|
#19
●
09-24-2021, 02:36 PM
| ||||||||
| My Rank: LANCE CORPORAL Poster Rank:2606 Join Date: Apr 2016 Posts: 163 Mentioned: 0 Post(s) Quoted: 53 Post(s)
| ||||||||
|
Re: Man Crushed in Work Accident
1. RESCUE FROM ENTRAPMENT CAN MAKE A PATIENT WORSE Many crush syndrome patients get worse after extrication from entrapment. Reperfusion of ischemic tissues spreads cellular toxins into the circulatory system. 2. ASSESSMENT OF CRUSH SYNDROME The primary cause of crush syndrome is injury to sarcolemma, which is the fiber covering muscles. This leads to water entry into muscle cells, increased pressure in the muscle compartment and disruption in cellular function. Cellular death releases myoglobin into circulatory system, which eventually leads to kidney injury. Local assessment findings for crush syndrome include pain out of proportion, swelling, bruising and weakness. Worrisome systemic findings are tea-colored urine, fever, malaise, nausea and vomiting, confusion, agitation, delirium and anuria, which is the inability to produce urine. Hospital diagnosis of crush syndrome includes elevated CK and lactic acid, grossly swollen, hard, cold, insensitive, necrotic muscle tissues, arrhythmias from the complications of electrolyte imbalances and shock. 3. EMS CRUSH SYNDROME PROTOCOL The focus of prehospital providers is to assure ABCs and deliver supportive care. In addition, initiate aggressive IV fluid administration, while the patient is still entrapped, at 1500 mL/hour. Rapid extrication, pain management and EKG are also important EMS treatment components. Paramedic level care, especially for long crush syndrome patients with long transport times, includes attempting to alkalize the patient's urine by administering sodium bicarbonate. A patient pH of > 6.5 helps protect kidney function. |