Crush/Compartment syndrome.

[Flasurfbum]

I know that the chances of one actually treating this are rare, but other then Calcium Chloride, 1mEq/kq of Sodium BiCarb, with a maintence drip of .25mEq/kg/hr in d5W, what else can we do prehospitally to treat this?

[Timmy]

Drive fast!

[p3medic]

Tourniquet.

[Kaisu]

Tourniquet.

?????

Why would you apply a tourniquet? Compartment syndrome causes loss of distal circulation and risk of loss of limb. How would a tourniquet be beneficial? Wouldn't it just compound the problem?

[AZCEP]

Treatment will depend entirely on how long they are entrapped, and the amount of force that is applied.

Cardiac monitoring will clue you in to the possibility of cellular destruction and the resulting hyperkalemia. If kidney function is maintained, fluid boluses will help to flush the nephrotoxic materials out some.

Rapid transport is key.

[Flasurfbum]

Treatment will depend entirely on how long they are entrapped, and the amount of force that is applied.

Cardiac monitoring will clue you in to the possibility of cellular destruction and the resulting hyperkalemia. If kidney function is maintained, fluid boluses will help to flush the nephrotoxic materials out some.

Rapid transport is key.

So if flushing of the toxins out is key, would lasix be indicated?

[Kaisu]

?????

Why would you apply a tourniquet? Compartment syndrome causes loss of distal circulation and risk of loss of limb. How would a tourniquet be beneficial? Wouldn't it just compound the problem?

Once again I misread.. I read compartment didn't see crush - I agree with tourniquet for crush injuries AKA the "grateful dead syndrome".

[p3medic]

Yeah, he titled the thread crush/compartment syndrome. The TQ isn't helpful in the latter, but could be in the former.

[AZCEP]

So if flushing of the toxins out is key, would lasix be indicated?

Flushing the toxins is not "key", but maintaining kidney function is. With all of the electrolyte abnormalities that will be present adding a diuretic would be troublesome.

[akroeze]

So if flushing of the toxins out is key, would lasix be indicated?

My understanding is that Lasix is of no benefit. It inhibits reabsorption of Na at the loop of Henle keeping water in with it.... it does not force water out, it stops it from coming back in. Additionally the toxins do not permeate the membrane at that part of the tubule.