Crush Injuries

Question 1

Crush injuries are also known as

Answer 1

traumatic rhabdomyolysis

Question 2

Define crush injury

Answer 2

prolonged compression (usually 4 to 6 hours but can occur in less than 1) of large muscle mass and compromised local circulation.

Question 3

Which two complications from crush injuries can have devastating effects on the myocardium?

Answer 3

metabolic acidosis and hyperkalemia

Question 4

Cardiac arrest from hyperkalemia typically occurs within ___ of removal from compression. Because of this treatment for crush injuries/compartment syndrome should _____________.

Answer 4

1 hour

prior to patient removal from compression.

Question 5

What are the 5 Ps of crush injuries / compartment syndrome?

Answer 5

Pain, pallor, paresthesia, poikilothermia, pulselessness

Question 6

What does poikilothermia mean?

Answer 6

cold skin

Question 7

What are the 4 parts of the EMT portion of this protocol?

Answer 7

Initial assessment, assess for signs of trauma (c-spine), assess respiratory effort and mental status, place patient on pulse ox/oxygen.

Question 8

What are the Paramedic’s Pre-extrication steps?

Answer 8

advanced airway, cardiac monitor, serial 12 leads, establish 2 IVs, administer 500mL normal saline bolus or 20mL/kg if pt. trapped more than an hour, administer maintenance infusions of 5ml/kg/hr after initial bolus, consider fentanyl, place but don’t tighten tourniquet around entrapped extremity, administer sodium bicarb if trapped more than 30 minutes just before release, prepare for significant hemorrhage and cardiac arrest.

Question 9

What is the dose of sodium bicarbonate?

Answer 9

1.0 mEq/kg IVP

Question 10

What is your dosage for fentanyl?

Answer 10

1 to 3 mcg/slow IVP

Question 11

What are the paramedic’s post extrication steps?

Answer 11

Immobolize if indicated, assess PMS before and after immobilization, for crush injury/entrapment with signs of hyperkalemia shown on 12 lead administer calcium chloride, transport

Question 12

Calcium chloride dosage and precautions

Answer 12

1 g slow IVP. Has to be put through different IV than sodium bicarb because it will form a precipitate.

Question 13

Suspect hyperkalemia if:

Answer 13

T waves become peaked, QRS becomes prolonged, P wave becomes absent, or hypotension develops

Question 14

What are the benefits of administering IV fluids in these patients?

Answer 14

minimizes potential of obstruction of renal tubules, dilutes concentration of myoglobin, and keep the kidneys working.

Question 15

What is a big advantage of sodium bicarb administration?

Answer 15

keeps the urine alkalotic and assists in renal tubule obstruction.