N'ọnọdụ oke ọbara ọgbụgba, ịchịkwa ọbara ọgbụgba ahụ na ohere ịbanye ya nso nwere ike ime ihe dị iche n'etiti ndụ na ọnwụ onye ọrịa. N’edemede a, anyị ga-akọ banyere ọmụmụ gbasara ndị ontali banyere iji ememme oriri na nkwari.

Usoro nlekọta mberede nke 118 nke Trieste ()tali) kpebiri inyefe ngwaọrụ intraosseous nke EZ-IO® na ọrụ niile nke ụgbọ ala ALS nke mpaghara ahụ. Ebumnuche bụ ịkwadebe ambulances n'ihe banyere ọbara ọgbụgba siri ike na ịzụ ndị ọkachamara ahụike na-arụ ọrụ na prehospital ntọala na nlekọta nke nnukwu nkwụsị nke nkwonkwo na ụkwụ. Ha sonyeere mkpọsa “Kwụsị ọbara”, nke American College of Surgeon kwalitere wee bubata n'Itali site n'aka Società Italiana di Chirurgia d'Urgenza e del Trauma (Italian Society of Surgery Surgery and Trauma). Ihe eji a njegharị na ịnweta intraosseous nwere ike ịpụta mgbanwe dị mkpa n'ịgwọ ọbara ọgbụgba dị mgbagwoju anya.

Ndị edemede: Andrea Clemente, Mauro Milos, Alberto Peratoner SSD 118 Trieste - Ngalaba Mberede (attività integrata di Emergenza, Urgenza ed Accettazione). Azienda Sanitaria Universitaria Giuliano Isontina

 

Ntinye intraosseous: njem nlegharị anya na nnukwu ọbara ọgbụgba

Kwa afọ, trauma na-akpata oke pasent nke ndị nwụrụ n'ụwa niile. Healthtù Ahụ Ike estimatedwa mere atụmatụ na na 2012, nde mmadụ nde 5.1 nwụrụ n'ihi ihe ọghọm, nke dị ka 9.2% nke ọnwụ n'ụwa nile (ọnụọgụ ọnwụ na-egosi na ikpe 83 na 100,000 ndị bi na). Pasent 50 nke ọnwụ dị n'agbata afọ 15 na 44, na ọnụ ọgụgụ ndị nwoke na-anwụkarị okpukpu abụọ nke ụmụ nwanyị (1).

Na ,tali, ihe omume trauma kpatara maka 5% nke ọnwụ kwa afọ (2). Ọ dabara n'ihe dị ka mmadụ 18,000 nwụrụ, n'ime ha:

• ihe ọghọm okporo ụzọ: ọnwụ dị puku asaa
• ihe ọghọm nke ụlọ: ọnwụ dị puku anọ
• ọghọm n’ebe ọrụ: ọnwụ dị puku 1,300
• ime ihe nzuzu / ma ọ bụ imerụ onwe ya ahụ: ọnwụ 5,000

Ọtụtụ na-akpata ihe karịrị nde nde ọgwụ iri n'ụlọ ọgwụ, ihe ruru 1% nke ngụkọta mbanye kwa afọ (10).

Ọrịa ọgbụgba ọbara bụ ihe nke abụọ na-akpata ọnwụ mgbe mmerụ ahụ akwara dị n'etiti, n'agbanyeghị usoro nke trauma. Haemorrhage na-akpata 30-40% nke ọnwụ trauma na 33-56% na-eme na ọnọdụ ụlọ ọgwụ (4).

Iji mee ka ọ baa uru karịa enwere ike, ekwesịrị ịnye ọgwụgwọ obara ozugbo enwere ike mgbe mbibi ahụ gasịrị. Nnukwu ọbara ọgbụgba nwere ike ibute ngwa ngwa a na-akpọ "trauma triad of ọnwụ" ma ọ bụ "egbu egbu triad": hypothermia, coagulopathy and metabolic acidosis.

