Emergency Medical Technician (EMT) Intermediate Practice Exam

You are unable to establish an IV on a critically injured conscious patient. What route should you use for gaining vascular access?

1. Intravenous

2. Intramuscular

3. Intraosseous (IO)

4. Subcutaneous

The correct answer is: Intraosseous (IO)

In a situation where establishing an IV is not possible, especially in a critically injured patient who is conscious, the intraosseous (IO) route is the most effective alternative for gaining vascular access. This method involves inserting a needle directly into the bone marrow, which allows for rapid absorption of fluids and medications into the bloodstream. The IO route is particularly valuable in emergency medicine because it can be performed quickly and does not require the same level of anatomical landmarks or vein visibility as IV placement. This is crucial in critical situations where time is of the essence, and fluid resuscitation or medication administration is needed urgently. The effectiveness of the IO route makes it a preferred option when peripheral access is challenging or impossible. Other methods such as intramuscular and subcutaneous routes do not provide the same immediacy or volume of absorption necessary for critically injured patients who may require large volumes of fluids quickly. The intramuscular route is slower to absorb and is not suitable for administering significant amounts of fluids quickly, while the subcutaneous route is even slower and generally used for small volumes of medication. Therefore, the intraosseous route is the best choice under these circumstances.