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【論文摘要】藉由骨針，在剛ROSC患者身上給予D50W藥物
【論文摘要】Giving D50W by intraosseous on the patient who just ROSC
摘要
研究背景：依據高級心臟救命術ACLS 2020年更新內容，OHCA（到院前心肺功能停止）的患者，給藥途徑除了IV（Intravenous，靜脈輸液），也可以考慮使用IO（Intraosseous，骨針），其使用藥物除了Epinephrine，其餘各類型急救用藥也都可以給予，且不須調整劑量或稀釋濃度。筆者所在單位配發骨針已經2年，欲藉由各類型案件研究，來證實骨針給藥之可行性和可靠度。案例描述：90歲男性，於案發前一日洗腎返家後，就一直昏睡不醒。家屬今日報案，勤指發現患者OHCA便指導DACPR。救護團隊到場後，施行了BLS和ALS照護，建立骨針和氣管內管，由骨針給了一次Epinephrine。現場施救8分鐘後，患者ROSC，團隊便在現場進行了簡易的復甦後照顧。由於意識不清，血糖測得50mg/dl，便由骨針給D50W 2amp IOP。到院後患者血糖回升至242mg/dl，各項生命徵象皆穩定，轉入加護病房照顧。入院8天後拔管，並轉至一般病房。後續因病情再次惡化，家屬同意終止無效醫療。案例討論：藉由上述個案，輔以醫學文獻，我們可以得知：一、IO（Intraosseous，骨針）在急救時，是快速、可靠且可行的輸液和給藥途徑，各類型急救用藥皆可給予，其禁忌僅有TPN全營養針、化療藥物等。二、NIH、RESUSCITATION等期刊，從2012年開始便對骨針有不少研究，雖然骨針給藥到體內的劑量較低，但對存活率並未達到顯著差異，仍須更多的案例研。三、更進一步推論，未來面對重大創傷患者，當IV失敗時，也可積極建立骨針，給予輸液和TXA，甚至是給血品。在NIH上也有相關文獻。
並列摘要
Background: According to the updated 2020 ACLS guidelines, for patients experiencing out-of-hospital cardiac arrest (OHCA), medication administration can be done via IV (Intravenous) or IO (Intraosseous) routes. This study investigates the feasibility and reliability of using IO access for medication administration, including Epinephrine and other emergency drugs, without the need for dose adjustments or concentration dilutions. Case presentation: A 90-year-old male, who had undergone kidney dialysis the day before the incident, remained unconscious after returning home. Upon discovery of OHCA, the dispatch instructed family to perform DACPR on the patient. Upon arrival of EMS team, both BLS and ALS were started.We established intraosseous route and endotracheal tube, and given the first dose Epinephrine via intraosseous route. Eight minutes after on-site resuscitation efforts, the patient ROSC(Return of Spontaneous Circulation). The team then provided post-resuscitation care at scene. Due to the hypoglycemia (50mg/dl), we given D50W 2amp via IO push.The patient's blood sugar rose to 242mg/dl at ER, others vital signs stabilized, The patient was admitted to the ICU for monitoring. After 8 days of hospitalization, extubation was performed, and the patient was transferred to a general ward. Subsequently, due to further deterioration in the patient's condition, the family consented to the withdrawal of futile medical treatment. Case Discussion: Based on this case and supported by medical literature: 1. IO (Intraosseous) access is a rapid, reliable, and feasible route for giving fluid and medicine during emergencies . Various types of emergency drugs can be administered via IO access, with few contraindications such as TPN(Total Parenteral Nutrition) and chemotherapy drugs. 2. Journals like NIH and RESUSCITATION have conducted studies on IO access since 2012. Although the administered drug dosages are lower via IO access, significant survival rate differences haven't been observed. Further case studies are still required to prove the impact of IO usage on survival rates. 3. It could be inferred that in cases of severe trauma when IV access is unsuccessful, proactive establishment of IO access could be utilized for fluid, TXA, and even blood product. Such administration methods are also documented in relevant studies on NIH.