Trick of the Trade: Tibial Intraosseous Line Stabilization in an Agitated Patient

Intraosseous needle - image from Dr. Rob CooneyWith the advent of commercial intraosseous (IO) needles for vascular access, administering IV medications for patients in extremis has been made much easier. Securing the IO needle to the patient’s tibia, femur, or humerus, however, is a different story. After successful patient resuscitation, these needles often tenuously secured through creative uses of sterile gauze, trimmed paper cups, bag valve masks, and/or just tape. Stabilization of tibial IO lines can be difficult in a sedated, intubated patient. This can be even more difficult in an agitated, moving patient.


By |2020-01-16T00:17:39-08:00Jul 20, 2016|Critical Care/ Resus, Tricks of the Trade|

AIR-Pro Series: Critical Care (part 2) Module

Welcome to the Critical Care (Part 2) Block!

Below we have listed our selection of the highest quality posts related to 4 advanced level questions on critical care topics posed, curated, and approved for senior residents by the AIR-Pro Series Board. The blogs relate to the following questions:

  1. Advanced ventilatory management
  2. Submassive pulmonary embolism management
  3. Hypotensive intubation
  4. End of life discussion

AIR Stamp of Approval and Honorable Mentions

In an effort to truly emphasize the highest quality posts, we have 2 subsets of recommended resources. The AIR-Pro stamp of approval will only be given to posts scoring above a strict scoring cut-off of ≥28 points (out of 35 total), based on our AIR-Pro scoring instrument, which is slightly different from our original AIR Series scoring instrument. The other subset is for “Honorable Mention” posts. These posts have been flagged by and agreed upon by AIR-Pro Board members as worthwhile, accurate, unbiased and useful to senior residents. Only the posts with the AIR-Pro stamp of approval will be part of the quiz needed to obtain III credit. To decrease the repetitive nature of posts relating to these advanced concepts, we did not always include every post found that met the score of ≥28 points.

Take the quiz at ALiEMU
ALiEMU AIR-Pro Critical Care (Part 2) block quiz

Interested in taking the quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link. You will need to create a one-time login account if you haven’t already.

Highlighted AIR-Pro posts

Article TitleAuthorDateLinkTitle
Taking ownership of the ventilatorEvan Miller & Maxim DzebaApril 21, 2016EM Docs: Ventilator managementAIR-PRO
Mechanical ventilation in ARDS: 2014 updateMatthew HoffmanMay 12, 2014PulmCCM: Mechanical VentilationAIR-PRO
Thrombolysis for submassive pulmonary embolismChris NicksonJan 7, 2016LITFL: Thrombolysis for submassive PEAIR-PRO
Controversies of thrombolytics for pulmonary embolismBrit LongMay 28, 2016EM Docs: Controversies in thrombolyticsAIR-PRO
How to intubate a patient with hypotensionScott WeingartAug 5, 2013EM Crit: Hemodynamic killsAIR-PRO
Intubating the critically ill patientZach RadwineJan 6, 2014EM Docs: Intubating the critically illAIR-PRO
DNR means do not treat… and other end of life care mythsAshley ShrevesAug 2014EP Monthly: DNR means do not treatAIR-PRO
Dominating the vent: Part 1Scott WeingartMay 24, 2010EM Crit: Dominating the vent (1)Honorable Mention
Dominating the vent: Part 2Scott WeingartJune 1, 2010EM Crit: Dominating the vent (2)Honorable Mention
Pulmonary embolism treatment optionsScott Weingart & Oren FriedmanJuly 14, 2014EM Crit: Pulmonary EmbolismHonorable Mention
Critical care palliationScott Weingart & Ashley ShrevesFeb 18, 2013 EM Crit: Critical care palliationHonorable Mention

If you have any questions or comments, please contact us!

Trick of the Trade: Pre-Charge the Defibrillator

Pre-Charge the Defibrillator CPRIn cardiac arrest care it is well accepted that time to defibrillation is closely correlated with survival and outcome.1 There has also been a lot of focus over the years on limiting interruptions in chest compressions during CPR. In fact, this concept has become a major focus of the current AHA Guidelines. Why? Because we know interruptions are bad.2,3 One particular aspect of CPR that has gotten a lot of attention in this regard is the peri-shock period. It has been well established that longer pre- and peri-shock pauses are independently associated with decreased chance of survival.4,5 Can we do better to shock sooner and minimize these pauses?


Trick of the Trade: Securing the intraosseous needle

So much attention is appropriately focused on the anatomy and technique for intraosseous needle placement. In contrast, very little attention is paid to securing the needle. Often this involves a make-shift setup which involves gauze, wraps, and/or tape. This becomes especially important in the prehospital setting where these can be easily dislodged. The following trick stems from a Twitter discussion in 2015 amongst prehospital providers, lamenting this fact.


By |2019-01-28T21:40:34-08:00May 3, 2016|Critical Care/ Resus, Tricks of the Trade|

AIR Pro Series: Critical Care, Part 1 (2016)

Below we have listed our selection of the 12 highest quality blog posts related to 5 advanced level questions on critical care topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:

  1. Ultrasound fluid assessment
  2. Ultrasound in critical care
  3. Vasopressors for critical care patients
  4. Peripheral intravenous vasopressor administration
  5. Extracorporeal membrane oxygenation basics

In this module, we have 8 AIR-Pro’s and 4 honorable mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through


Highlights from the 2015 American Heart Association CPR and ECC guidelines

AHA guidelinesThe newest round of the 2015 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) contains 315 recommendations.1 It is easy to be overwhelmed by this massive (275 pages) document so this post will distill what you need to know in the emergency department. This update marks the end of a 5-year revision cycle for the AHA and the shift to a continuously updated model. Current and future guidelines can now be found at This round lacks any of the major foundational changes seen in 2010; however, we do say goodbye to some recommendations (bye bye vasopressin).


PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

capnographyFor many years, end tidal CO2 monitoring initially was helpful in differentiating tracheal versus esophageal intubations. Now with continuous end tidal capnography, providers have access to so much more information during a cardiac arrest resuscitation, as summarized by the recently released 2015 American Heart Association (AHA) recommendations.1 Thanks to Dr. Abdullah Bakhsh from Emory University for a great PV card to help remind us of these key cardiac resuscitation pearls.