Nnukwu ọbara na-ebelata njem nke ikuku oxygen ma nwee ike bute hypothermia site na mgbanwe nke coagulation cascade. Enweghị oxygen na nri na - ebugharị dị ka ọbara (hypoperfusion), mkpụrụ ndụ na - agbanwe ka metabolism anaerobic, na - eme ka mwepụta nke lactic acid, ahụ ketone na ihe ndị ọzọ acidic na - eme ka ọbara pH na - ebute metabolic acidosis. Acidba ụba nke acidity na-emebi nsị anụ ahụ na akụkụ ahụ gị ma nwee ike belata arụmọrụ myocardial site na imebiwanye ụgbọ njem oxygen.

 

Njem njem nlegharị anya na nnweta intraosse: ọgbaghara na-azọpụta ndụ

Site na esemokwu ndị dị na Iraq na Afghanistan, anyị amụtala na iji ngwa ọhụụ na ọnụnọ ọmalịcha mmiri dị mkpa na njikwa ndụ na-azọpụta ndụ. Ofzọ nzaghachi dị oke mma, Kọmitii Ndị Ọrụ US nke Kọmitii Na-ahụ Maka Ngwá Ọrụ ọgụ (C-TCCC) nyochara ya nke ọma. Ntinye aka nke usoro TCCC emeela ka mbelata nke ukwuu na oke ọnwụ ọbara (5).

Site n’inwe ahụmihe etolite na ọkwa ndị agha, ụzọ ọgwụgwọ a ebidola ịgbasa na mpaghara nkịtị, karịa, na-esote mwakpo nke ndị omekome dịka nke ahụ mere n’oge Boston Marathon na 2013 (6).

Ihe omume ịzọputa ndụ ngwa ngwa maka njikwa nke ọria ọbara site na nzaghachi mbụ, ndị sonyere gụnyere, nwere ike ịpụta isi okwu dị mkpa na mbelata ọnwụ na - egbochi (7). Na United States, otu ụzọ nke gosipụtara n'ụzọ dị irè iji belata oke ọnwụ ọgbụgba bụ ịkwadebe ma ndị ọrụ nlekọta ahụike na ndị azịza mbụ (ndị uwe ojii na ndị uwe ojii) ndị na-ere ọkụ) na ngwaọrụ nchịkwa ọbara ọgbụgba na ọzụzụ (8).

N'ime ọrụ nlekọta ahụike mberede na kwa ụbọchị, mmakọ mmakọ ejiri ya na ọbara ọgbụgba anaghị adịkarị mma. Ọ na - arụ ọrụ naanị mgbe emechara mkpakọ ntuziaka, nke a na - agaghị ekwe nkwa ọlị oge ọ bụla enwere mmerụ ahụ ma ọ bụ ihe mberede mberede (5).

Ọ bụ ya mere ọtụtụ ndị otu ihe mberede na-eji eme njem. O nwere naanị otu ebumnuche: gbochie oke ure ọbara na oke ọbara ọgbụgba site na aka. Egosiputara na sayensi na ihe omuma ya azoputara ndu. Ndị ọrịa na-enwe oke ahụ mgbagha hypovolemic nwere prognosis siri ike ọnụọgụ ọnụọgụ lanarị ala. Nchịkọta anakọtara n'ọhịa ndị agha egosila na ndị merụrụ ahụ bụ ndị etinyere maka njegharị tupu mmalite nke ujo hypovolemic nwere lanarị 90%, ma e jiri ya tụnyere 20% mgbe etinyere na njem ahụ mgbe akara izizi mbụ nke ụjọ (9).

Ofme njem tupu oge eruo na-ebelata mkpa ọ dị ịlọ ụwa ọzọ na ikuku ọgwụ (haemodilution, hypothermia) na usoro ọgwụgwọ n'ụlọ ọgwụ (coagulopathies), na-ezere ihe ndị ka njọ n'ihe metụtara ọnwụ atọ (10).

