Crush syndrome

Background

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

Pathophysiology

• Hypovolemic shock
  • Third spacing of fluids
• Metabolic acidosis
  • Hyperkalemia
  • Hyperphosphatemia
  • Hypocalcemia
  • Rhabdo and Renal Failure

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

• Compartment syndrome
• Rhabdomyolysis
• Disseminated Intravascular Coagulation (DIC)