A crush injury happens when a body part is trapped under heavy weight, damaging muscle and blood vessels. When the weight is removed after a long time, potassium, acid and myoglobin flood the circulation and can cause cardiac arrest and kidney failure.
Key symptoms
- Pain or numbness in the trapped limb
- Swelling and tense skin
- Weakness or paralysis of the limb
- Dark urine later on
What you find on exam
- Scene safety and time trapped
- Pulses, sensation and movement below the injury
- Signs of compartment syndrome: severe pain, tense swelling
- Heart rate, blood pressure and cardiac rhythm
Tests
- Cardiac monitor and 12-lead ECG for peaked T waves
- Potassium, CK, kidney function and blood gas
- Urine for myoglobin and urine output
Treatment basics
- IV access and normal saline before the weight is removed
- Cardiac monitoring during and after release
- Treat high potassium: calcium, sodium bicarbonate, albuterol, insulin with dextrose
- Aggressive fluids to keep urine flowing
- Tourniquet if release causes severe bleeding; surgery for compartment syndrome
Red flags
- Peaked T waves, wide QRS or arrhythmia
- Low blood pressure after release
- Dark urine or very low urine output
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.