Intraosseous? Think ! www.waismed.com

Let’s Discuss Think B.I.G.TM - Bone Injection Gun How to operate Competition FAQ www.waismed.com

B.I.G.TM - Bone Injection Gun Novel, automatic IOI injector. One of its kind in the world. Think www.waismed.com

The BIG Movie Think www.waismed.com

BIG Advantages Easily used by a single rescuer after short training. Allows immediate vascular access of infusion, medications and fluids. Minimizes exposure to the patient’s bodily fluids. Can be successfully used by any physicians and paramedics. Think www.waismed.com

BIG Advantages Think Disposable. Quick and accurate infusion into the bone marrow. FDA and CE approval. Patented in the USA Think www.waismed.com

Competition There are mainly 2 Manually inserted hand-held infusion needles in the market: Jamshidi – Baxter A bone marrow aspiration needle 2. Sussmane-Raszynski - Cook critical care An IOI needle

Competition There is one semi-automatic device For Adults - FAST 1 Disadvantages Adults only Double cost Sternal device Semi automatic Larger dimensions Heavier Weight Longer time to establish

Instrument in locked position (before triggering). Design of the B.I.G™… Instrument in locked position (before triggering). Think www.waismed.com

Design of the B.I.G™… After triggering. Think www.waismed.com

Indications for I.O. infusions Emergencies All cardiac arrests. Acute respiratory syndromes (COPD, Asthma, APE). When ever rapid vascular access is required. TRAUMA Fluid replacement in shock. Rapid vascular access during mass casualty incidents. Think www.waismed.com

Think FROM THE ECC GUIDELINES 2000 Rescuers should increase attention to early vascular access, including immediate Intraosseous access for victims of cardiac arrest, and extend the use of Intraosseous techniques to victims >6 years ECC Guidelines 2000: Pediatric Advanced Life Support Think www.waismed.com

Technique of insertion… Movie Think www.waismed.com

Insertion site In adults, 1-2 cm medially and 1 cm proximally to the tibial tuberosity. In pediatrics and the elderly, 1-2 cm medially and 1-2 cm distally to the tibial tuberosity. Think www.waismed.com

Insertion Technique Think 1. Mark Penetration Site In adults, 1-2 cm medially and 1 cm proximally to the tibial tuberosity. In pediatrics and the elderly, 1-2 cm medially and 1-2 cm distally to the tibial tuberosity. Think www.waismed.com

Think 2. Adjust Penetration Depth Adults – Pedies 0-3 Pedies 3-6 Recommended penetration depths Adults – Pedies 0-3 Pedies 3-6 Pedies 6 – 12 2.5 cm 0.5 - 0.7 cm 1.0 cm 1.5 cm Think www.waismed.com

with one hand to the site 3. Position the BIG with one hand to the site 4. pull out the Safety Latch with the other hand. Think www.waismed.com

5. Trigger the BIG at 90º to the surface. Think www.waismed.com

7. Pull out the stylet trocar. 6. Remove the BIG. 7. Pull out the stylet trocar. Think www.waismed.com

8. Fix the cannula with the Safety Latch. 9. Connect IV Set with a stopcock Think www.waismed.com

Now 2 – 5 cc of bone marrow can be aspirated into a heparin-coated syringe for laboratory sampling, or proceed to inject medications or infuse fluids. To reduce pain in the adult patient inject Lidocaine in concentration of 20 mg/cc (2%) or 10 mg/cc (1%). To maintain optimal flow, high pressure, up to 300 mmHg to the infusion bag may be necessary. Think www.waismed.com

Medications and fluids… All medications and fluids can be safely injected into the B.I.G™. I.O. medication and fluid boluses remain the same as those for I.V. injection. It is not recommended that large boluses of hypertonic solutions be infused through the I.O. cannula. In case of user inaccuracy, or technical malfunction, it is strongly recommended to always have a second B.I.G. On hand. Think www.waismed.com

FAQ Think Q: What are the flow rates? Gravity – 20 – 40 ml/min 300 mercury – 110 – 130 ml/min Q: What about Osteomyelitis? A study was done by Rosseti in 1985 over 4,000 patients shows the chance for Osteomyelitis is less than 0.6%. Think www.waismed.com

FAQ Think Q: Does it painful? The needle penetrates the bone in 0.02 seconds. Penetration is much less painful than manual devices. Q: Who uses the BIG? The BIG is in use for the past 1.5 years in Europe, Australasia and Israel. In the US it was introduced on March 2002. Q: Are there any reported complications? The only complications we faced are user’s errors. www.waismed.com