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Trauma

CRUSH SYNDROME

Signs and Symptoms: Complications:
• Entrapped extremity (as little as 1hr) • Hyperkalemia
• Erythema, ecchymosis, abrasion • Hypocalcemia
• Swelling, tense muscle compartment • Compartment Syndrome
• Rhabdomyolysis
• Arrhythmia
• Hypotension
Continued From: Treatment for Hyperkalemia
Tactical Evacuation Guideline
• Calcium: 30mL of 10% Calcium
Gluconate IV over 5 minutes or 10mL of
Consider Tourniquet placement for crush injury before 10% Calcium chloride IV over 2

extrication if the length of entrapment exceeds 1 hours and minutes
crush injury protocol cannot be initiated immediately. • Insulin and Glucose: Regular Insulin 5

units IV followed by D50 50mL IV.
r
Titrate p prn n
Apply two tourniquets side by side and proximal to • 10mg Nebulized Albuterol
the injury immediately before extrication.
Initiate crush injury protocol before extrication if possible and EXTRICATION! PRIOR TO
before loosening tourniquets (if tourniquet conversion indicated)
IV/IO Guideline

Initiate Aggressive Fluid Administration of IV/IO crystalloids
2L Initial bolus; followed by an initial rate: 1L/h

Adjust to urine output (UOP) goal of >100–200mL/h (Via Foley or
improvised graduated cylinder)
Monitor for life-threatening hyperkalemia If no signs of hyperkalemia
develop, continue fluid
(PVCs, bradycardia, peaked T-waves, decreased peripheral pulse administration and continuously
strength, hypotension)
monitor
If PVCs become more frequent, the patient develops bradycardia,
peripheral pulse strength decreases, or potassium levels are

>5.5mEq/L or rising, treat urgently for hyperkalemia.
Pearls:
• Crush syndrome can occur in as little as 1 hour of entrapment
• Tourniquets may delay life-threatening complications if fluid resuscitation and treatment cannot be immediately initiated

• Aggressive fluid resuscitation for Crush injury in the setting of noncompressible hemorrhage may increase hemorrhage. Balance the risk

of uncontrolled hemorrhage against cardiotoxic effects of hyperkalemia.

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