ORTHOPEDICS■ Monitor platelets, PT/PTT for early DIC.
■ Measure compartment pressures if compartment syndrome is suspected.
TREATMENT
■ Aggressive IV hydration:Administer isotonic fluid at a rate of 500 cc/hour
to produce a urine output of 2 cc/kg/hour.
■ Urinary alkalinizationto a pH of 6.5 or above with D5W with 2–3 amps
of NaHCO 3 to help solubilize the myoglobin and promote excretion; be
careful of worsening hypocalcemia
■ Diuretics (eg, mannitol) if patient is oliguric
■ Treat associated hyperkalemia if present.
■ Admit to telemetry unit for continued treatment and monitoring of fluids,
electrolytes, and renal function.
COMPLICATIONS
■ Renal failure
■ Electrolyte abnormalities: Hyperkalemia, hypocalcemia
■ Fluid overload
■ DIC
■ Compartment syndrome
OVERUSE SYNDROMESBursitis
Bursitis refers to any inflammation over any one of the body’s >100 bursae. It
is usually caused by overuse or local trauma and can be complicated by the
presence of infection. StaphylococcusandStreptococcusspecies account for
the vast majority of associated infections.
SYMPTOMS/EXAM
■ Swelling, tenderness over superficially located bursa, usually located near
a large joint (elbow, knee, shoulder, hip)
■ Common areas: Prepatellar(housemaid’s knee, pauper’s knee), olecranon
(student’s elbow), subacromial, trochanteric
■ Redness, warmth, and fever may signify an infection or associated cellulitis.
DIFFERENTIAL
Cellulitis, tendonitis, abscess, arthritis
DIAGNOSIS
■ Characteristic history and exam
■ Aspiration of the bursa may be necessary to establish diagnosis or presence
of infection.
TREATMENT
■ Ice, rest, elevation, compression
■ Steroid injection may be helpful but presence of infection must first be
eliminated.
■ Complete drainage via aspiration and oral antibiotics covering staphylo-
coccal and streptococcal species are usually adequate to treat an infected
bursitis.
Suspect rhabdomyolysis when
the urine dipstick test is
positive for blood but there
are no RBCs in the urine
microscopic exam.