Difference between revisions of "Crush syndrome"
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==Background== | ==Background== | ||
| − | + | Also known as traumatic rhabdomylosis | |
| − | + | ===Criteria=== | |
| − | + | #Involvement of muscle mass | |
| + | #Prolonged compression of 4-6 hours but possible in <1 hr | ||
| + | #Compromised local circulation | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
| − | * | + | *Hypovolemic [[shock]] |
**Third spacing of fluids | **Third spacing of fluids | ||
| − | *Metabolic acidosis | + | *[[Metabolic acidosis]] |
| − | **Hyperkalemia | + | **[[Hyperkalemia]] |
| − | **Hyperphosphatemia | + | **[[Hyperphosphatemia]] |
| − | **Hypocalcemia | + | **[[Hypocalcemia]] |
| − | **Rhabdo and | + | **[[Rhabdo]] and [[Renal Failure]] |
| + | |||
| + | ==Clinical Features== | ||
| + | *Skin trauma or local signs of compression over a muscle mass | ||
| + | **Erythema, ecchymosis, bullae, abrasion | ||
| + | *Tense muscle mass | ||
| + | |||
| + | ==Differential Diagnosis== | ||
| + | {{Extremity trauma DDX}} | ||
| + | |||
| + | ==Evaluation== | ||
| + | ===Work Up=== | ||
| + | *CBC | ||
| + | *Chem 10 | ||
| + | *CK | ||
| + | *Urine dip and UA | ||
| + | *Strict I&Os | ||
| + | *[[ECG]] | ||
| + | *Imaging as indicated by injury | ||
| + | *Compartment pressure monitoring for suspected [[Compartment syndrome]] | ||
| + | |||
| + | ===Results=== | ||
| + | One or more of these should be found in the right clinical setting | ||
| + | *Myoglobinuria and/or hematuria | ||
| + | *Peak CK (typically >10,000) | ||
| + | *Oliguria (<400ml/24hrs) | ||
| + | *Elevated BUN (>40) | ||
| + | *Elevated creatinine (>2.0) | ||
| + | *Elevated uric acid (>8) | ||
| + | *[[Hyperkalemia]] (>6) | ||
| + | *Hyperphosphotemia (>8) | ||
| + | *Hypocalcemia (<8) | ||
==Management== | ==Management== | ||
| − | ===Prehospital | + | ===Prehospital Protocol 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 | ||
| + | |||
| + | ===ED Management=== | ||
| + | *ATLS | ||
| + | *Aggressive IVF | ||
| + | *Treat [[Hyperkalemia]] with typical management | ||
| + | |||
| + | ===Extended Management=== | ||
| + | *250ml IV bolus q15min until UOP is 2ml/kg/hr | ||
| + | *[[Lasix]] or [[Mannitol]] for forced diuresis | ||
| + | *[[Acetazolamide]] for pH >7.5 | ||
| + | |||
| + | ==Disposition== | ||
| + | *ICU | ||
| + | *Intermediate Care or Floor for minor cases | ||
==See Also== | ==See Also== | ||
| − | *[[Compartment | + | *[[Compartment syndrome]] |
*[[Rhabdomyolysis]] | *[[Rhabdomyolysis]] | ||
*[[Disseminated Intravascular Coagulation (DIC)]] | *[[Disseminated Intravascular Coagulation (DIC)]] | ||
| + | ==References== | ||
| + | <references/> | ||
[[Category: EMS]] | [[Category: EMS]] | ||
[[Category: Trauma]] | [[Category: Trauma]] | ||
Latest revision as of 01:33, 2 September 2019
Contents
Background
Also known as traumatic rhabdomylosis
Criteria
- Involvement of muscle mass
- Prolonged compression of 4-6 hours but possible in <1 hr
- Compromised local circulation
Pathophysiology
- Hypovolemic shock
- Third spacing of fluids
- Metabolic acidosis
Clinical Features
- Skin trauma or local signs of compression over a muscle mass
- Erythema, ecchymosis, bullae, abrasion
- Tense muscle mass
Differential Diagnosis
Extremity trauma
- Compartment syndrome
- Contusion
- Crush syndrome
- Degloving injury
- Fracture
- Laceration
- Myositis ossificans
- Open joint injury
- Peripheral nerve injury
- Rhabdomyolysis
- Tendon injury
- Vascular injury
Evaluation
Work Up
- CBC
- Chem 10
- CK
- Urine dip and UA
- Strict I&Os
- ECG
- Imaging as indicated by injury
- Compartment pressure monitoring for suspected Compartment syndrome
Results
One or more of these should be found in the right clinical setting
- Myoglobinuria and/or hematuria
- Peak CK (typically >10,000)
- Oliguria (<400ml/24hrs)
- Elevated BUN (>40)
- Elevated creatinine (>2.0)
- Elevated uric acid (>8)
- Hyperkalemia (>6)
- Hyperphosphotemia (>8)
- Hypocalcemia (<8)
Management
Prehospital Protocol 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
ED Management
- ATLS
- Aggressive IVF
- Treat Hyperkalemia with typical management
Extended Management
- 250ml IV bolus q15min until UOP is 2ml/kg/hr
- Lasix or Mannitol for forced diuresis
- Acetazolamide for pH >7.5
Disposition
- ICU
- Intermediate Care or Floor for minor cases