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Crush Syndrome — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaCrush SyndromeFRCA Final

A 32-year-old man weighing 75 kg has had his right leg trapped beneath a collapsed structure for 6 hours. Before release he is conscious, with a blood pressure of 110/70 mmHg. There is no catastrophic external haemorrhage, and his ECG shows no features of hyperkalaemia. Intravenous access has been obtained. Which intervention should be started before the limb is released?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Infuse IV 0.9% sodium chloride at 1–1.5 L/hour

The correct answer is E. Prolonged compression causes sequestration of fluid within damaged muscle and rhabdomyolysis. Releasing the limb may abruptly return potassium, acids and myoglobin to the circulation, causing hypotension, dysrhythmia and acute kidney injury. Isotonic crystalloid should therefore be started before extrication to restore circulating volume and support renal perfusion; NHS major-incident guidance permits rates up to 1.5 L/hour, with ongoing reassessment. A tourniquet is not routinely used for crush syndrome and is reserved for catastrophic haemorrhage. Calcium gluconate treats hyperkalaemic cardiotoxicity rather than being given routinely when the ECG is normal. Routine bicarbonate-driven alkaline diuresis is not required. Mannitol is not first-line pre-extrication therapy and may be harmful in hypovolaemia or established renal failure.

Reference: NHS England. Clinical Guidelines for Use in a Major Incident, version 2: Crush injury and crush syndrome, 2020. https://www.england.nhs.uk/wp-content/uploads/2018/12/B0128-clinical-guidelines-for-use-in-a-major-incident-v2-2020.pdf?sJUUAJ4Tml7=w9gofd0qiWyJkT1