Traumatic rhabdomyolysis ("crush syndrome")--updated 1989

In rescue operations for people trapped under fallen debris, i.v. replenishment of the massive internal fluid volume losses should be started as soon as physical contact has been established with the injured person. This should be followed by induced alkaline-mannitol diuresis. This regimen will stabilize the impaired hemodynamics, prevent myoglobinuric and hyperuricosuric renal failure, and correct the hyperkalemia and metabolic acidosis often seen in rhabdomyolysis. This treatment is effective even in individuals rescued after 28 h. Local treatment of the crushed limbs should be conservative. A closed injury should not be converted into an open one unless distal arterial perfusion has been compromised.