Difference between revisions of "Crush syndrome"

(Created page with "==Background== *>4-6 hours to develop *Starts after blood flow is restored *Cardiovascular shock **Third spacing of fluids *Metabolic acidosis **Hyperkalemia **Hyperphosphate...")
 
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==Background==
 
==Background==
 
*>4-6 hours to develop
 
*>4-6 hours to develop
 +
**Rare cases with severe compression can develop <1 hr
 
*Starts after blood flow is restored
 
*Starts after blood flow is restored
  
 +
===Pathophysiology===
 
*Cardiovascular shock
 
*Cardiovascular shock
 
**Third spacing of fluids
 
**Third spacing of fluids
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==Management==
 
==Management==
*Prehospital Proticol for entrapment lasting longer than 4hrs or suspicion of hyperkalemia
+
===Prehospital Proticol for Entrapment Lasting >4hrs or Suspicion of Hyperkalemia===
**Should begin BEFORE extrication
+
*Should begin BEFORE extrication
 
**Cardiac monitoring
 
**Cardiac monitoring
 
**Hydration (~NS 1.5 L/hr)
 
**Hydration (~NS 1.5 L/hr)

Revision as of 16:11, 3 October 2013

Background

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

Pathophysiology

  • Cardiovascular 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
      • Emergency Medicine Care Development
        • 1mEq/kg added to 1L of normal saline, run IV wide open just prior to extrication
    • Release compression

See Also