By Sylvia Foley, AJN senior editor

An example of a manual pediatric intraosseous needle insertion. Reprinted with permission from King C, et al. Textbook of Pediatric Emergency Procedures. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2007.

In this month’s CE Emergency feature, “Intraosseous Vascular Access for Alert Patients,” authors Stacy Hunsaker and Darren Hillis  describe this scenario: a three-year-old girl arrives in the ED after three days of fever, vomiting, and diarrhea. She needs fluids urgently, but efforts to establish IV access have been unsuccessful. Now she’s on the verge of decompensated shock. The team is about to try an alternative route—intraosseous (IO) vascular access—but there are concerns: “Could such access be attempted on a patient who wasn’t unconscious? Would the parents understand why a hole was going to be drilled into the bone of their child’s leg?” The team must decide whether and how to proceed.

If this child were your patient, would you know what to do? If you aren’t sure, you are not alone. In this article, Hunsaker and Hillis provide some answers. Here’s a short summary. […]