Fluid resuscitation

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Transfer times are unpredictable because an ambulance is usually not immediately available. However, the average delay between speaking to a GP and receiving the patient is 3-4 hours, it might be less but is often longer.

Ron, we don't have myoglobin assay available. We do creatine kinase in Worcester, district hospitals have to send labs to us and the specimen would probably arrive at the same time as the patient. If a patient had soft tissue injury >10%BSA and oliguria with tea coloured urine positive for blood/myoglobin, we would recommend they start a forced diuresis. Tim is right that microscopy would help to differentiate rhabdomyolysis from microscopic haematuria. I have no idea if they have microscopes in the district, must check.

Miranda
Worcester RSA

What kind of rural prehospital intervals are you discussing. Military is 2-3 hours

Norman

Professor, Tulane University, Surgery
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
New Orleans, Louisiana
504 988 5111


      

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