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
- IO access provides rapid vascular access in a variety of emergency situations.
- There are several types of IO devices that can be used.
- The humeral site is generally the least painful and quickest to access
- All resuscitation and anaesthetic drugs can be given via the IO route.
- Fluids need to be administered under pressure.
- All devices need to be monitored and a clear handover given.
|Airway||Intubate → Ventilation tidal volume @ 6-8 mL/kg|
|Place OG or NG tube|
|Confirm endotracheal and OG/NG tube placement with chest x-ray|
|Breathing||SpO2 goal >94% → adjust PEEP & FiO2 to achieve goal|
|EtCO2 goal 30-40 mmHg → adjust respiratory rate to achieve|
|Circulation||12-lead ECG → Activate cardiac catheterization lab for STEMI; consult cardiology for all other patients|
|SBP goal >90 mmHg (MAP > 65 mmHg) → Use fluids, norepinephrine infusion, then epinephrine infusion to achieve goal|
|Place central line|
|Place arterial line|
|Perform point of care ultrasound with the cardiac, lung, and IVC views|
|Send labs, which includes an arterial blood gas and serum lactate|
|Place Foley catheter → Goal urine output 0.5-1 mL/kg/hr|
|Consider CT chest angiography to rule-out a pulmonary embolism|
|Disability||Begin cooling → Goal temperature 32–36°C|
|Consider head CT|