Crush Injuries 

 

 

Considerations

 

  • Critically ill/trauma patient/ATLS

  • Co-existing traumatic injuries 

  • Complications of rhabdomyolysis:

    • Hyperkalemia, hyperphosphatemia, hypocalcemia, anion-gap metabolic acidosis

    • Myoglobinuria & renal failure

    • DIC (rare, can happen with severe rhabdomyolysis) 

 

 

Goals

 

  • ATLS resuscitation 

  • Treat underlying condition 

  • Prevention of hyperkalemia:

    • No succinylcholine

    • No potassium-containing fluids

    • Monitor K closely 

  • Prevention of acute tubular necrosis (ATN):

    • Start with 2L bolus NS then, isotonic fluid at ~500 cc/hr for 24 hours titrated to urine output of 200-300 cc/hr

    • Alkaline therapy: 3 amps of HCO3- in 1L D5W at 2x maintainence titrated to urine pH > 6.5 (generally, a total of 200-300 mEq of bicarbonate is given on the first day) 

      • Must monitor:

        • Serum bicarbonate/pH: do NOT allow serum pH >7.5

        • Calcium: severe hypocalcemia is a side-effect

        • Potassium

        • Urine pH

    • Mannitol 5 g/hr infusion for a total of 1-2g/kg per day maximum

    • Loop diuretics if volume overload

 

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