1890 Correspondence / American Journal of Emergency Medicine 34 (2016) 1883–1910

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2. The American Geriatrics Society. 2015 Beers criteria Update Expert Panel. American Geriatrics Society 2015. Updated Beers Criteria for potentially inappropriate medica- tion use in older adults. J Am Geriatr Soc 2015;63:2227-46. http://dx.doi.org/10. 1111/jgs.13702.
3. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Cristin R, Gallagher P. STOPP/ START criteria for potentially Inappropriate prescribing in older people: version 2. Age Ageing 2015;44:213-8. http://dx.doi.org/10.1093/ageing/aful45.
4. Hustey FM, Wallis N, Miller J. Inappropriate prescribing in an older ED population. Am J Emerg Med 2007;25:804-7. http://dx.doi.org/10.1111/j.1365-2710.2007. 00793.x.
5. Gallagher P, Lang PO, Cherubini A, Topinkova E, Cruz-Jentoft A, Errasquin BM, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol 2011;67: 1175-88. http://dx.doi.org/10.1007/s00228-011-1061-0.
6. The American College of Emergency Physicians, the American Geriatrics Society, emergency nurses Association, the Society for Academic Emergency Medicine. Geri- atric emergency department guidelines. Ann Emerg Med 2014;63:e7-25. http://dx. doi.org/10.1016/j.annemergmed.2014.02.008.
7. Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prog- nostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987;40:373-83. http://dx.doi.org/10.1016/0021-9681(87)90171-8.
8. Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC. Interventions to im-

   prove the appropriate use of polypharmacy for older people. Cochrane Database Sys Rev 2014;10, CD008165. http://dx.doi.org/10.1002/14651858.CD008165.pub3.

   Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Hospitalization and death associ- ated with potentially inappropriate Medication prescriptions among elderly nursing home residents. Arch Intern Med 2005;165:68-74. http://dx.doi.org/10.1001/ archinte.165.1.68.

9. Hohl CM, Zed PJ, Brubacher JR, Abu-Laban RB, Loewen PS, Purssell RA. Do emergency physicians attribute drug-related emergency department visits to medication- related problems? Ann Emerg Med 2010;55:493-502. http://dx.doi.org/10.1016/j. annemergmed.2009.10.008.

   Nurses’ attitudes and beliefs concerning intraosseous access in pediatric patients?

   

   To the Editor,

   Obtaining intravascular access in a pediatric patient with hypovolemic shock caused by bleeding, vomiting, diarrhea, or Severe dehydration or with sudden cardiac arrest in a prehospital setting can be difficult for medical personnel, and a delay in parenteral access can be associated with higher morbidity [1]. Therefore, Intraosseous infusion is an adequate alternative to parenteral access. Although many puncture sites are described in literature, the tibial bone seems a preferred location for intraosseous infusion in emergency care [1,2]. A recently published study proposed the Doppler Ultrasound technique to confirm intraosseous flow after intraosseous needle placement. It can also verify whether the intraosseous device is still adequately functioning after transportation or patient positioning [3]. In a conscious patient, pain on puncture might become an issue–then analgesia with lidocaine should be considered. Prior studies reported osteomyelitis as a most serious complication (0.6%) [4]. Hansen et al [4] described a 0.4% incidence rate for osteomyelitis in 1802 patients. On the other hand, intraosseous infusion has proved easy to learn and to perform [1,5] and offers a wide range of advantages [2], combined with a relatively low rate of severe complications [6,7].

   The aim of the study was to discover the attitudes of nurses toward applying intraosseous access in pediatric patients.

   The study was conducted with the diagnostic survey method. A questionnaire concerning attitudes toward obtaining intraosseous access in pediatric patients was distributed among 200 nurses. The degree of questionnaire return reached 67.5%.