N'oge esemokwu Vietnam, 9% nke ọnwụ kpatara ọbara ọgbụgba. N’esemokwu nke taa, a belatara ya n’ime 2% maka ọzụzụ n’otú e si eme njem na mgbasa ya. Uzo lanarị n'etiti ndị agha e mesoro usoro ihe oriri njem na ndị nke etinyeghị ya n'ọrụ bụ 87% vs. 0% (9). Nchoputa nke ihe omumu ihe omuma 6 nke mba nile dere na mbepu onu aka aka 19% nke aka na aka.

Enwere ike bepu ndị a site na mmerụ ahụ dị ukwuu ma akọwaghị ya dịka nsogbu nke abụọ metụtara ojiji nke njem (11). N'ime ihe omumu abuo agha abuo, achoputara na onu ogugu nsogbu n'ihi njem nlere sitere na 0.2% (12) ruo 1.7% (9). Ihe omumu omumu gosiputara na enweghi ihe nlere njem nlebara anya nke di n’agbata awa 3 na 4 (13.14).

Anyị kwesịrị ịtụle awa 6 ka oke kachasị maka nbibi nke aka (15). Ndị otu na-arụ ọrụ n'etiti ụlọ ọrụ dịgasị iche iche nke Ngalaba Homeland Security nke “National Security Councill Staff” na-arụ ebe White House na-akwalite mkpọsa “Kwụsị Ọbara” na ebumnuche nke iwulite nguzogide n'etiti ọha mmadụ site na ịba ụba mara banyere ihe ndị dị mkpa iji kwụsị ọbara ọgbụgba na-egbu ndụ kpatara ma ihe mberede nke ndụ kwa ụbọchị yana ihe omume ọdachi ma ọ bụ ọdịdị ma ọ bụ nke ndị na-eyi ọha egwu.

“Kọmitii na Nsogbu” nke American College of Surgeons na Hartford Conservation so na ndị na-akwalite mkpọsa a. A na-ahụta ọbara ọgbụgba a na - achịkwaghị achịkwa bụ ihe kachasị akpata ọnwụ ọnwụ site na mmerụ ahụ na - egbochi ọnwụ, ebe isi mmalite nke oge a bụ ojiji nke ndị na - abịa ya dị ka ndị mbụ na - azazi ọbara ọgbụgba ruo mgbe ndị nnapụta ọkachamara, mgbe ọ jisịrị chọpụta na itinye aka ahụ dị irè n'ime mbụ 5 -10 nkeji.

Ndị na-eme usoro 118 Trieste sonyere na usoro “Kwụsị Ọbara”, ndị Società Italiana di Chirurgia d'Urgenza e del Trauma webatara na Italytali. Ebumnuche bụ idozi omume banyere etu esi eme njem, ugbu a na ụgbọ ala ndị a na - azọpụta.

 

Banyere njem oriri na nkwari intraosseous

N’ebe ụlọ ọgwụ dị, ọ na-adịkarị mkpa iji hụ na irighiri akwara ji ọsọ, mana idowe ya na-abụkarị nsogbu (16,17). Nweta ohere imebi ihe ahụ ka na-abụ ụkpụrụ, mana ọ bụrụ na-emebi ihe ndị dị mkpa, ịnweghachị ya nwere ike isi ike ma ọ bụ nwee ike ogologo oge.

Ihe ndị metụtara gburugburu ebe obibi dịka ọkụ na-adịghị mma, ohere dị mkpirikpi, onye ọrịa siri ike ma ọ bụ ihe gbasara ahụike dịka ọrịa vasoconstriction gbara gburugburu ma ọ bụ ndị ọrịa hypothermic, akụ na-adịghị mma nke venous n'ihi ọgwụgwọ intravenous ma ọ bụ oke ibu nwere ike ime ka o sie ike ịnweta ohere venous akụkụ.

Ndị nwere mmerụ ahụ na mgbali elu, njide obi ma ọ bụ sepsis nwere ike ịchọ ịnweta vaskụl ozugbo.
N'ebe ndị ọrịa ụmụaka nọ, ịnweta ịnweta akwara nwere ike isi ike site na teknụzụ (18). Ọdịmma ọganiihu n'ịnọgide ohere ịdakwasị ụkwụ na ọnwụnwa mbụ na mpụga ụlọ ọgwụ bụ 74% (19.20) ma belata na-erughị 50% bụrụ ndị ejidere obi (20). Ndi oria no na ure hemorrhagic choro, na, nkeji iri abuo ka ha wee nweta ohere idi nso (20).

