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

• Normal Saline up to 1,000 mL IV

 

Signs of hyperkalemia:

 

peaked T waves and QRS > 0.12 ?

 

• Yes

 

• • Calcium Gluconate 10-20 mL IV

 

• • Normal Saline 100 mL IV

 

• • Sodium Bicarbonate 1 mEq/kg IV

 

• • if IV unavailable, Albuterol (Ventolin) 5 mg via nebulizer

 

• • See Pain Management Protocol

 

• No

 

• • See Pain Management Protocol

 

• • 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.