Crush syndrome: Difference between revisions

 
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==Background==
==Background==
*>4-6 hours to develop
*Also known as traumatic rhabdomylosis
**Rare cases with severe compression can develop <1 hr
 
*Starts after blood flow is restored
===Criteria===
#Involvement of muscle mass
#Prolonged compression of 4-6 hours but possible in <1 hr
#Compromised local circulation


===Pathophysiology===
===Pathophysiology===
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==Clinical Features==
==Clinical Features==
*Skin trauma or local signs of compression over a muscle mass
**Erythema, ecchymosis, bullae, abrasion
*Tense muscle mass


==Differential Diagnosis==
==Differential Diagnosis==
{{Extremity trauma DDX}}
{{Extremity trauma DDX}}


==Diagnosis==
==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 >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
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**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
**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==
==Disposition==
*ICU
*Intermediate Care or Floor for minor cases


==See Also==
==See Also==
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==References==
==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