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Crush injury — DipIMC MCQ

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HardPre-Hospital Trauma ManagementCrush injuryDipIMC

A builder has both legs trapped under concrete for 90 minutes. He is awake with severe leg pain and release is expected in 10 minutes. What is the most appropriate management?

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Correct answer: E — Establish IV access and start cautious crystalloid before limb release

Option E is correct because Prolonged entrapment creates crush syndrome risk, and early fluid before release can reduce metabolic and renal complications where feasible. Option C is less appropriate because watchful waiting risks deterioration or delays definitive care; option B is less appropriate because the clinical risk exceeds that destination or timeframe. Option D is less appropriate because it is plausible in a different scenario but suboptimal for the features described; option A is less appropriate because analgesia is important but not sufficient as the primary intervention. Clinical pearl: in DipIMC-style questions, the best answer is the intervention that changes outcome earliest in the pre-hospital phase.

Reference: ATACC Manual; JRCALC Guidelines