Treating crush

Safety will be of initial importance as the likelihood is that a patient or patients suffering crush injuries/syndromes will be in a hazardous environment.

A primary survey of the patient is required to identify and treat any life-threatening injuries/symptoms that the patient may be suffering with. Due to the nature of the event, it is likely that there will be multiple significant injuries that will need correcting to keep the patient haemodynamically stable.

Consider Catastrophic tourniquets loosely applied above trapped limbs in a readied position for potential haemorrhage for when the patient is released.

IV fluids prior to release are also important as a measure to help against any hypovolaemia, hyperkalaemia, and metabolic acidosis. There are multiple guidelines available in regards to fluid treatment and crush syndrome depending on your trust and local guidelines. It usually involves a large bolus of fluid prior to the release of the compressive force.

After releasing the patient from the compressive object, their condition can deteriorate very suddenly and rapidly. It is important to have completed a primary survey and treated deficits, have given fluids, have monitoring equipment and extrication devices/route ready. Analgesia may assist with the extrication process and will help with the patient’s comfort.

Within the environment, specialist clinical support and services would likely be on scene/heading to the scene, if not, specialist support would be recommended.