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Objective |
Describe the clinical presentations common with crush injury.
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Crush Syndrome: Clinical Presentation
 #81
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The general condition of a patient with crush syndrome is dictated by: (1) other injuries, (2) delay in extrication, and (3) environmental conditions.
Common presentations are:
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#82
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The affected part is usually a limb that has:
tense edema and decreased sensation
overlying skin that may be shiny, contused, necrotic
There may be penetrating wounds as well (worse prognosis).
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Objective |
List the potential complications for crush syndrome.
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Crush Syndrome: Potential Complications
#83
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hyperkalemia
hypocalcemia
hyperphosphatemia
metabolic acidosis
hypothermia
acute renal failure
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Objective |
Explain the treatment (prehospital and initial hospital) for crush injury.
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Crush Syndrome: Treatment
#84 & 85
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The greatest initial danger follows the release of a crushed limb from entrapment and restoration of circulation. The mainstay of treatment is aggressive fluid resuscitation and brisk diuresis. Although the amount of tissue damage is correlated with the need for dialysis, the actual tissue damage cannot be determined based on area of the affected body part.
Delay in treatment is associated with greater morbidity and mortality. Specifically, there is 50% renal failure at 6 hours, 100% at 12 hours. Renal failure induced by rhabdomyolysis has a 40% mortality rate.
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Prehospital Treatment
#86
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Primary survey and initial stabilization (ABC’s)
Fluid resuscitation before patient is extricated with severe or prolonged entrapment of limb or pelvis (more than a hand or foot).
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Hospital Treatment
#87
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Monitor CVP, urine output
>12 L may be required in first 24 hours
Diuresis will help correct most metabolic derangements, including acidosis
Maintain high urine flow rate (300-500 cc/hour)
Urine alkalinization to pH>6.5 may prevent myoglobin deposits
Optimal diuretics: acetazolamide 500 mg IV (alkalinization), consider mannitol 1 g/kg IV
Diagnose and treat other metabolic derangements
Hyperkalemia
Fluid resuscitation
Calcium chloride IV (do not mix with sodium bicarbonate)
Sodium bicarbonate
Glucose (25 cc D50W) + regular Insulin 10 units
Kaylexalate exchange resin (slower acting)
Albuterol
Furosemide
Dialysis
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Hypocalcemia – usually does not require specific therapy
Free radicals (reduce injury to tissues and kidneys)
Deferoxamine (blocks Fe+++ induced cytotoxicity)
Renal failure
Fluid resuscitation
Dialysis
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