Difference between revisions of "Crush syndrome"

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

Background

Also known as traumatic rhabdomylosis

Criteria

  1. Involvement of muscle mass
  2. Prolonged compression of 4-6 hours but possible in <1 hr
  3. Compromised local circulation

Pathophysiology

Clinical Features

  • Skin trauma or local signs of compression over a muscle mass
    • Erythema, ecchymosis, bullae, abrasion

Differential Diagnosis

Extremity trauma

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

Disposition

See Also

References