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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.

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