Management of Crush Injury/Syndrome

Crush syndrome is a life and limb-threatening condition that can occur as a result of entrapment of the extremities accompanied by extensive damage of a large muscle mass. It can develop following as little as 1 hour of entrapment. Effective medical care is required to reduce the risk of kidney damage, cardiac arrhythmia, and death. Management includes;

  • Fluids: IV fluid to provide 1L/h for 24 to 48 hours (depending on evacuation availability)
  • Equipment: ECG, laboratory tests for serum potassium and urine myoglobin, Foley catheter with graduated collection system, tourniquets
  • Medications: hyperkalemia
  • Manage Pain
  • Give Antibiotics
  • Continuous monitor with portable monitor; 15-minute to hourly vital signs, examination, urine output documented on flow sheet

 

Ticking Time Bombs

Several of the conditions discussed here can easily be overlooked because they may present, at least initially, with non-concerning symptoms. However, they have the ability to cause serious harm. Remember,

  • Address abnormal vital signs or have a cohesive explanation as to why you are not addressing them.
  • Abnormal vital signs without a clear explanation, as well as vital signs that do not resolve with treatment, should prompt expanded consideration of the patient’s complaint, further investigation, and likely both.
  • Bad things happen and even healthy people get sick.