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Mon Aug 27 01:46:32 BST 2007

Your patient probably most closely resembles those with myonecrosis.  An
example would be a patient who is so drunk that the falls down and lays in
spot for hours.  It would seem that muscle damage would be the main problem.

I'm not sure that one crystalloid solution will be the magic bullet.  The
patient should be resuscitated with any balanced solution.  Frequent lab
draws will guide your therapy in this patient.  Because you will need to
watch the potassium closely I would start with NS.  I would get frequent
CK's also.  Once the CK's have turned the corner and start trending down you
can back off the forced diuresis.  

Hope that he does well. 

E

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Author - Letter to America
Asheville, NC
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Sa'ad Lahri
Sent: Saturday, August 25, 2007 3:45 PM
To: trauma-list at trauma.org
Subject: crush injury

requesting opinions and possible suggestion for management

A 25
y old man was caught by members of his community for stealing chickens. He
was beaten with a belt (community assault) and arrived to hospital with
his relatives.

his back, both arms and thighs were bruised.

couple of questions regarding crush injury?
how do you
estimate severity? do you use % body surface area involved?
How
useful is CK measurement?
what type of fluid is used?
ringers/saline?

kind regards
Sa'ad

Dr Sa'ad
Lahri 
Emergency Medicine Registrar 
UCT/US 
Cape Town 
South Africa

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crush injury