• Placing an IO in a bone with a proximal fracture, a previous IO placement attempt or any circulatory compromise proximal to the site is contraindicated
• Blood work drawn from an IO are generally not accurate, so once the patient has been resuscitated with the IO, intravenous blood draws are recommended
• Dislodgement is common; it is best to use the stabilizer that comes with the IO kit; if the kit does not have a stabilizer, stack lots of gauze on both sides of the IO needle and tape it down

• While proximal humerus site portents faster infusion rates than proximal tibia site, the main limitation of the proximal humerus site is that the arm must be held in internal rotation to avoid dislodgement of the IO
• Proximal tibia may be easier to landmark than proximal humerus
• Other sites include distal tibia, distal femur and sternum but are uncommonly employed in EDs

1. Suspect tension ptx not just in trauma but also in mechanically ventilated patients who become unstable and after central line placement
2. Confirm with US if time allows
3. Needle decompression is a suboptimal approach to decompression. Finger thoracostomy is more likely to be successful

In this episode, we will dive into a simple yet effective bedside approach to a patient in shock. By using quick physical exam findings and bedside vitals (particularly pulse pressure), you can form a quick assessment of the likely underlying etiology of a critically ill patient.