Page 274 - ATP-P 11th Ed

RHABDOMYOLYSIS PROTOCOL

SPECIAL CONSIDERATIONS

1. Aggressive hydration is the cornerstone of treatment.
2. Causes: Limb ischemia, Carbon Monoxide Poisoning, Electrical or thermal
burns, Blunt trauma or Crush injury, Snake Bite, Hyperthermia, Hypothermia,
Physical Exertion
SECTION 2 Signs and Symptoms

1. Acute muscle pain (myalgias)
2. Muscle Weakness
3. Fever
4. Malaise
5. Nausea or Vomiting
6. Tea-colored urine
7. Oliguria/Anuria
8. Dipstick positive for blood, but no intact RBC on a spun specimen
Management
1. Crystalloid 1–2L bolus IV/IO followed by 500mL–1L/hr
a. Maintain urine output at greater than or equal to 200mL/hr. If possible, insert Foley
catheter.
b. Consider urinary alkalinization to achieve urine pH >6.5
i. Mix sodium bicarbonate 40mEq (1 ampule/bristojet) in 500mL normal saline.
ii. Run at 100mL/hr.
2. Reassess vital signs and mental status frequently.
3. Utilize Propaq or AED cardiac monitoring if available.
®
4. Potential Problems/Complications:
a. Monitor for signs and symptoms of hyperkalemia (cardiac dysrhythmia) – ad-
minister 1g calcium and 40mEq sodium bicarbonate (1 ampule) IV/IO.
Calcium should not be given in bicarbonate containing solutions due to precipi-
tation of calcium carbonate.
Calcium chloride should be given SLOW IV push to prevent vein necrosis.
b. Persistent oliguria despite adequate fluid resuscitation
c. Hypocalcemia (provoked by sodium bicarbonate) – perioral tingling, muscle tetany,
increased deep tendon reflexes, QT prolongation on cardiac monitor – stop sodium
bicarbonate infusion.

264 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 265