Page 137 - ATP-P 11th Ed

CRUSH SYNDROME PROTOCOL

SPECIAL CONSIDERATIONS SECTION 1
1. Be aware of development of crush syndrome starting as early as 4 hours post
injury.
2. There is a theoretical benefit from using non-potassium containing fluids due
to the increased risk of hyperkalemia, but the important goal is to establish ad-
equate renal output regardless of which fluid is available.
3. These medications are not part of the standard ATP aid bag and require develop-
ment of a separate crush injury kit.

The principles of hypotensive resuscitation according to TCCC DO NOT apply in
the setting of extremity crush injury requiring extrication.
In the setting of a crush injury associated with noncompressible (thoracic, ab-
dominal, pelvic) hemorrhage, aggressive fluid resuscitation may result in increased
hemorrhage.
With extremity injuries, tourniquets should NOT be applied during Phase 1 un-
less there is hemorrhage that is not controllable by other means.
Be aware of development of cardiac dysrhythmias due to hyperkalemia immedi-
ately following extrication.
Definition
Massive, prolonged crush injury resulting in profound muscle and soft tissue damage
places the patient at significantly increased risk for developing circulatory and renal
complications.
Management
PHASE 1: IMMEDIATE (while attempting extrication)
1. Maintain patent airway (NPA, OPA, etc.) and adequate ventilation.
2. Monitor O saturation with pulse oximetry and administer high flow oxygen if available.
2
3. Give initial bolus of 1–1.5L of any available crystalloid PRIOR to attempts at extrica-
tion and continue at 1.5L/hr.
4. Maintain urine output at greater than or equal to 200mL/hr. If possible, insert Foley
catheter.
5. Assess and reassess mental status.
6. Follow Pain Management Protocol (TMEP)
7. Consider prophylactic antibiotics—Ertapenem (Invanz ) 1g IV.
c
®
8. Utilize Propaq or AED cardiac monitoring if available.
PB SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 127