Crush Injury and Rhabdomyolysis
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First Things First (assess & treat for the following)
- Rhabdomyolysis is a constellation of pathophysiologic changes resulting from injury to skeletal muscle w/ the resultant release of intracellular contents (including myoglobin). Can result from both traumatic & atraumatic causes. Most common causes: alcohol, drug abuse, overexertion, seizure, compression or crush syndrome.
- Traumatic causes
- Cold salt water near-drowning, crush syndrome, prolonged compression (eg, splints), ischemia, postexertional, seizures, heatstroke, malignant hyperthermia, electric shock/burns, prolonged CPR, decerebrate posturing
- Nontraumatic causes
- Medical disorders: peripheral blood stem cell transplantation, status asthmaticus, addisonian crisis, Becker muscular dystrophy, Duchenne muscular dystrophy, pancreatitis
- Metabolic disorders: myophosphorylase deficiency, phosphofructokinase deficiency, carnitine palmitoyltransferase deficiency, phosphoglycerate mutase deficiency, myoadenylate deaminase deficiency, DKA, nonketotic hyperosmolar coma, hyperthyroidism/hypothyroidism, sickle cell trait
- Electrolyte deficiency: hypokalemia, hypophosphatemia, hypomagnesemia, severe hyponatremia
- Inflammatory muscle disease: polymyositis, dermatomyositis, arteritis/vasculitis, idiopathic paroxysmal myoglobinuria
- Infection: CMV, EBV, adenovirus, Streptococcus pneumoniae, bacteremia, hepatitis, influenza/coxsackie viruses, shigellosis, salmonellosis, gram-negative septic shock, Legionella, leptospirosis, Rocky Mountain spotted fever, trichinosis, tetanus, gangrene, HIV
- W/ history of trauma, maintain high index of suspicion if pt entrapped for prolonged length of time (>4 hrs).
- If the result of trauma, begin w/ ATLS algorithm (chapter 1.4). Will need large-bore IV access & Foley catheter.
- Begin NS (wide open) to avoid additional potassium & begin to replace third-spaced fluid. Administer 2 L for adults or 20 cc/kg for children as initial volume.
- Place on cardiac monitor. Cardiac arrest at scene may occur secondary to hyperkalemia.