8.4. CRASH SYNDROME

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Absent.

The purpose of providing EMD

1. Recognize the mechanism of crash syndrome.
2. Minimizing the systemic effects of the crash syndrome.

Inclusion criteria

Injury causing crash syndrome.

Exclusion criteria

Absence of crash syndrome in the patient.

Management of the patient

Status assessment

1. Detection of any massive bleeding.
2. Assessment of airway patency, breathing and circulation.
3. Assessment of the presence of multiple injuries (fractures, damage to internal organs, spine).
4. Monitoring to detect the development of crash syndrome.

Treatment and intervention

1. Treat patients with crash syndrome as soon as it is detected.
2. In the presence of massive bleeding, act according to the guideline “Injury of the limbs/Control of external bleeding”.
3. Carry out oxygen therapy.
4. Provide IV access and start bolus infusion therapy in a volume of 10-15 ml/kg (if possible before starting the patient’s release process).
5. In case of severe injury or prolonged stay of the limbs under blockages, enter sodium bicarbonate 1 mEq/kg (max dose – 50 mEq) intravenously as a bolus for 5 min.
6. Attach a heart monitor. Record and interpret 12-lead ECG readings, if possible. Be alert for the development of arrhythmias or signs of hyperkalemia before and after evacuation of the embolus and during transport (eg, peaked T waves, wide QRS complex, long QT intervals, disappearance of the P wave).
7. Use analgesics for pain relief (see the instruction “Pain control”).
8. Procedure of actions after discharge of the patient:

a) continue infusion resuscitation (500-1000 ml/h for adults, 10 ml/kg/h for children);
b) if the ECG indicates the presence of hyperkalemia , conduct IV infusion with the addition of:

• • • • calcium chloride – 1 g IV or IV for 5 min, ensure IV patency and do not exceed 1 ml/min
        OR
      • calcium gluconate – 2 g IV or IV for 5 minutes with constant monitoring of heart rhythms;

c) if you have not previously administered, in case of severe crash syndrome and the presence of signs of hyperkalemia on the ECG, administer sodium bicarbonate 1 mEq/kg (maximum dose – 50 mEq) intravenously in a bolus for 5 minutes;
d) if there are signs of hyperkalemia on the ECG, use salbutamol 5 mg through a small nebulizer.

Patient safety

Scene safety is very important for both the EMD specialist and the patient.

Useful information for training

Causes of mortality due to lack of treatment in crash syndrome:

a) instant:

• • • • severe head injury;
      • traumatic asphyxia;
      • trunk injury with damage to the internal organs of the chest or abdomen;

b) early:

• • • • hyperkalemia (potassium is released from damaged muscle cells);
      • hypovolemia/shock;

c) late:

• • • • kidney failure (due to the release of toxins by damaged muscle cells);
      • coagulopathy and bleeding;
      • sepsis.

Key points

1. Quick release and hospitalization in a hospital (preferably a trauma center).
2. Crash trauma patients may not show many signs and symptoms in the early stages. Therefore, you should have a high level of suspicion in any patient with crash syndrome.
3. A fatal complication of crash syndrome is hyperkalemia. Suspect the presence of hyperkalemia in the presence of peak T-waves, wide QRS complexes (longer than 0.12 seconds), absence of P-waves, presence of long QT segments.
4. Avoid the use of a combined medicine containing sodium chloride + potassium chloride + sodium lactate + calcium chloride because it contains potassium.
5. Continue infusion resuscitation during evacuation and transport to the hospital.< /li>

Corresponding evaluation results

1. State of consciousness/number of points according to SHKG.
2. Evaluation of fractures and potential development of compartment syndrome (neurovascular status of the injured limb).
3. Examination of the spine.
4. Evidence of additional trauma, potentially masked by other painful injuries with a pronounced pain sensation.

Key elements of documentation

1. Time of applying a hemostatic tourniquet (if applied).
2. Neurovascular status of the injured limb.
3. ECG data indicating hyperkalemia.
4. The volume of injected liquids.

Criteria for the effectiveness of aid provision

1. Start liquid resuscitation before starting evacuation.
2. Using an EKG/heart rate monitor to monitor for arrhythmias or changes associated with hyperkalemia.
3. Treatment of potassium after its detection on ECG.