Prolonged Field Care Podcast 180: Crush Syndrome Deep Dive

In this conversation, Dennis and Doug discuss crush syndrome and the challenges it presents in dynamic environments such as natural disasters or man-made incidents. They emphasize the importance of scene safety and the need to assess and stabilize any other traumatic injuries before addressing crush syndrome. They also discuss the use of tourniquets and the potential risks and benefits associated with their application. The conversation covers the management of crush syndrome, including fluid resuscitation, monitoring for cardiac complications, and the use of calcium and sodium bicarbonate. They highlight the need for a comprehensive approach to diagnosis and treatment, considering factors such as time of response and the presence of other injuries. In this conversation, Dennis and Doug discuss the management of crush syndrome in a resource-limited setting. They cover topics such as tourniquet use, fluid resuscitation, potassium management, and the use of sodium bicarbonate. They also touch on wound management and the importance of antibiotics. The conversation concludes with a discussion on the use of insulin and dextrose, as well as albuterol, in managing cardiac instability. Overall, the conversation provides a comprehensive overview of the management of crush syndrome in a challenging environment.

Takeaways
Scene safety is paramount in crush syndrome situations, and rescuers should be aware of potential hazards such as secondary devices, unstable structures, and chemical releases.
Assessing and stabilizing any other traumatic injuries is crucial before addressing crush syndrome.
The use of tourniquets in crush syndrome is a topic of debate, and a protocol should be in place to reassess their necessity and remove them as soon as possible.
Fluid resuscitation is important in managing crush syndrome, and the amount and rate of fluid administration should be based on the patient's condition and available resources.
Monitoring for cardiac complications, such as arrhythmias and acidosis, is essential, and interventions such as calcium and sodium bicarbonate may be necessary.
A comprehensive approach to diagnosis and treatment is necessary, considering factors such as time of response and the presence of other injuries. Tourniquets can be used to manage crush syndrome in the lower extremities, but there is a risk of unnecessary amputations.
Fluid resuscitation is important in stabilizing the patient and increasing urine output.
Sodium bicarbonate can be used to manage metabolic acidosis and improve the effectiveness of vasopressors.
Calcium can be given to stabilize cardiac rhythm, and insulin and dextrose can be used to manage high potassium levels.
Albuterol can be used to treat respiratory acidosis, but it may be challenging to administer in a resource-limited setting.

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