Traumatic rhabdomyolysis (crush syndrome) in the rural setting
Objectives. We assessed identification and management of these patients, considering: (i) early adverse parameters used to identify poor prognosis, (ii) the importance of early recognition, and (iii) appropriate management with aggressive fluid therapy and alkaline diuresis to prevent progression to renal failure.
Methods. Diagnosis was based on clinical suspicion and haematuria. Exclusion criteria included a blood creatine kinase level <1 000 U/l on admission. Data captured included demographics, the offending weapon, time of injury and presentation to hospital, and admission laboratory results. Outcome measures included length of time in the resuscitation unit, and subsequent movement to the main ward or dialysis unit, discharge from hospital, or death.
Results. Forty-four patients were included in the study (41 male, 3 female), all presenting within 24 hours of injury: 27 were assaulted with sjamboks or sticks, 43 were discharged to the ward with normal or improving renal function, and 1 patient died.
Conclusions. Serum potassium, creatinine, and creatine kinase levels were important early parameters for assessing CS severity; 43 patients (98%) had a favourable outcome, owing to early recognition and institution of appropriate therapy – vital in the absence of dialysis services.
K J Rosedale, CT1 Anaesthetics, UK
D Wood, Chief Specialist, Emergency Medicine
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Date published: 2011-12-14
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