crush injury Flashcards
What is the recommended action if there is a significant risk of asphyxiation?
The weight must be released as soon as possible.
What is the maximum time to delay weight release while preparing for release syndrome?
Up to 20 minutes.
What should be done if the limb(s) are trapped under a weight?
Apply a tourniquet on the limb(s) if possible.
What is the minimum volume of 0.9% sodium chloride to be administered?
A minimum of two litres.
What should be monitored continuously during this situation?
The cardiac rhythm.
When should continuous nebulised salbutamol be administered?
Approximately ten minutes prior to release of the weight.
What is the IV administration protocol during weight release?
Administer 100 ml of 8.4% sodium bicarbonate, a large flush of 0.9% sodium chloride, and 6.8 mmol of calcium chloride.
What should be done if signs of hyperkalaemia persist or recur?
Administer further doses of 8.4% sodium bicarbonate and calcium chloride.
What is the role of tranexamic acid in this protocol?
Administer 2 g of tranexamic acid IV.
What should be done with the patient after initial treatment?
Transport the patient direct to a major trauma hospital whenever feasible and safe.
What is a crush injury?
Occurs when tissue is crushed underneath a heavy object with subsequent muscle damage.
What factors determine the degree of damage in a crush injury?
The amount of tissue crushed, the weight of the object, and the length of time the weight is in place.
What is release syndrome?
A combination of severe shock, acidosis, hyperkalaemia and dysrhythmia that occurs immediately after weight release.
What conditions must be met for release syndrome to occur?
A significant amount of tissue must be crushed and the weight must be in place for at least one hour.
What occurs to muscle cells during prolonged crush?
Ischaemia and subsequent cell death lead to the release of acid, myoglobin, and potassium.
What are the consequences of reperfusion after weight release?
Fluid moves into the crushed area causing hypovolaemia, and acid, myoglobin, and potassium enter circulation.
What can potassium cause in the context of release syndrome?
Severe dysrhythmia, including cardiac arrest.
What is the role of inflammatory mediators after weight release?
They may cause severe pulmonary oedema and impaired oxygenation.
How do tourniquets help in crush injuries?
They contain toxic products and help control bleeding.
What is the purpose of pre-loading with sodium chloride?
Increases intravascular volume, dilutes released products, and protects cardiac cell membranes.
What is the function of salbutamol in this treatment?
Stimulates beta-2 receptors to lower potassium concentration in blood.
How does sodium bicarbonate protect cardiac function?
Helps protect cell membranes, raises blood pH, and reduces myoglobin deposition.
When should tourniquets be re-evaluated?
Following release of the weight.
What should be ensured between administering calcium and sodium bicarbonate?
An adequate flush to prevent precipitation.
Is amputation commonly required in crush injuries?
Amputation is only rarely required.
