List Archives

Sun Aug 29 19:48:45 BST 2010

Treat the crush syndrome, but do not create a hypertension greater than the 
 pre injury blood pressure.   Do NOT OVERTREAT the possible crush  
syndrome.   Define your parameters you wish to achieve and the end  points of your 
treatment and then stick to your game plan.   

k

In a message dated 8/29/2010 1:44:47 P.M. Central Daylight Time,  
mvossak at yahoo.co.uk writes:

Dear  List Members,

How do you reconcile the benefits of permissive  hypotension with the need 
for a forced diuresis for a probable crush syndrome  in a polytrauma patient?

Hypothetical case: 20 year old male MVA from  rural hospital seen 6 hours 
after injury. BP 100/60, Pls 108, Hb 10. Bilateral  haemopneumothoraces 
drained. GCS 15/15 but restless. L temporal scalp  laceration sutured. R 
hemiparesis. Tender upper abdomen but not peritonitic.  Soft tissue injury torso. 
30ml tea coloured urine in bag, positive for dipstix  blood. You cannot get a 
CK in a reasonable time frame. Blood gas shows  metabolic acidosis.

Needs a head scan which will require a further  transfer.

Would you keep him dry to protect a possible solid viscus  injury, or start 
a forced diuresis to try to protect his  kidneys?

Granted that you might have missed the boat with a forced  diuresis by this 
time, what advice on fluid resuscitation would you give to  primary care 
physicians at district hospital level, assuming the whole  clinical picture 
was picked up?

Does anybody have experience of  permissive hypotension with long transfer 
times? Should priorities be  different in these patients?   

Looking forward to your  insights,

Miranda Voss
Worcester RSA.
Sent via my BlackBerry from  Vodacom - let your email find you!
--
trauma-list : TRAUMA.ORG
To  change your settings or unsubscribe  visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Fluid resuscitation - Rhabdomyolysis