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Crush injury — DIPIMC MCQ

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HardPre-Hospital TraumaCrush injuryDIPIMCDipIMC

A construction worker has been trapped with his leg crushed beneath a fallen concrete beam for four hours. He is conscious and the fire service are about to lift the load to release him.

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

Reveal the answer and explanation

Correct answer: B — Commence IV crystalloid before release and anticipate and monitor for hyperkalaemia

Explanation lettering: C = shown as A · A = shown as C · E = shown as D · D = shown as E

Prolonged crush carries a risk of reperfusion injury: on release, potassium, myoglobin, acid and other metabolites wash into the circulation and can cause hyperkalaemic cardiac arrest, while third-space losses cause hypovolaemia. Pre-loading with crystalloid before release and being ready to treat hyperkalaemia (calcium, then measures to shift potassium) is the priority. Releasing without fluid (D) risks sudden arrest, and potassium-containing fluid (C) is exactly wrong. Anticipate the metabolic insult of reperfusion before the load is lifted.

Reference: JRCALC Clinical Guidelines; ATACC