CRUSH INJURIES
ALL LEVELS
DESIGNATION OF CONDITION
Compression of extremities or other parts of the body for >1 hr that causes muscle swelling and/or neurological disturbances in the affected areas of the body. Crush syndrome is localized crush injury with systemic manifestations.
EMPHASIS ON PATIENT CARE
Crush injury is very painful, see PAIN MANGEMENT GUIDELINES. EKG changes associated with hyperkalemia: peaked T waves, QRS > 0.12, loss of P wave, “bizarre” wide complex. Patients may easily become hypothermic.
1. Assess the scene for safety. Do not enter area until it has been determined safe for the EMT to have immediate contact with patient.
2. Control exsanguinating hemorrhage
3. Primary Management - Assess ABC’s and manage as indicated.
4. Evaluate for spinal restriction
5. Treat for shock
6. Check distal pulses frequently
AEMT:
1. Establish IV fluid therapy and provide bolus prior to releasing the crushed body part
a. 1-2 L NS/LR bolus then titrate for hypotension.
2. Goal to maintain SBP greater than 90.
PARAMEDIC:
1. If patient is entrapped for longer than 60 min infuse NS at 1000ml/hr and give 1 amp of Sodium Bicarbonate
2. Provide appropriate pain control.
3. May give MIDAZOLAM 2.5 mg IV/IO/IM/IN for anxiety. Repeat as needed.
4. Apply EKG and monitory for EKG changes and hyperkalemia. See HYPERKALEMIA in Medical Section.
ALL LEVELS
DESIGNATION OF CONDITION
Compression of extremities or other parts of the body for >1 hr that causes muscle swelling and/or neurological disturbances in the affected areas of the body. Crush syndrome is localized crush injury with systemic manifestations.
EMPHASIS ON PATIENT CARE
Crush injury is very painful, see PAIN MANGEMENT GUIDELINES. EKG changes associated with hyperkalemia: peaked T waves, QRS > 0.12, loss of P wave, “bizarre” wide complex. Patients may easily become hypothermic.
1. Assess the scene for safety. Do not enter area until it has been determined safe for the EMT to have immediate contact with patient.
2. Control exsanguinating hemorrhage
3. Primary Management - Assess ABC’s and manage as indicated.
4. Evaluate for spinal restriction
5. Treat for shock
6. Check distal pulses frequently
AEMT:
1. Establish IV fluid therapy and provide bolus prior to releasing the crushed body part
a. 1-2 L NS/LR bolus then titrate for hypotension.
2. Goal to maintain SBP greater than 90.
PARAMEDIC:
1. If patient is entrapped for longer than 60 min infuse NS at 1000ml/hr and give 1 amp of Sodium Bicarbonate
2. Provide appropriate pain control.
3. May give MIDAZOLAM 2.5 mg IV/IO/IM/IN for anxiety. Repeat as needed.
4. Apply EKG and monitory for EKG changes and hyperkalemia. See HYPERKALEMIA in Medical Section.