Njem nlegharị anya na ohere intraosseous: nhọrọ ziri ezi maka ịnweta venous peripheral bụ ohere intraosseous: a na-enweta ya ngwa ngwa karịa iweghachi azụ azụ (50± 9 s vs 70± 30 s) (22). N'ime ụlọ ọgwụ n'ime ụlọ ọgwụ na ndị ọrịa ACR na-enweghị veins peripheral adịghị adị, ohere intraosseous egosila ọganihu dị elu na obere oge karịa. CVC ntinye (85% vs 60%; 2 min vs 8 min) (23), Ọzọkwa usoro ahụ anaghị achọ nkwụsị nke mkpakọ obi na n'ihi ya nwere ike imeziwanye ndụ onye ọrịa (24).

European Resuscitation Council na-atụ aro ka ịnweta nnabata dị ka ụzọ ọzọ dị mma ma ọ bụrụ na enweghi ike ịchọta usoro akwara ụkwụ na onye ọrịa okenye (25) yana dịka nhọrọ mbụ na onye ọrịa ahụ (26).
Ruo Eprel 2019, EZ-IO® Intraosseous Access Sistem emere arụmọrụ na ASUITS 118 Advanced Rescue Ambulances mgbe ọzụzụ nke ndị nọọsụ na mgbasa nke usoro arụmọrụ, n'oge gara aga naanị usoro eji edozi onwe ya.

Mgbasa nke njikwa ahụ maka ambulances niile na-eme ka o kwe omume ịnweta nkwa vaskụla ngwa ngwa, belata oge ọgwụgwọ ma nwekwuo ogo ọrụ maka ụmụ amaala. Ọtụtụ ọmụmụ egosila na EZ-IO® bụ usoro nnweta nnweta intra-osseous dị irè: ọnụ ọgụgụ ihe ịga nke ọma dị elu (99.6% 27; 98.8% 28; 90% 29) yana ọnụego ihe ịga nke ọma na mbido mbụ ( 85.9% 27; 94% 28; 85% 23) ma mara ezigbo usoro mmụta (29). Ntinye intraosseous bụ ohere a na-enweta ọgwụ ọjọọ na usoro ọgwụ (30) yana ngbanyeghị erughị 1% (24).

Banyere intraosseous intraosseous and ojiji nke tourniquet, case Report

Akuko ikpe:

Elekere isii nke elekere isii nke mgbede: Roomlọ Ọrụ Ahụike Mpụga Ahụike Mberede na FVG mere ka 6.35 Trieste rụọ ọrụ iji zaghachi koodu acha ọbara na-agba aghara na ụlọ.

6.44 pm: ụgbọ ihe mberede rutere na saịtị na ndị ọrụ ụgbọ mmiri na-esonyere ndị ikwu onye ọrịa n'ime ime ụlọ ịwụ ahụ. Otu nwanyị dị afọ 70, nọ ọdụ n'ụlọ mposi ma amaghị ihe ọ bụla (GCS 7 E 1 V2 M 4). Iku ume, chanwụrụ, diaphoretic, pulse carotid nke na-adịghị ahụkebe, oge njuputa capillary> 4 sekọnd. Nnukwu ọbara slick n'ụkwụ onye ọrịa; ọnya vaskụla pụtara ìhè n'akụkụ aka nri nke ala, a fụchiekwa nwa ehi aka nri akwa ákwà nhicha ahụ nke minyekwa n'ọbara.

6.46 pm: koodu uhie. Ha rịọrọ ka ha jiri ọgwụ na-enyocha onwe ha ma ha ga-akpọ maka enyemaka mgbanye ọkụ iji nyere aka na-ebugharị onye ọrịa, na-atụle ọnọdụ ịdị arọ ya yana obere ohere dị. Mgbe ewepụrụ akwa nhicha ahụ, a chọpụtara ọbara obara site na ihe nwere ike imebi anụ ahụ na ọnya afọ, nke dị n'akụkụ akụkụ nwa ehi ahụ.

