Crush Injury/Rhabdomyolysis

Table of Contents

Aliases

Crush, compartment syndrome

Patient Care Goals

1. Recognizing traumatic crush injury mechanism
2. Minimize systemic effects of the crush syndrome

Patient Presentation

Inclusion criteria

Traumatic crush mechanism of injury

Exclusion criteria

Non-crush injuries

Patient Management

Assessment

1. Identify any severe hemorrhage
2. Assess airway, breathing, and circulation
3. Evaluate for possible concomitant injury (e.g. fractures, solid organ damage, or spinal injury)
4. Monitor for development of compartment syndrome

Treatment and Interventions

1. The treatment of crushed casualties should begin as soon as they are discovered
2. If severe hemorrhage is present, see Extremity Trauma/External Hemorrhage Management guideline
3. Administer high-flow oxygen
4. Intravenous access should be established with normal saline initial bolus of 20 ml/kg (max of 1L) (prior to extrication if possible)
5. For significant crush injuries or prolonged entrapment of an extremity, consider sodium bicarbonate 1 mEq/kg (maximum dose of 50 mEq) IV bolus over 5 minutes
6. Attach cardiac monitor. Obtain/interpret 12-lead EKG, if available. Carefully monitor for dysrhythmias or signs of hyperkalemia before and immediately after release of pressure and during transport (e.g. peaked T waves, wide QRS, lengthening QT interval, loss of P wave)
7. For pain control, consider analgesics [see Pain Management guideline]
8. Consider the following post extrication
   1. Continued resuscitation with normal saline (1L for adults, 20 cc/kg for children)
   2. If EKG suggestive of hyperkalemia, administer IV fluids and consider administration of:
      1. Calcium chloride (10%) – 20 mg/kg or 0.2 mL/kg (max of 1 gm) slow IVP
      2. Albuterol 10 mg via small volume nebulizer
   3. If not already administered, for significant crush injuries with EKG suggestive of hyperkalemia, administer sodium bicarbonate 1 mEq/kg (max dose of 50 mEq) slow IVP

Notes – Crush Injury/Rhabdomyolysis