Crush syndrome: Difference between revisions

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===Pathophysiology===
===Pathophysiology===
*Cardiovascular shock
*[[Cardiovascular 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]]

Revision as of 06:31, 13 September 2015

Background

  • >4-6 hours to develop
    • Rare cases with severe compression can develop <1 hr
  • Starts after blood flow is restored

Pathophysiology

Management

Prehospital Proticol 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.

See Also