Ọ gaghị ekwe omume na-ekwe nkwa mmakọ usoro dị mma na ịrara onye ọrụ maka nzube a. Yabụ, ha tinyere Combat Application Tourniquet (CAT) ozugbo, kwụsị ọbara ọgbụgba ahụ. Mgbe nke ahụ gasị, ọnụ ọzọ ọbara ọgbụgba achọpụtaghị.

Ebube siri ike ma tinye O2 na 100% FiO2 site na ume iku ume.
Nyere ọnọdụ nke ujo na oke ibu, ọ gaghị ekwe omume ịchọta ebe a na-agafe agafe, yabụ, mgbe mbọ nke mbụ gachara, etinyebere nnweta intraosseous n'ime ụlọ ebe ana-eme nri nke ọma na usoro EZ-IO® nwere agịga 45mm.

Ekwenyela nnweta ebe kwesịrị ekwesị: nkwụsi ike agịga, ọchịchọ nke ọbara na ịdị mfe nke inye 10 ml SF pushing. Ngwọta ọgwụgwọ anụ ahụ 500 mil infusion with bag squeezer bidoro na mmachi nwere mmachi na aka ya. Mgbe edobere ECG, 80 rhythmic HR, PA na SpO2 anaghị achọpụta.

Mgbe ahụ, a na-etinye akwa akwa ahụmịhe ahụ mgbe ọ na-agba ọbara. Nchịkọta na-eme ngwa ngwa gosipụtara na onye ọrịa ahụ na-arịa hyperthyroidism, ọbara mgbali akwara, dyslipidemia, OSAS na nocturnal CPAP, atrial fibrillation na TAO. Nwanyi ya mechara soro Ahụ Ike Ọrịa na Ọrịa na-efe efe maka ọnya ụkwụ na-adịghị ala ala nke ọrịa MRSA, P. Mirabilis na P. Aeruginosa na usoro ọgwụgwọ ya na tapazole 5mg 8, bisoprolol 1.25mg h 8, diltiazem 60mg kwa awa 8, coumadin dị ka INR.

Elekere 6.55; onye kwuru ya abịarute ebe ahụ. Onye ọrịa ahụ gosipụtara ya na GCS 9 (E 2, V 2, M 5), FC 80r, PA 75/40, SpO2 98% na FiO2 100%. Ejiri 1000mg EV tranexamic acid mee ihe. Site n'enyemaka nke ndị agha mgbanyụ ọkụ, a kpọkọtara onye ọrịa ahụ na a oche ma tinyezie n’elu ya.

N'ime ụgbọ ihe mberede, ọkpara onye ọrịa ahụ bụ GCS 13 (E 3, V 4, M 6), PA 105/80, FC 80r na SpO2 98% na FiO2 100%. Achoputara ohere olulu ozu di omimi n'oge ogba aghara, ya mere ozokwa ozigbo abanyero n’oche nwoke nke aka ekpe na onwonye nke mmiri na-aga n’ihu.

N'iburu n'uche mmụba na paramita dị mkpa, a na-eji fentanest 0.1mg mee ọgwụgwọ analgesic na ngụkọta nke 500ml nke saline na 200ml nke ringeracetate. Na 7.25 pm ụgbọ ihe mberede, na dọkịta na osisi, hapụrụ na koodu uhie gaa na Cattinara Emergency ime ụlọ.

Dọkịta, ngalaba ịtụgharị mmadụ na ụlọ akụ ọbara amaara. Thegbọ ihe mberede rutere PS na elekere asaa nke abalị
Ngụgụ ọbara mbụ gosipụtara: haemoglobin 5 g / dL, sel ọbara ọbara 2.27 x 103µL, hematocrit 16.8%, ebe maka coagulation: INR 3.55, 42.3 sekọnd, Ratio 3.74. A nabatara onye ọrịa ahụ ka ọ bụrụ ọgwụ mberede na ọnya ọbara maka ọnụọgụ asaa nke usoro hematocrits na usoro nje na dalbavancin na oge ikuku.

