Differences In Depth Of Soft Tissue At The Proximal Tibia Intraosseous Catheter Insertion Site Based On Sex And BMI

Introduction Intraosseous (IO) cannulation is commonly used for emergent vascular access in unstable patients treated in the emergency department (ED). However, inappropriate depth of IO insertion may be associated with increased risk of complications associated with IO catheter use, including extravasation and subsequent compartment syndrome. Our objective was to characterize the thickness of soft tissue overlying the proximal tibial IO insertion site according to patient sex, body mass index (BMI), and common medical comorbidities. Methods Retrospective chart review was performed for patients who received x-ray imaging of the proximal tibia at the study site. Patients were excluded if they had traumatic injury at the site of insertion, or if data were unavailable regarding BMI or other demographics. X-ray images were reviewed by trained abstractors utilizing a standardized protocol including a priori methods for depth measurements. Data were presented utilizing standard techniques, including mean values with standard deviation. Results A total of 373 patients were included in the analysis, although five patients were excluded due to lack of BMI data, leaving 368 patients for the final data analysis. Mean age for included patients was 60.0 years (SD 14.0), and 189 (50.7%) patients were male. A total of 201 (54.6%) patients had their left lower extremity imaged. The mean depth of soft tissue overlying the proximal tibial IO insertion site for all patients was 18.2-mm (SD 8.4 mm), including a depth of 14.2 mm (SD 5.8) for genetic males and 22.4 mm (SD 8.6) for females, with a statistically-significant difference seen between sexes (p Conclusion We found that genetic sex appeared to influence the depth of IO insertion at the proximal tibia, with statistically-significant greater depth of IO insertion required for genetic females than with males at the proximal tibia, despite no significant difference in BMI between sex groups. Larger studies are needed with more enrolled subjects to determine if these differences may be explained by other factors

The Application of Exercise Prescription Education in Medical Training

Objective: Physical inactivity is a significant contributor to many acute and chronic medical conditions. While the dangers of physical inactivity are well understood and physicians have a desire to address them, a lack of education in exercise prescription (ERx) may be a barrier to properly prescribing exercise to patients. The aim of this research was to explore the need for ERx education amongst students and physicians in training and determine the effectiveness of ERx didactic. Methods: A one hour curriculum was developed based on the American College of Sports Medicine principles of ERx. Pre- and post-surveys were administered immediately before and after curriculum session to Wayne State School of Medicine medical students and residents to assess perceived ERx education level and confidence levels for prescribing aerobic and anaerobic exercise to patients. Virtual curriculum sessions were held over Zoom. Results: A total of 144 pre-survey and 119 post-survey results were analyzed. Mean perceived ERx education level significantly increased from 4.67/10 + 1.98 to 7.35/10 + 1.56 (P\u3c.001). Mean confidence level discussing PA with patients, ability to answer exercise related questions, confidence level in ability to prescribe aerobic exercise, and ability to prescribe anaerobic exercise significantly increased in all groups and overall (P\u3c.001) Conclusion: A one-hour session to educate medical students and residents on how to write an ERx improved perceived knowledge and confidence in this subject matter. Further study is needed to determine long term knowledge retention and the impact on ERx behavioral practice in a patient care setting

Biological sex is a predictor of pretibial subcutaneous tissue depth for intraosseous catheter insertion

Introduction Intraosseous (IO) vascular access is most commonly used when critical patients need rapid establishment of vascular access. They have shown high rates of successful placement, with the proximal tibia showing the highest first-attempt success rates. Proper establishment of vascular access requires a needle properly sized to enter the bony cortex and stay there. In this study, we analyzed demographic associations with pre-tibial subcutaneous tissue depth (PTSTD). Methods The PTSTD was calculated using computed tomography (CT) images of adult (³ 18 years old) patients. Variables including side, age, sex, height, weight, BMI, hypertension, diabetes mellitus, atherosclerosis, coronary artery disease, and osteoarthritis were analyzed statistically. Results 368 patients were included in the final data analysis. Patient body mass index, height and weight showed a statistically significant impact on PTSTD overall, and betweenx \u3e 20 mm and \u3c 20 mm and \u3e 40 mm groups. Only height displayed a statistically significant effect between 40 mm \u3e x \u3e 20 mm and \u3e 40 mm group. Sex displayed a statistically significant effect on PTSTD. Conclusions Female sex and higher BMI appear to be related to increased soft tissue thickness in this patient population. Longer catheters may be needed for some obese patients, especially females