Crush syndrome

(Redirected from Crush injury)

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
  • Tense muscle mass

Differential Diagnosis

Extremity trauma

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

See Also

References

Authors:

Ross Donaldson