Difference between revisions of "Crush syndrome"

(Prehospital Proticol for Entrapment Lasting >4hrs or Suspicion of Hyperkalemia)
Line 24: Line 24:
 
**Sodium Bicarbonate
 
**Sodium Bicarbonate
 
***Flush IV with NS (prevent precipitation), then
 
***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
****1mEq/kg added to 1L of normal saline, run IV wide open just prior to extrication
 
 
**Release compression
 
**Release compression
  

Revision as of 16:12, 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
      • 1mEq/kg added to 1L of normal saline, run IV wide open just prior to extrication
    • Release compression

See Also