Crush syndrome

Background

• >4-6 hours to develop
  • Rare cases with severe compression can develop <1 hr
• Starts after blood flow is restored

Pathophysiology

• Hypovolemic shock
  • Third spacing of fluids
• Metabolic acidosis
  • Hyperkalemia
  • Hyperphosphatemia
  • Hypocalcemia
  • Rhabdo and Renal Failure

Management

Prehospital Proticol for Entrapment Lasting >4hrs or Suspicion of Hyperkalemia

• Should begin BEFORE extrication
  • Cardiac monitoring
  • Hydration (~NS 1.5 L/hr)
  • Pain control
  • Albuterol neb
  • Calcium Chloride
    • 1 gram slow IV push over 60 sec
  • Sodium Bicarbonate
    • Flush IV with NS (prevent precipitation), then
    • 1mEq/kg added to 1L of normal saline, run IV wide open just prior to extrication
  • Release compression
• In the field, use of tourniquet before extrication is controversial.

See Also

• Compartment syndrome
• Rhabdomyolysis
• Disseminated Intravascular Coagulation (DIC)