 

Njem nlegharị anya, nnukwu ọbara ọgbụgba na nnweta intraosseous: G ARKWU AK ITKỌ ALtali

 

GỤRỤ AHỤ

Njem njem: Kwụsị ọbara ọgbụgba mgbe ọnya egbe gachara

Ajụjụ ọnụ nke AURIEX - Mwepụ ahụike nke usoro ọgwụgwọ, ọzụzụ na nchịkwa ọbara ọgbụgba

Njem njem ma ọ bụ mba? Ndi okacha amara nke abuo kwuru okwu n’ikpere ikpere

Nlekọta Uche Egwu: olee otú a ga-esi chekwaa usoro ọgwụgwọ iji chebe agha?

 

Njem nlegharị anya, nnukwu ọbara ọgbụgba na nnweta intanet

1. Healthtù Ahụ Ike Worldwa. Ogo na ihe kpatara mmerụ ahụ. 2–18 (2014). doi: ISBN 978 92 4 150801 8
2. Giustini, M. OSSERVATORIO NAZIONALE AMBIENTE E TRAUMI (ONAT) Traumi: non solo strada. na Salute e Sicurezza Stradale: l'Onda Lunga del Trauma 571–579 (CAFI Editore, 2007).
3. Balzanelli, MG Il supporto delle funzioni vitali al paziente politraumatizzato - Trauma Life Support (TLS). na Manuale di Medicina di Emergenza e Pronto Soccorso 263-323 (CIC Edizioni Internazionali, 2010).
4. Kauvar, DS, Lefering, R. & Wade, CE Mmetụta nke ọbara ọgbụgba na nsonaazụ trauma: nchịkọta nke epidemiology, nkwupụta ahụike, na nlebara ọgwụgwọ. J. Trauma60, S3-11 (2006).
5. Eastridge, BJ et al. Ọnwụ n'ọgbọ agha (2001-2011): Mmetụta ọdịnihu nke nlekọta ọgụ ọgụ. J. Trauma Acute Care Surg.73, 431–437 (2012).
6. Mgbidi, RM & Zinner, MJ Nzaghachi Marathon nke Boston: gịnị kpatara ọ jiri rụọ ọrụ nke ọma? JAMA309, 2441–2 (2013).
7. Brinsfield, KH & Mitchell, E. Ngalaba nke Homeland Security ọrụ ke ime na mmejuputa mmeghachi omume na-arụsi ọrụ ike shooter na kpachaara anya Massty ihe. Ehi. Am. Coll. Surg.100, 24-6 (2015).
8. Holcomb, JB, Butler, FK & Rhee, P. Hemorrhage akara ngwaọrụ: Tourniquets na hemostatic dressings. Ehi. Am. Coll. Surg.100, 66-70 (2015).
9. Kragh, JF et al. Surlanahụ na njem njem mberede iji kwụsị ọbara ọgbụgba na nnukwu akwara trauma. Ann. Surg.249, 1–7 (2009).
10. Mohan, D., Milbrandt, EB & Alarcon, LH Black Hawk Down: Ntughari nke atumatu iweghachite na oke igba oria ojoo. Ekwuru Nlekọta12, 1-3 (2008).
11. Bulger, EM et al. Ntụgharị-aka nke ọgbụgba ndụ dị na ya maka njikwa ọbara na mpụga: Kọmitii Na-ahụ Maka Ahụike Na-ahụ Maka Ahụhụ na Trauma. Prehosp. Emerg. Nlekọta18, 163-73
12. Brodie, S. et al. Njem njem nlegharị anya na mbuso agha: Ahụmahụ ndị agha UK. J. Kwuru. Oper. Med.9, 74-7 (2009).
13. Welling, DR, McKay, PL, Rasmussen, TE & Rich, NM Akụkọ dị mkpirikpi nke tourniquet. J. Vasc. Surg.55, 286-290 (2012).
14. Kragh, JF et al. Ndi mmadu agha agha jiri oge oghachu mee ihe ka oghara igba obara. J. Emerg. Med.41, 590–597 (2011).
