Crush Syndrome Flashcards
what is the considered the best tx for a patient with crush injuries in the PFC setting?
IV/IO crystalloids, immediately, initial 2L bolus @ 1L/h; adjust to UOP >100-200mL/h
what are some options for fluids in the PFC setting for a crush injury when IV/IO fluids are not available?
oral intake of electrolyte solution
Rectal infusion of electrolyte solution (up to 500mL/h)
What is the goal UOP in the crush injury patient?
100-200mL/h
How can you evaluate for the presence of myoglobin in the urine if you do not have a lab available?
urine dipstick - erythrocyte/hemoglobin
monitor urine color
what lab value represent hyperkalemia?
> 5.5 mEq/L
What are some ECG signs that may indicate hyperkalemia?
sinus bradycardia peaked T waves lengthening PR interval prolonged QRS interval PVCs or runs of ventricular tachycardia Conduction block
What is considered the best treatment for hyperkalemia in the PFC setting?
calcium gluconate
insulin + D50
albuterol
sodium polystyrene sulfonate
How is calcium gluconate adminstered?
10mL (10%) IV over 2-3 minutes
What is the onset of effect and duration of calcium gluconate?
immediate onset
duration 30-60 minutes
How should insulin and glucose be administered?
10 units of regular insulin followed immediately by 50mL of D50 (onset 20 min, duration 4-6 hours)
How is albuterol administered to the crush injury patient?
12mL of albuterol sulfate solution (0.083%) in nebulizer, onset 30 minutes, duration 2 hours
how is sodium polystyrene sulfonate administered to the patient with a crush injury in the PFC setting?
15-30g suspended in 50-100mL liquid. oral or rectal.
what is the onset and duration of soidum polystyrene?
onset >2hours
duration 4-6 hours
what should be used to prevent injection in the crush injury patient in the PFC setting?
Ertapenem 1gm/IV/Day
