DIAGNOSIS
■ Elevated creatine phosphokinase (>5 times normal) is the most sensitive
marker.
■ Myoglobinuria is pathognomonic, but is rapidly cleared.
■ UA with blood on urine dipstick, but minimal RBCs on microscopic
evaluation
■ Electrolyte abnormalities include hypocalcemia (most common), hyper-
phosphatemia, hyperkalemia.TREATMENT
■ Mainstay of therapy is aggressive hydrationwith crystalloid that does not
contain potassium.
■ Intravenousbicarbonateto urine pH > 6.5 to enhance renal myoglobin
clearance (uncertain benefit)
■ Consider mannitol to maintain urine output.
■ All cases require admission to follow and treat metabolic abnormalities.COMPLICATIONS
■ Acute renal failure
■ DIC
■ Metabolic abnormalities (especially hyperkalemia)
■ Compartment syndrome
■ Peripheral neuropathyPeripheral Vascular InjuriesMECHANISMS
■ Occlusive (complete loss of distal perfusion)
■ Transection (most common vascular injury)
■ Thrombosis
■ Reversible spasm
■ Nonocclusive (some perfusion remains)
■ Intimal flap
■ AV fistula
■ PseudoaneurysmSYMPTOMS/EXAM
■ Hard findings (90% chance of injury)
■ Pulsatile bleeding
■ Audible bruit
■ Palpable thrill
■ Expanding/pulsatile hematoma
■ Cyanosis
■ Decreased temperature
■ Soft findings (up to 35% chance of injury; most do not require emergent
repair)
■ Diminished pulse/BP when compared with uninjured extremity
■ Isolated peripheral nerve injury (next to vasculature)
■ Large nonpulsatile hematomaTRAUMA
In rhabdomyolysis, hydration
and alkalinization of urine
(pH > 6.5) prevent renal
failure by preventing
precipitation of myoglobin in
the urine.Cases in which you give
intravenous bicarbonate:
■Rhabdomyolysis
■Salicylate toxicity
■Tricyclic antidepressant
toxicity
■Hyperkalemia with acidosis
■Severe acidosis