What is the recommended method for establishing vascular access when IV is difficult in a severely injured patient?

• A. Intraosseous access for rapid vascular access when IV is not quickly obtainable
• B. Peripheral IV cannulation after multiple attempts
• C. Central venous catheter via neck vein
• D. Intramuscular injection

Answer: (A)

When rapid vascular access is needed and IV access is not quickly obtainable, the fastest and most reliable option is intraosseous access. Intraosseous access gets a needle into the bone marrow, where the venous system drains into the central circulation, bypassing collapsed or difficult-tofind peripheral veins. This allows immediate administration of fluids, blood products, and medications without delays, which is crucial during severe trauma resuscitation.

This method is quick to establish, works across ages, and has a high success rate, making it the preferred choice when time is critical and IV access is proving difficult. After stabilization or once IV access becomes feasible, treatment can continue via IV or central lines as appropriate. Central venous catheterization, while sometimes necessary, takes longer and carries more risk in the emergent setting; peripheral IV attempts after multiple failed tries can waste valuable time; intramuscular injections do not provide the rapid, reliable access needed for resuscitation.