Understanding & Establishing Intraosseous Access
Intraosseous (IO) access is an alternative method to providing venous administration of drugs and fluids. Commonly used by the military and pre-hospital medics, intraosseous access has expanded its use to a variety of settings: in the emergency department, at cardiac arrests, in the paediatric population, and is gaining popularity in adult settings where intravenous access is challenging or time critical.
Length of Study: 50 min
Aminosteroids are a group of steroids with a similar structure based on an amino - substituted steroid nucleus.   They are neuromuscular blocking agents , acting as competitive antagonists of the nicotinic acetylcholine receptor (nAChR), and block the signaling of acetylcholine in the nervous system .    These drugs include candocuronium iodide (chandonium iodide), dacuronium bromide , dihydrochandonium , dipyrandium , malouetine , pancuronium bromide , pipecuronium bromide , rapacuronium bromide , rocuronium bromide , stercuronium iodide , and vecuronium bromide .  
The γ- cyclodextrin derivative sugammadex (trade name Bridion) has been recently introduced as a novel agent to reverse the action of rocuronium.  Sugammadex has been in use since 2009 in many European countries; however, it was turned down for approval twice by the US FDA due to concerns over allergic reactions and bleeding,  but finally approved the medication for use during surgical procedures in the United States on December 15, 2015.  Neostigmine can also be used as a reversal agent of rocuronium but is not as effective as sugammadex. Neostigmine is often still used due to its low cost compared with sugammadex.