Difference between revisions of "Crush syndrome"
Neil.m.young (talk | contribs) |
Neil.m.young (talk | contribs) |
||
| Line 23: | Line 23: | ||
==Diagnosis== | ==Diagnosis== | ||
| + | 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== | ||
Revision as of 17:24, 26 December 2015
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
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
Diagnosis
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 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