ABSTRACT
INTRODUCTION: Obtaining vascular access is of paramount importance in trauma care. When peripheral venous access is indicated but cannot be obtained, the intraosseous route represents an alternative. The Bone Injection Gun (BIG) is the device used for intraosseous access by the Israeli Defense Force (IDF). The purpose of this study is to assess the success rate of intraosseous access using this device. METHOD: The IDF Trauma Registry from 1999 to 2012 was searched for patients for whom at least 1 attempt at intraosseous access was made. RESULTS: 37 attempts at intraosseous access were identified in 30 patients. Overall success rate was 50%. No differences in success rates were identified between different care givers. Overall mortality was 87%. CONCLUSION: The use of BIG in the IDF was associated with a low success rate at obtaining intraosseous access. Although inability to achieve peripheral venous access can be considered an indicator for poor prognosis, the high mortality rate for patients treated with BIG can also stand for the provider's low confidence in using this tool, making its use a last resort. This study serves as an example to ongoing learning process that includes data collection, analysis, and improvement, constantly taking place in the IDF.
Subject(s)
Infusions, Intraosseous/statistics & numerical data , Administration, Intravenous/statistics & numerical data , Adolescent , Adult , Allied Health Personnel/statistics & numerical data , Child, Preschool , Female , Humans , Infusions, Intraosseous/instrumentation , Infusions, Intraosseous/mortality , Israel , Male , Military Personnel/statistics & numerical data , Physicians/statistics & numerical data , Registries , Treatment Outcome , Wounds, Gunshot/therapy , Wounds, Nonpenetrating/therapy , Wounds, Penetrating/therapy , Young AdultABSTRACT
PURPOSE: Pneumocystis jirovecii (PCP) and cytomegalovirus (CMV) are opportunistic pathogens which cause lung infection in immunocompromised individuals. However, scarce data are available regarding the carriage of CMV or PCP in immunocompetent, non critically ill patients. The purpose of this study was to evaluate the prevalence of PCP and CMV in broncholaveolar lavage of adult immunocompetent, non critically ill patients. METHODS: BAL fluids from immunocompetent patients who underwent bronchoscopy were analyzed by polymerase chain reaction (PCR) for CMV and PCP DNA. We tested CMV antibodies in serum. In patients with positive CMV DNA in lavage fluid, we further analyzed peripheral blood for the presence of CMV DNA. RESULTS: Ninety three patients were included. We did not detect PCP DNA in BAL in any patient. CMV DNA was found in BAL of 5 of 86 CMV IgG positive patients (5.8 %). Patients who were positive for CMV did not differ from patients with negative PCR for CMV regarding demographic and clinical features. CONCLUSION: We did not find PCP colonization in our cohort of patients. However, we found significant prevalence of CMV DNA in BAL from immunocompetent patients, with no evidence of acute CMV infection. This finding may represent colonization by CMV in immunocompetent, non-critically ill individuals.
