Crush syndrome: Difference between revisions
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==Management== | ==Management== | ||
===Prehospital Proticol for Entrapment Lasting >4hrs or Suspicion of [[Hyperkalemia]]=== | ===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 | *In the field, use of tourniquet before extrication is controversial | ||
==Disposition== | ==Disposition== | ||
Revision as of 06:34, 13 September 2015
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
Clinical Features
Differential Diagnosis
Diagnosis
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