Crush Syndrome

ACTION/TREATMENT:

1. ABCs/monitor cardiac rhythm/spinal immobilization/control hemorrhage.

2. Protect the airway/oxygen via facemask for dust inhalation protection.

3. Wipe out mouth with damp cloth.

4. Provide a barrier protection mask, if O2 is not safe to administer, to act as a dust filter.

5. Advanced airway prn.

6. IV access in unaffected limb:

7. Normal saline 20 mL/kg up to 2 liters for fluid resuscitation, prior to release of compression force.

8. Psychological support.

9. Consider Albuterol for possible hyperkalemia (peaked T-waves or wide QRS > 0.12 seconds), wheezing or bronchospasm:

10. 3 ml (2.5 mg) of a 0.083% solution nebulized. May repeat.

11. Sodium bicarbonate (NaHCO3) 1 mEq/kg IVP. (FOR CRUSH SYNDROME)

12. Morphine sulfate for pain: 2-20 mg IVP titrated to pain, or 10 mg SQ one time.

13. Isolated extremity trauma. Not recommended for multi-system injury or systolic BP

14. Release compression and extricate patient.

15. Non-compressive splints/dressings prn.

16. Keep affected limb at level of the heart.

Pediatric:

1. IV access in unaffected limb:

2. Normal saline 20 ml/kg for fluid resuscitation, prior to release of compression force.

3. Consider Albuterol for possible hyperkalemia, wheezing or bronchospasm:

4. 3 ml (2.5 mg) of a 0.083% solution nebulized. May repeat.

5. Sodium bicarbonate (NaHCO3) 1 mEq/kg IVP. (FOR CRUSH SYNDROME)

6. Morphine sulfate for pain: 0.1 mg/kg slow IVP or SQ one time.

Note:

- Confined space and a MVI situation may compromise treatment. Ideally, treatment should be started prior to release of compression.
- Hydrate prior to release of compression to combat hypovolemia and to dilute cellular toxins.
- Contact hospital for determination; consider trauma receiving center.