Crush syndrome


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



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