sandra
Forum Guru
Topics: 178
Posts: 422
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22. A 25-year-old man is brought to the emergency
department after being pinned beneath a steel
girder for 3 hours when a building collapsed. His
pulse is 140/min, respirations are 22/min, and
blood pressure is 80/60 mm Hg. He has extensive
soft-tissue crush injuries of both thighs without
fractures. There are no other obvious injuries.
After intravenous administration of 3 L of lactated
Ringer solution, his pulse is 110/min, respirations
are 20/min, and blood pressure is 100/70 mm Hg.
Insertion of a Foley catheter produces 30 mL of
dark, wine-colored urine; test of the urine for
myoglobin is positive. In addition to continued
hydration, which of the following is the most
appropriate next step in management?
(A) Intravenous administration of
hydrochloric acid until urine pH is less
than 4.0
(B) Intravenous administration of mannitol
(C) Continuous infusion of dopamine
(D) CT scan with oral and intravenous
contrast
(E) Arteriography
please explain ur answer
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| dr.wad
Forum Senior
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B
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| farnsworth
Forum Newbie
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Posts: 165
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B
a lot about crush injury-induced acute renal failure (ARF) was learned after the earthquakes in Kobe (Japan, 1995), the Marmara region (1999), Iran (2003), Pakistan 2005 etc. Patient received NSS initially (10-15mL/kg/h), hypotonic saline with 50mEq bicarbonate to each 2nd (or 3rd) liter. When diuresis is restore (>20mL/h), 1-2g/kg/d (not exceeding 120g/d) mannitol may be added.
In volume depleted pts mannitol can provoke ARF!
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| Adam
Forum Senior
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Posts: 137
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B.
We should also alkalinize the urine by bicarbonate, to prevent uric acid stones.
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| sherry39
Forum Junior
Topics: 3
Posts: 105
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eeeeeeeeeeeee...as pulse is still high beside perfusion..thigh injury predispose to vasculer injury ruled out by arteriography
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