A construction worker is extricated after 6 hours under collapsed debris. He is alert with extensive thigh ede…

Question

A construction worker is extricated after 6 hours under collapsed debris. He is alert with extensive thigh edema and tea-colored urine. Which intervention should the nurse anticipate as the immediate priority?

Accepted Answer

Option 1: Initiate aggressive isotonic IV crystalloid at 1 to 1.5 L/hr while monitoring urine output

Crush syndrome causes massive myoglobin release with AKI risk and life-threatening hyperkalemia. Immediate priority is aggressive isotonic crystalloid (1-1.5 L/hr initially, target urine output 200-300 mL/hr) to flush myoglobin and prevent AKI. IV calcium gluconate stabilizes the cardiac membrane in hyperkalemia, then insulin/dextrose and beta-agonists shift K, and potassium binders or dialysis remove K. Adding KCl is contraindicated. Tourniquets are not indicated and can worsen ischemia. Withholding fluid worsens AKI and hyperkalemia.

Answer

Option 2: Administer IV potassium chloride to replace presumed losses

Answer

Option 3: Apply tourniquets above the affected extremities to prevent toxin release

Answer

Option 4: Withhold fluids until creatinine returns to baseline

A construction worker is extricated after 6 hours under collapsed debris. He is alert with extensive thigh edema and tea-colored urine. Which intervention should the nurse anticipate as the immediate priority?

In-depth explanation

Clinical scenario

Key concepts

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A construction worker is extricated after 6 hours under collapsed debris. He is alert with extensive thigh edema and tea-colored urine. Which intervention should the nurse anticipate as the immediate priority?

In-depth explanation

Clinical scenario

Key concepts

Master the NCLEX-RN with MyMerci