Page 142 - PJ MED OPS Handbook 8th 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, excessive physical exertion.

Signs and Symptoms:
1. Acute muscle pain (myalgias)
2. Muscle weakness, fever, malaise, nausea, vomiting
3. Tea-colored urine
4. Oliguria/anuria
Management:
1. Normal saline 1–2L bolus IV/IO followed by 500mL – 1L/hr
a. Avoid Ringer’s lactate due to the potassium content
b. Titrate to achieve target urine output of >200mL/hr
c. Monitor intake/output hourly. Consider Foley catheter to aid measuring output
2. Reassess vital signs and mental status frequently
3. Utilize cardiac monitoring if available
4. Potential Problems/Complications
a. Monitor for signs and symptoms of hyperkalemia (cardiac dysrhythmia, peaked T waves) –
administer 1g calcium and 40mEq sodium bicarbonate (1 ampule) IV/IO.
b. Persistent oliguria despite adequate fluid resuscitation
c. Avoid Lasix
d. Compartment syndrome – see Prolonged Field Care/Extended Care TTP

DISPOSITION:
1. Urgent evacuation.

140 n Pararescue Medical Operations Handbook / 8th Edition