Crush Injuries

 

History:

 

  • Previous medical history
  • Medications
  • Drugs
  • Entrapment/crushing >1 hour
  • 6 P's
    • Pain
    • Pallor/Paleness
    • Pulselessness
    • Paralysis
    • Paresthesia (tingling or burning sensation on skin
    • Poikilothermia (cool to touch)

 

 Significant Findings:

 

  • Entrapment/crushing of one or more large muscle extremity
  • Entrapment/crushing of pelvis
  • Absent pulse in extremity
  • Delayed capillary refill
  • Blanched skin in affected extremity
  • Diminished sensation
  • Extremity cold to touch
  • Differential:
  • Rhabdomyolysis
  • Drug overdose
  • Compartment syndrome
  • Hyperthermia
  • Spinal trauma

 

Treatment:

 

 

  • Oxygen

 

 

  • 12-Lead EKG

 

 

  • Initiate IV

 

 

Signs of hyperkalemia:

  • peaked T waves and QRS > 0.12 ?

 

  • Yes

 

 

 

 

 

 

 

 

 

    • if SBP ≥ 90 request Morphine 0.1 mg/kg IV/IM;  may repeat in 5 mins up to a max 10 mg

 

  • No

 

 

 

    • if SBP ≥ 90 request Morphine 0.1 mg/kg IV/IM; may repeat in 5 mins up to a max 10 mg

 

    • Notify receiving facility or contact Medical Control

 

 

PEARLS:

 

  • Fluid administration should be conducted prior to patient extrication.
  • Treatment may be compromised by confined space or MCI situation. Ideally, start treatment prior to release of compression.
  • Patients may become hypothermic even in warm environments.
  • Other injuries can cause compartment syndrome such as circumferential burns, pulmonary embolus, thrombosis, severe edema, etc.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NRP

National Registry Paramedic

NRP

National Registry Paramedic