   The study involved 135 nurses (107 females; 79.2%). The average age of the study participants was 34.7 +- 12.5 years, and the mean work experience equaled 12.2 +- 5.7 years. The total of 4 respondents

   ? Source of support: No sources of financial and material support to be declared.

   had previously obtained intraosseous access in a critically ill pediatric patient. From among the nurses, 48.1% would obtain intraosseous access in a pediatric patient as an intravascular access method of choice in sudden cardiac arrest, 34.1% in hypovolemic shock, and 11.1% in trauma. Intraosseous access was indicated as a method for intravascular access burdened with more complications than peripheral vein cannulation by 62.5% of the respondents. According to 49.6% of the respondents, only 0.9% NaCl infusions can be administered through intraosseous access, 17.3% pointed at drugs used in cardiopulmonary resuscitation (epinephrine, amiodarone), and 9.6% indicated morphine and other analgesics.

   In summary, there is a need for training among nursing staff to raise the Level of knowledge with regard to intraosseous access and thus to improve attitudes toward emergency intraosseous access in pediatric patients.

   Anna Drozd, MD

   Polish Society of Disaster Medicine, Poland

   Marcin Madziala, MSc Polish Society of Disaster Medicine, Poland Department of Emergency Medicine, Medical University of Warsaw, Poland Corresponding author. Department of Emergency Medicine

   Medical University of Warsaw, 4 Lindleya Str., 02-005 Warsaw

   Poland. Tel.: +48 519160829

   E-mail address: [email protected]

   http://dx.doi.org/10.1016/j.ajem.2016.06.064

   References

   Zasko P, Szarpak L, Kurowski A, Truszewski Z, Czyzewski L. Success of intraosseous access procedure in simulated adult resuscitation. Crit Care Resusc 2016;18(2):134.

10. Szarpak L, Truszewski Z, Fudalej M, Krajewski P. The intraosseous access devices as a method of vascular access during cardiopulmonary resuscitation. Am J Emerg Med 2016;34(2):321-2. http://dx.doi.org/10.1016/j.ajem.2015.11.013.
11. Tsung JW, Blaivas M, Stone MB. Feasibility of point-of-care colour Doppler ultrasound confirmation of intraosseous needle placement during resuscitation. Resuscitation 2009;80:665-8.
12. Hansen M, Meckler G, Spiro D, Newgard C. Intraosseous line use, complications, and outcomes among a population-based cohort of children presenting to California hospitals. Pediatr Emerg Care 2011;27:928-32.
13. Kurowski A, Timler D, Evrin T, Szarpak L. Comparison of 3 different intraosseous ac- cess devices for adult during resuscitation. Randomized crossover manikin study. Am J Emerg Med 2014;32(12):1490-3. http://dx.doi.org/10.1016/j.ajem.2014.09.007.
14. Szarpak L, Truszewski Z, Smereka J, Krajewski P, Fudalej M, Adamczyk P, et al. A randomized Cadaver study comparing first-attempt success between tibial and humeral intraosseous in- sertions using NIO device by paramedics: a preliminary investigation. Medicine (Baltimore) 2016;95(20), e3724. http://dx.doi.org/10.1097/MD.0000000000003724.
15. Szarpak L, Truszewski Z, Smereka J, Krajewski P, Fudalej M, Madziala M. Ability of paramedics to perform intraosseous access. A randomized cadaver study comparing EZ-IO((R)) and NIO((R)) devices. Resuscitation 2016;104:e5-6. http://dx.doi.org/10. 1016/j.resuscitation.2016.04.011.

    “Cunningham technique” for dislocated shoulder reduction?,??

    

    To the Editor,

    We read with great interest the article entitled “The effective- ness of a newly developed Reduction method of anterior Shoulder dislocations; Sool’s method” in the issue of the American Journal of Emergency Medicine (2016 Apr 9. pii: S0735-6757(16)30,036-

    ? Re: Park MS, Lee JH, Kwon H, Kim YJ, Jung JY. The effectiveness of a newly developed reduction method of Anterior shoulder dislocations; Sool’s method. Am J Emerg Med. 2016 Apr 9. pii: S0735-6757(16)30036-5. doi: 10.1016/j.ajem.2016.04.012. [Epub ahead

    of print]

    ?? Disclaimer: None.