Crush syndrome

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Background

  • >4-6 hours to develop
  • Starts after blood flow is restored
  • Cardiovascular shock
    • Third spacing of fluids
  • Metabolic acidosis
    • Hyperkalemia
    • Hyperphosphatemia
    • Hypocalcemia
    • Rhabdo and renal failure

Management

  • Prehospital Proticol for entrapment lasting longer than 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