Sir.—It is gratifying to see that the almost forgotten "virtues of emergency bone marrow infusions"1 have been brought to the attention of younger physicians who may not know of a way to administer drugs and fluids if intravenous access is unavailable.2 Since bone marrow instruments have not been stocked in large numbers of emergency rooms and pediatric wards during the past several decades, it is important for physicians to learn the technique of bone marrow infusion even when trephine instruments are not available.
However, methods that do not rely on removal of particles of bone by the trephine technique may permit entry of cortical fragments into general circulation, producing pulmonary emboli.3 If the sternal route is used in older children, an improper instrument or technique can perforate the heart, while the "safety features embodied in this [trephine] type of instrument obviate preventable deaths due to sternal
TURKEL H. Emergency Bone Marrow Infusions. Am J Dis Child. 1985;139(5):438-439. doi:10.1001/archpedi.1985.02140070012003