Tuesday, April 28, 2015

Prevention and treatment of acute kidney failure due to crush injury after natural disasters - a field guide

After head injuries and bleeding, the medical staff need to watch for and prevent hyperkalemia (causes arrhytmias), myoglobinuria and myoglobinemia (cause acute renal failure), hyperphospatemia, hypocalcemia, acidosis and later on, onset of compartment syndrome in victims of crush injuries whose muscles were crushed or compressed by rubble. These can begin to set in soon after extrication of the victim from rubble when circulation is restored, and the intracellular potassium and myoglobin from crushed tissue enter the circulation.

Follow the field guide produced by the International Society of Nephrology Renal Disaster Relief Task Force, published in the journal Nephrology Dialysis Transplantation(2012). Screenshots of relevant flowcharts embedded as images for quick reading. The information here is reproduced with kind permission from the International Society of Nephrology.




Step 1. IV or subcutaneous fluids before extrication under the rubble 
(avoid potassium containing fluids)

Step 2. Primary Survey in the Field

Step 3. Assessment in the Field

Step 4. Treatment after Extrication

Table: IV fluids for use in Crush Victims

Recommendations for the management of crush victims in mass disasters, short field version, by the International Society of Nephrology Renal Disaster Relief Task Force (published in Nephrology Dialysis Transplantation, 2012; vol 27, suppl 1). PDF file with the treatment guidelines.

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