SELF/Intraosseous Access/IO Module Test

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Instructions

Work through each question carefully to choose the best answer, and submit the quiz to view your results. After completing the quiz, read through the answer explanations to review the reasoning behind both correct and incorrect options.

A trauma patient in hemorrhagic shock has cold, clammy extremities and capillary refill >3 seconds. Attempts at peripheral IV access have already failed. On inspection, the left tibia shows swelling and crepitus. What is the most appropriate next step?

	Attempt placement in the left tibia but angle away from the suspected fracture
	Delay IO and attempt central venous access first due to suspected limb trauma
	Proceed with left proximal tibial IO placement since shock physiology makes fracture less relevant
	Select the right proximal tibia and prepare a drill-assisted IO with full sterile setup

A conscious adult patient in sepsis requires rapid access, and peripheral IV attempts have failed. The patient asks whether the IO will stay in “for days.”

	It stays in until your blood pressure normalizes, typically several days
	The IO is temporary, usually used for less than 24 hours until IV or central access is obtained
	We will remove it once antibiotics are completed, usually within 48–72 hours
	Yes, IO lines can remain safely for several days if kept sterile

During an IO flush in the distal tibia, a nurse notes increasing resistance and new swelling at the site. The patient grimaces with pain.

	Stop the infusion and assess for extravasation or compartment syndrome
	Continue flushing since pain is expected during saline push
	Increase pressure to overcome early marrow resistance
	Reposition the limb and continue infusion while monitoring

An unconscious cardiac arrest patient requires IO access. No family is present. Time is critical.

	Attempt verbal consent from bystanders for legal protection
	Proceed but document that consent was “not applicable” in emergencies
	Proceed under implied consent and document emergency conditions
	Delay insertion until family can be reached for consent

Preparing for proximal humeral IO placement in an unstable patient:

	Prepare equipment sequentially during insertion to save time
	Choose the needle after insertion once depth is estimated
	Skip sterile draping if the procedure is emergent
	Prime IV tubing, attach pressure system, and have flush ready before insertion

A pediatric patient needs proximal tibial IO. What consideration is most important?

	Use the longest needle available
	Insert slightly distal to avoid the tibial tuberosity
	Avoid the epiphyseal growth plate during landmarking
	Angle the needle 30° cephalad

During transport after humeral IO placement, the limb shifts and the site leaks fluid.

	Stop the infusion, reassess stability, and abandon if needed
	Tighten the dressing and continue infusion
	Increase pressure to maintain flow
	Tape the limb firmly and continue

Which documentation detail is most essential to prevent unsafe repeat IO attempts?

	Whether the patient tolerated the procedure
	The exact site and bone used for each attempt, including unsuccessful ones
	Whether marrow aspiration was achieved
	The type of fluids administered

You need rapid IO infusion but have no pressure bag in a low-resource setting.

	Rely on gravity flow
	Substitute pressure with rapid boluses of undiluted meds
	Delay infusion until equipment becomes available
	Inflate a manual BP cuff around the IV bag to generate pressure

A hypotensive but conscious patient is anxious about IO pain. Best communication approach?

	It won’t hurt at all; the needle bypasses nerves
	Pain is expected but unavoidable, so we’ll proceed quickly
	There may be discomfort, especially during flush; we’ll use slow flush and analgesia if feasible
	Most patients feel no pain; it’s just pressure

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Keywords	surgery, health
SDG	SDG03 Good health and well-being
Authors	Global Surgical Training Challenge
License	CC-BY-SA-4.0
Organizations	WACS, SELF
Language	English (en)
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Redirects	WACS Training Modules/Intraosseous Access/IO Module Test
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Created	November 16, 2025 by KatKor
Last edit	March 9, 2026 by Ian-laurel
Cite as	KatKor (2025–2026). "SELF/Intraosseous Access/IO Module Test". Appropedia. Retrieved June 4, 2026.
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