15. Walters, TJ, Holcomb, JB, Cancio, LC, Beekley, AC & Baer, ​​DG Mbempe njem ọsọ ọsọ. J. Am. Coll. Surg.204, 185-186 (2007).
16. Zimmermann, A. & Hansmann, G. Intraosseous ohere. Oge Mberede Ọhụrụ A Practice. Nduzi. Resusc. Ntughari. Ekwuru Na-elekọta Infmụaka amụrụ ọhụrụ 39, 117-120 (2009).
17. Olaussen, A. & Williams, B. Intraosseous ohere na prehospital ọnọdụ: Nyocha akwụkwọ. Na-akwado. Ọdachi Med.27, 468-472 (2012).
18. Lyon, RM & Donald, M. Intraosseous nnweta na prehospital ọnọdụ-Ezigbo mbụ-nhọrọ ma ọ bụ kacha mma bailout? Ntughari84, 405-406 (2013).
19. Lapostolle, F. et al. Nleba anya n’ihu nke nnweta nsogbu ịkpa oke na nlekọta mberede. Ahụike siri ike Med.33, 1452–1457 (2007).
20. Na-agụ, R., Studnek, JR, Vandeventer, S. & Garrett, J. Intraosseous vesos intravenous vaskụla ohere n'oge a na-apụ n'ụlọ ọgwụ na-ejide obi: Ọnwụnwa a na-achịkwa aghara aghara. Ann. Emebi. Med.58, 509-516 (2011).
21. Engels, PT et al. Iji ngwaọrụ intraosseous na trauma: Nnyocha nke ndị na-eme ihe mberede na Canada, Australia na New Zealand. Nwere ike. J. Surg.59, 374-382 (2016).
22. Lamhaut, L. et al. Tụnyere nke nnabata na ntinye anya nke ndị ọrụ ahụike mberede ụlọ ọgwụ na mgbe na - enweghị nchedo CBRN ngwá. Resuscitation81, 65-68 (2010).
23. Leidel, BA et al. Tụnyere nke intraosseous intraosseous vesos visas visas vaskụla nke ndị okenye n ’ịhazigharị na ngalaba ngalaba ihe mberede na ọnya na-enweghị ike ịba uru. Resuscitation83, 40–45 (2012).
24. Petitpas, F. et al. Ojiji nke intra-osseous n’ime ndị okenye: nyocha usoro. Crit. Nlekọta20, 102 (2016).
25. Uda, J. et al. Ntuziaka Council Resuscitation nke European Resuscitation 2015: Nkebi 3. Nkwado ndụ ndị okenye. Resuscitation95, 100–47 (2015).
26. Maconochie, IK et al. Ntuziaka Council Resuscitation Council nke European Resuscitation 2015. Nkebi 6. Nkwado ndụ ụmụaka. Resuscitation95, 223–248 (2015).
27. Helm, M. et al. Mmeju ntinye ngwaọrụ EZ-IO® na Ọrụ Ahụike Ọrịa Helicopter German. Resuscitation88, 43–47 (2015).
28. Reinhardt, L. et al. Afọ anọ nke usoro EZ-IO® nọ n'ọnọdụ ọnọdụ mberede n'ụlọ ọgwụ. Centre. Eur. J. Med.8, 166–171 (2013).
29. Santos, D., Carron, PN, Yersin, B. & Pasquier, M. EZ-IO® ngwaọrụ intraosseous ntinye na ọrụ mberede ụlọ ọgwụ: A na-achọ ịmụ na nyocha akwụkwọ. Ntughari84, 440-445 (2013).
30. Von Hoff, DD, Kuhn, JG, Burris, HA & Miller, LJ Ndi intraosseous hà intravenous? Ọmụmụ ọgwụ pharmacokinetic. Am. J. Emerg. Med.26, 31-38 (2008).