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Crush syndrome — DIPIMC MCQ

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HardPre-Hospital TraumaCrush syndromeDIPIMCDipIMC

A construction worker has been trapped under a collapsed wall with his legs crushed for over three hours. Extrication is imminent. He is alert with stable observations at present. Which intervention is most important before the crushing force is released?

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

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Correct answer: D — Establish intravenous access and begin generous crystalloid fluids before release

Reperfusion after prolonged crush can release potassium, myoglobin and acid into the circulation, precipitating hyperkalaemic cardiac arrest and acute kidney injury, so aggressive intravenous crystalloid started before release is the key intervention. Withholding fluids increases this risk, and giving potassium is dangerous. Tourniquets are not routinely used and may worsen ischaemia. Pearl: anticipate hyperkalaemia with ECG monitoring and have calcium, and measures to shift potassium, ready at the moment of release.

Reference: JRCALC Clinical Guidelines; ATACC