Crush syndrome

[Ridryder 911]

akroeze, I doubt that the physician would want to leave their practice or ER to treat, since this might even cause more trouble at the local ER. ALS response (helo) is not too uncommon. I suggest having a dispatch agreements with the local helo, and placing them on stand-by if needed. Pre-planning as much as possible is the key...

Sometimes you can only do what your resources allow.. life sucks..

R/R 911

[kevkei]

Tricyclic antidepressants, Barbituate od's, Same question applies. I know bicarb is the treatment for these emergencies, but would lasix help the problem faster.

Since the first question has been well represented (the issue is with excess potassuim from cellular death and release) I'd like to add to the second.

By treating with bicarb, the point is to alkanalize the plasma to force the free drug to become plasma bound. Alkanalizing the urine is a much better choice than non-potassium sparing diuretics. You run the risk of inducing significant hypokalemia. The bicarb will cause a shift in extracellular potassium intracellularly, plus the lasix will cause dumping of any remaining extracellular potassium through the proximal renal tubule. Keep in mind over 80% of the body's potassium is within the cells and that it shifts constantly via the sodium/potassium pump (this is why it's treated in crush injury/syndrome, because you get a mass efflux of the K+ as the cells break down and die - cellular lysis, plus the acidosis as well.)

[firefighter523]

Outstanding, thank you for the info. I forgot about the non-potassium sparing part of lasix..

[Dustdevil]

Kev, we need to save a link directly to your last post to use everytime somebody whines about how hard medic school is and asks if they really need to know all that biochemistry just to be a medic.

Excellent job.

[Ridryder 911]

Kev, we need to save a link directly to your last post to use everytime somebody whines about how hard medic school is and asks if they really need to know all that biochemistry just to be a medic.

Excellent job.

Ditto... Nice to see medics that actually understand emergency medicine... good job Kev..

R/R 911

[Ridryder 911]

Here is a link for a power point presentation with etilogy, and treatment etc.. for EMS

http://www.aanet.org/ems/info/CRUSH_INJURY...SH_SYNDROME.pdf

R/R 911

[firefighter523]

Thanks Rid for the link, very informative.

[Spock]

Sorry to resurrect an old topic (at least I didn't start a new one) but I have read what was posted and found it informative and supportive of what I already suspected. Great minds think alike. Anyway, I am looking for articles in peer review journals evaluating the effectiveness of the treatments mentioned. I have to update a crush injury protocol we developed last year but medical command never considered it because my service was the only one that would use it out of the 14 EMS agencies in this command system.

I strongly feel that treatment of crush injuries is very similar to the way we manage a patient during open AAA repairs and we use all the treatment modalities mentioned except albuterol. The biggest difference is the time of ischemia for the lower extremities which would be longer in the field as opposed to the OR.

Thanks for the help.

Live long and prosper.

Spock