Q: Trauma victims with crush injury may die of ventricular fibrillation on evacuation from the rubble. What is the reason behind such an acute event?
Answer: Extremity reperfusion and hyperkalemia
When a trapped extremity is released from the rubble at the disaster site, it causes immediate release of potassium from tissues and leads to acute severe hyperkalemia resulting in ventricular fibrillation. The objective of the above question is to emphasize the need to rapidly initiate non-potassium containing intravenous fluid (IVF), evaluation of EKG to determine peaked T waves, and any other treatment needed to counter this hyperkalemia. A massive load of calcium to counter this hyperkalemia is discouraged. Some experts advise prophylactic administration of oral potassium resin binders.
In the past tourniquets have been placed above crushed extremities to counter this acute release of potassium but evidence shows that it's not helpful rather may cause further damage to already ischemic tissues.
1. Sever MS, Erek E, Vanholder R, et al. Lessons learned from the Marmara disaster: Time period under the rubble. Crit Care Med 2002; 30:2443.
2. Sever MS, Vanholder R, Lameire N. Management of crush-related injuries after disasters. N Engl J Med 2006; 354:1052.
3. Sever MS, Erek E, Vanholder R, et al. Serum potassium in the crush syndrome victims of the Marmara disaster. Clin Nephrol 2003; 59:326.