3-11 CRUSH INJURY

Notes:

• For patients < 18 years old, contact medical control for management recommendations.

EMR/EMT - EMERGENCY MEDICAL RESPONDER

1. Provide routine medical care as indicated.
2. Oxygen – High Flow, assist with ventilations as indicated.
3. Treat for signs and symptoms of shock as indicated.
4. Control bleeding as indicated.
5. Spinal Motion Restriction as indicated.
6. If pulseless, treat for cardiac arrest as indicated.

EMT- EMERGENCY MEDICAL TECHNICIAN

PERFORM/CONFIRM ALL ABOVE INTERVENTIONS

1. Assure ALS intercept is en route.
2. Apply ECG monitor & run strip (if trained, if time allows, and after all other interventions are completed).
3. Perform 12-lead ECG (if trained) as indicated.
4. Monitor for signs of hyperkalemia:

1. Peaked T-waves
2. Widened QRS complex
3. Lengthening QT interval
4. Absent P-waves

AEMT – ADVANCED EMERGENCY MEDICINE TECH

PERFORM/CONFIRM ALL ABOVE INTERVENTIONS

1. Initiate IV/IO.
2. Administer NS fluid bolus, 1,000 mL wide open (do not delay transport).

INTERMEDIATE/PARAMEDIC

PERFORM/CONFIRM ALL ABOVE INTERVENTIONS

1. Address pain per Pain Management and/or Trauma-Prolonged Extrication Guidelines.
2. For crush injuries lasting GREATER THAN 2 HOURS, and with EKG/monitor evidence for HYPERKALEMIA (Peaked T-waves, Absent P-waves, Widened QRS complex), administer:
   1. Albuterol 5mg in 6ml normal saline via nebulizer
   2. Sodium Bicarbonate 1mEq/kg IV, delivered over sixty (60) seconds
   3. Calcium Chloride 1gm IV
   4. NOTE: Flush the IV tubing well between injections when administering Calcium Chloride and Sodium Bicarbonate in sequence. When these drugs are mixed, a milky precipitate (calcium carbonate) may result.
3. Special Considerations:
   1. Monitor for signs of Compartment Syndrome (severe swelling/tightness of an extremity with loss of pulses/sensation).
      1. Usually requires compression for 6+ hours.
   2. Tourniquets should only be used for hemorrhage control.

Contact Medical Control if a physician is needed at the scene for surgical extrication.