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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Fat Intravasation from Intraosseous Flush and Infusion Procedures.

Bernard J Rubal, Belinda L Meyers, Sarah A Kramer

    Prehospital Emergency Care
    |December 16, 2014
    PubMed
    Summary
    This summary is machine-generated.

    Intraosseous (IO) infusions in swine commonly cause bone marrow fat intravasation, influenced by infusion rates and cannula site. Emergency providers should be aware of this risk during emergent care.

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    Area of Science:

    • Emergency Medicine
    • Anesthesiology
    • Surgical Procedures

    Background:

    • Intraosseous (IO) infusions are vital for emergent vascular access.
    • Potential complications of IO infusions require thorough investigation.
    • Fat intravasation during IO infusions is a poorly understood phenomenon.

    Purpose of the Study:

    • To investigate the procedural factors of IO infusions that lead to fat intravasation.
    • To test the hypothesis that fat content in effluent blood increases during IO infusions.
    • To assess the impact of infusion pressures, flow rates, and cannulation sites on fat intravasation.

    Main Methods:

    • Swine models (n=35) underwent proximal tibial IO cannulation.
    • Fat intravasation was quantified using a lipophilic fluoroprobe and vascular ultrasound.
    • Effluent bone marrow fat was analyzed at various infusion pressures (73-300 mmHg) and flow rates (0.3-3.0 mL/s).

    Main Results:

    • Fat intravasation occurred during all IO infusion regimens.
    • Initial flush significantly contributed to fat intravasation.
    • Increased infusion rates and specific cannulation sites exacerbated fat intravasation and bone marrow shear-strain.
    • Subclinical pulmonary fat emboli were observed 24 hours post-infusion.

    Conclusions:

    • Bone marrow fat intravasation is a frequent outcome of swine IO infusions.
    • Cannulation site and infusion forces are key determinants of intravasation magnitude.
    • Emergency care providers must recognize and consider fat intravasation during IO infusion procedures.