Pre-hospital intraosseous use in children: Indications and success rate.

OBJECTIVE: Intraosseous (IO) needle insertion is an effective method to obtain circulatory access in unwell children. METHODS: We conducted a 12-month retrospective record review of children aged less than 18 years who had a recorded IO attempt by Ambulance Victoria paramedics. RESULTS: Sixty-five children underwent IO attempt during pre-hospital care, 60 had IO outcome recorded and were included. 58/60 (96.7%) children had IO successfully placed, 35 were aged <5 years. Cardiorespiratory arrest (39/58, 67.2%) and status epilepticus (11/58, 19%) were the most common indications. CONCLUSION: While IO placement is uncommonly performed pre-hospital, in critical situations there is a high success rate.

MR imaging of midfoot injury.

MR imaging is the imaging modality of choice for the evaluation of acute and chronic injuries of the midfoot. The complex anatomy of this region demands the multiplanar capabilities of this modality, and because injuries of this region most commonly involve the tendon, ligament, and muscular supports of the foot and ankle, MR imaging offers superior soft tissue resolution. MR imaging has the added advantage of accurate osseous injury characterization in most instances; however, CT also may be required, because the two modalities are complementary for demonstrating pathology of bone.

Magnetic resonance imaging findings of injuries to the calf muscle complex.

OBJECTIVE: The objective was to describe the imaging findings following acute injury to the calf musculature. DESIGN AND PATIENTS: We retrospectively reviewed 59 MR examinations in patients who sustained injuries to the calf muscle from April 2001 to September 2004 (48 men, 11 women), with an average age of 31 and 47 years respectively (range in men 20-53; range in women 33-63). Attention was directed to the frequency of muscle involvement, the location of the injury within the musculotendinous unit and the extent of the injury. RESULTS AND CONCLUSIONS: A total of 79 separate sites of strain injury were identified (39 solitary, 20 dual). Of the 39 isolated strains, injury to the gastrocnemius was most common (19 out of 39; 48.7%), preferentially involving the medial head in 18 cases and the lateral head in 1 case. The soleus was also commonly involved (18 out of 39; 46.2%), with 2 cases (5.1%) of distal avulsions of the plantaris. Of the 20 dual injuries, a combination of gastrocnemius injury with soleus injury was the most frequent finding (12 out of 20; 60%). Dual injuries of both heads of the gastrocnemius muscles were demonstrated in 4 cases (20%), with the soleus and tibialis posterior injured in 3 cases (15%). A combination of soleus and flexor hallucis longus injury was seen in 1 case (5%). CONCLUSION: This retrospective study utilizing MRI demonstrates that the medial head of the gastrocnemius is the most commonly injured muscle of the calf, closely followed by the soleus, the latter finding rarely reported in the sonographic literature. Dual injuries of the calf muscle complex occur much more commonly than previously reported and may be of prognostic significance.