TMENT OF HEALTH SE
DEPART H ERVICES RAMEDIC, M
(PAR MICN)
Y A
COUNTY OF LOS ANGELES RENCE NO. 1273
REFER
ENT PROT
TREATME RUSH INJU
TOCOL: CR USH SYNDR
URY / CRU ROME
1. Basic airway
B
2. S
Spinal immob n/control blee
bilization prn eding prn
3. O e
Oxygen/pulse oximetry
4. A
Advanced air rway prn
5. C
Cardiac moni itor: docume rhythm and attach EC strip if dy
ent CG identified
ysrhythmia i
6. V
Venous access
7. For pain man nagement:
Morphine
M
2-12mg slow IV pus titrate to pain relief
sh,
4-12mg IM, if unable to obtain venous acce
v ess
Pediatr 0.1mg/kg slow IV pu or IM
ric: g ush
See Color Code Dru Doses/L.A. County K
ug Kids
8. E
ESTABLISH BASE CON NTACT (ALL L)
9. Fluid resuscit e ease of com pressive for to minimize hypovole
tate, hydrate prior to rele rce emia
and to dilute cellular toxin
c ns.
N
Normal Salin ne
20ml/kg IV bolus (adult and ped
g diatric)
hr nce
500ml/h maintenan fluid:
ric
Pediatr maintena ance fluid:
Weight up to 10kg: 4ml/kg/hr
Weight 10-20kg: 40 2 r
0ml/hr plus 2ml/kg/hr for each kg be nd
etween 10 an 20kg
Weight greater than 20kg: 60m
n ml/kg/hr for e
ml/hr plus 1 m ove
each kg abo 20 kg
10. If pain unrelie
f eved,
Morphine
M
2-12mg slow IV pus titrate to pain relief
sh,
4-12mg IM, if unable to obtain venous acce
v ess
May rep um ult mg
peat every 5min, maximu total adu dose 20m all routes
ric: g
Pediatr 0.1mg/kg slow IV pu or IMush
See Color Code Dru Doses/L.A. County K
ug Kids
Maximu pediatric total dose 4mg all route
um 4 es
11. Release compression and extricate patient
R p
12. f elease comp
If unable to re d
pression and situation p progresses to CRUSH SYNDROME
(e l er
entrapment lasting longe than 4hrs) or suspicio of hyperka
) on ked
alemia (peak T-waves s,
ves w
absent P-wav and/or widened QRS complex: S
A
Albuterol
5mg via continuous mask nebulization
a s
ric: or ug A.
Pediatr See Colo Code Dru Doses/L.A County Kiids
a
1yr of age or youn nger: 2.5mg
a r:
1yr of age or older 5mg
C
Calcium Chloride
1gram slow IV push over 60 sec
s h
Pediatrrics: See Co Code Drug Doses/L
olor L.A. County Kids.
g ush
20mg/kg slow IV pu over 60 sec s
um ose
Maximu single do 500mg
Flush IV tubing with normal saline prior to administ
V s um
tering sodiu bicarbo onate
to prevent precipit tation
S
Sodium Bica arbonate
kg 1 en
1mEq/k added to 1L of normal saline, run IV wide ope just prior to extrication
Pediatr : See Co Code Dr Doses/L .A. County K
rics olor rug Kids
kg 1
1mEq/k added to 1L of normal saline, adm ml/kg IV
minister 20m
13. Release compression and extricate patient
R p
TIVE DATE: 7-1-11
EFFECT F
PAGE 1 OF 2
SUBJECT: CRUSH INJURY/CRUSH SYNDROME REFERENCE NO. 1273
TREATMENT PROTOCOL: CRUSH INJURY / CRUSH SYNDROME
SPECIAL CONSIDERATIONS
Treatment may be compromised by confined space or MCI situation. Ideally, start
treatment prior to release of compression. Evaluate for early HERT notification as per
Ref. No. 817, Hospital Emergency Response Team. A HERT is utilized in a situation
where a life-saving procedure, such as an amputation, is required due to the inability to
extricate a patient.
Use with caution: in elderly; if SBP less than 100mmHg; sudden onset acute headache;
suspected drug/alcohol intoxication; suspected active labor; nausea/vomiting; respiratory
failure or worsening respiratory status
Absolute contraindications: Altered LOC, respiratory rate less than 12 breaths/min,
hypersensitivity or allergy
For example, the maintenance rate for a 15kg child is as follows:
40ml/hr + (2ml/kg/hr X 5kg) = 50ml/hr
For example, the maintenance rate for a 30kg child is as follows:
60ml/hr + (1ml/kg/hr X 10kg) = 70ml/hr
EFFECTIVE DATE: 7-1-11 PAGE 2 OF 2