and sitagliptin. The patient is triaged in the emergency department, and immediately goes into cardiac arrest. Advanced cardiac life support measures are implemented, including external chest compressions. The cardiac monitor shows ventricular tachycardia, but the first defibrillation attempt fails. Chest compressions are resumed, but no peripheral intravenous line can be obtained for medication administration.
Which of the following is the best way of administering medication to this patient?

Question

A 43-year-old man comes to the hospital due to substernal chest pressure, dyspnea, and nausea that began an hour ago.  He has a history of hypertension, hypercholesterolemia, and type 2 diabetes mellitus.  He takes aspirin, lisinopril, rosuvastatin, metformin, and sitagliptin.  The patient is triaged in the emergency department, and immediately goes into cardiac arrest.  Advanced cardiac life support measures are implemented, including external chest compressions.  The cardiac monitor shows ventricular tachycardia, but the first defibrillation attempt fails.  Chest compressions are resumed, but no peripheral intravenous line can be obtained for medication administration.
Which of the following is the best way of administering medication to this patient?

Quizplus · Accepted Answer

Intraosseous cannulation refers to a catheter placement in the bone marrow of long bones (proximal tibia, femur, proximal humerus, distal tibia, or sternal manubrium) to provide intravascular access via the medullary sinuses. These veins are supported by bony matrix and, unlike peripheral or central veins, do not collapse in patients with hypovolemia or profound shock. Intraosseous cannulation provides rapid intravascular access for fluid and medication administration and should be performed in patients with severe shock and/or cardiopulmonary arrest when intravenous access cannot be readily obtained. (Choices A and D) Central venous line insertion and surgical venous cutdown are potential options for intravascular access. However, they are more time consuming and have a lower success rate in patients with collapsed veins during severe shock or cardiopulmonary arrest. (Choice B) Femoral arterial access can be used for intra-arterial blood pressure monitoring during cardiopulmonary resuscitation (CPR) or severe shock. It should not be used to directly administer medications to patients in shock or cardiac arrest. (Choice E) Administration of a drug solution directly into an endotracheal tube for absorption via the alveoli may be used during CPR in patients with limited venous access. However, alveolar drug absorption is unreliable, and only certain medications can be given via this route. Educational objective: Intraosseous cannulation can provide rapid intravascular access in patients with severe shock and cardiopulmonary arrest when intravenous access cannot be readily obtained. __________ References: Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients in the hospital setting. (http://www.ncbi.nlm.nih.gov/pubmed/23283646) Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (http://www.ncbi.nlm.nih.gov/pubmed/20956224)

A 43-Year-Old Man Comes to the Hospital Due to Substernal