Just Plain Ruff Posted February 4, 2008 Share Posted February 4, 2008 Taking this from a previous topic. You lift off the weight that has crushed the Oil workers legs - What do you want to do now. You can either be ALS or BLS - preferrably ALS care What are you gonna do. Be specific Link to comment Share on other sites More sharing options...
Ridryder 911 Posted February 4, 2008 Share Posted February 4, 2008 It all depends. The duration of transport, the amount of weight an degree of potential crushing injuries. Is there adequate circulatory and neuro involvement? Compartment syndrome involves swelling within the fascia and I know of no EMS performing emergency fasciotomy. Some however; initiate treatment for rhabdomyolysis. This is tricky because rhabdo is usually made of the CPK (>10k) and many EMS treat fluids and with NaHCo3 IV drip. The general treatment is to treat for potential fractures, pain management and possibility of cooling application to reduce swelling (dependent upon circulatory compromise). Personally, I cannot answer with a text book answer. There is too many variables. Depends again, if I am considering a true crushing trauma injury, or compartment syndrome from the swelling or potential rhabdo. R/r 911 Link to comment Share on other sites More sharing options...
Scaramedic Posted February 5, 2008 Share Posted February 5, 2008 Ummm isn't the scenario presented crush injury not compartment syndrome? Link to comment Share on other sites More sharing options...
JPINFV Posted February 5, 2008 Share Posted February 5, 2008 I fail to see how compartment and crush is mutually exclusive. Link to comment Share on other sites More sharing options...
chbare Posted February 5, 2008 Share Posted February 5, 2008 As stated, compartment syndrome is related to elevated pressures within the various facial tissue compartments. While a crush injury will increase the risk of compartment syndrome, many other injury types can precipitate compartment syndrome as well. Pre-hospital treatment of the injury above will likely revolve around supportive care, pain control, and isotonic fluids. With massive tissue disruption, byproducts of dead muscle will be released into the blood stream. This is the Rhabdo that Ridryder911 talked about. Renal failure, acidosis, and electrolyte abnormalities are primary concerns at this point. (assuming the ABC's are intact) Unless we have a highly progressive system, our treatment will still be supportive. Placing a foley catheter in addition to the other interventions if not contraindicated would be a very helpful intervention. Bicarb can be considered; however, without labs I would hesitate to use bicard in the pre-hospital setting unless we are looking at prolonged transport. Take care, chbare. Link to comment Share on other sites More sharing options...
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