D. Stabilize extremity. E. Introduce the intraosseous needle at a 90 degree angle, to the flat surface of the tibia. F. For manual insertion, pierce the bony cortex using a firm rotary or drilling motion (do not move needle side to side or up and down). A distinct change in resistance will be felt upon entry into the medullary space. G. Remove the stylet and confirm intramedullary placement by injecting, without marked resistance, 10 mL normal saline.
K. Monitor pulses distal to area of placement L. Monitor leg for signs of swelling or cool temperature which may indicate infiltration of fluids into surrounding tissues. M. For adult patients who awaken and have pain related to infusion, slowly administer SO - LIDOCAINE 40 mg IO. May repeat dose once at 20 mg LIDOCAINE IO. N. For pediatric patients with pain related to infusion, slowly administer SO - LIDOCAINE 0.5 mg/kg IO (max dose 20 mg).