IV/IO  Access

• Minimum: If (IV) / intraosseous (IO) attempts fail or when unavailable: medication may be given intramuscularly or intranasally for immediate sedation to facilitate surgical cricothyroidotomy. Continue attempts at IV/IO access after airway has been controlled
• Better: 2 patent IV/IO
• Best: 2 patent IV/IO and if appropriately trained large bore central venous access

Flow is directly proportional to the fourth power of the catheter radius and inversely proportion to the length of a catheter (R4 /Length).  Prior to administering medications and providing positive pressure ventilation two 16 gauge or larger angiocatheters should be placed. If continued massive transfusion is required, consideration should be given to placement of a 9 French central venous line so that rapid transfusion can be maintained.  Ultrasound may be used to help identify deep veins.