Crush syndrome: Difference between revisions

(Created page with "==Background== *>4-6 hours to develop *Starts after blood flow is restored *Cardiovascular shock **Third spacing of fluids *Metabolic acidosis **Hyperkalemia **Hyperphosphate...")
 
 
(31 intermediate revisions by 5 users not shown)
Line 1: Line 1:
==Background==
==Background==
*>4-6 hours to develop
*Also known as traumatic rhabdomylosis
*Starts after blood flow is restored


*Cardiovascular shock
===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
**Third spacing of fluids
*Metabolic acidosis
*[[Metabolic acidosis]]
**Hyperkalemia
**[[Hyperkalemia]]
**Hyperphosphatemia
**[[Hyperphosphatemia]]
**Hypocalcemia
**[[Hypocalcemia]]
**Rhabdo and renal failure
**[[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 Proticol for entrapment lasting longer than 4hrs or suspicion of hyperkalemia
===Prehospital Protocol for Entrapment Lasting >4hrs or Suspicion of [[Hyperkalemia]]===
**Should begin BEFORE extrication
''Should begin BEFORE extrication''
**Cardiac monitoring
*Cardiac monitoring
**Hydration (~NS 1.5 L/hr)
*Hydration (~NS 1.5 L/hr)
**Pain control
*Pain control
**Albuterol neb
*[[Albuterol]] neb
**Calcium Chloride
*[[Calcium chloride]]
***1 gram slow IV push over 60 sec
**1 gram slow IV push over 60 sec
**Sodium Bicarbonate
*[[Sodium bicarbonate]]
***Flush IV with NS (prevent precipitation), then
**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
****1mEq/kg added to 1L of normal saline, run IV wide open just prior to extrication
*Release compression
**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 syndrome]]
*[[Rhabdomyolysis]]
*[[Disseminated Intravascular Coagulation (DIC)]]


 
==References==
<references/>
[[Category: EMS]]
[[Category: EMS]]
[[Category: Trauma]]
[[Category: Trauma]]

Latest revision as of 03:10, 8 May 2021

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

Disposition

  • ICU
  • Intermediate Care or Floor for minor cases

See Also

References