Crush syndrome: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
|||
| (5 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
Also known as traumatic rhabdomylosis | *Also known as traumatic rhabdomylosis | ||
===Criteria=== | ===Criteria=== | ||
#Involvement of muscle mass | #Involvement of muscle mass | ||
| Line 30: | Line 31: | ||
*Urine dip and UA | *Urine dip and UA | ||
*Strict I&Os | *Strict I&Os | ||
*ECG | *[[ECG]] | ||
*Imaging as indicated by injury | *Imaging as indicated by injury | ||
*Compartment pressure monitoring for suspected [[Compartment syndrome]] | *Compartment pressure monitoring for suspected [[Compartment syndrome]] | ||
| Line 42: | Line 43: | ||
*Elevated creatinine (>2.0) | *Elevated creatinine (>2.0) | ||
*Elevated uric acid (>8) | *Elevated uric acid (>8) | ||
*Hyperkalemia (>6) | *[[Hyperkalemia]] (>6) | ||
*Hyperphosphotemia (>8) | *Hyperphosphotemia (>8) | ||
*Hypocalcemia (<8) | *Hypocalcemia (<8) | ||
| Line 59: | Line 60: | ||
**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=== | ===ED Management=== | ||
| Line 69: | Line 70: | ||
*250ml IV bolus q15min until UOP is 2ml/kg/hr | *250ml IV bolus q15min until UOP is 2ml/kg/hr | ||
*[[Lasix]] or [[Mannitol]] for forced diuresis | *[[Lasix]] or [[Mannitol]] for forced diuresis | ||
*Acetazolamide for pH >7.5 | *[[Acetazolamide]] for pH >7.5 | ||
==Disposition== | ==Disposition== | ||
| Line 81: | Line 82: | ||
==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
- 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
- Metabolic acidosis
Clinical Features
- Skin trauma or local signs of compression over a muscle mass
- Erythema, ecchymosis, bullae, abrasion
- Tense muscle mass
Differential Diagnosis
Extremity trauma
- Compartment syndrome
- Contusion
- Crush syndrome
- Degloving injury
- Fracture
- Laceration
- Myositis ossificans
- Open joint injury
- Peripheral nerve injury
- Rhabdomyolysis
- Tendon injury
- Vascular injury
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