MedBugs: SAQ #50

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Case: Prehospital entrapment

You are the retrieval doctor at a pre-hospital scene where there has been a single-occupant rollover MVA. The driver has been trapped for 2 hours by extensive compression of both legs by dashboard and steering column intrusion. He has chest and head injuries with GCS 7.

1. What are the potential physiologic consequences of rapid release of this patient’s legs? 2 marks

2. What therapies could you use to mitigate these pathophysiological consequences? 3 marks

On arrival at the nearby trauma centre, concerns are raised about the possibility of a bilateral lower leg compartment syndrome.

3. Outline a technique for measuring compartment pressures. 3 marks

4. What pressure threshold would confirm suspicion of compartment syndrome? 1 mark

The pa ent’s CK is 7000 IU/L. The renal registrar wants you to start a mannitol infusion to reduce renal injury from tubular deposi on.

5. List (3) disadvantages or adverse effects of mannitol in this context. 3 marks

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