# 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?

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> language: en  
> subject: NCLEX-RN  
> category: PPT

## 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?

## Option

1. Initiate aggressive isotonic IV crystalloid at 1 to 1.5 L/hr while monitoring urine output **✔ Correct answer**
2. Administer IV potassium chloride to replace presumed losses
3. Apply tourniquets above the affected extremities to prevent toxin release
4. Withhold fluids until creatinine returns to baseline

**Correct answer: 1**

## Explanation

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.

## In-depth explanation

Urine alkalinization with bicarbonate is controversial — modern guidelines emphasize aggressive isotonic fluid as the proven mainstay. Mannitol is no longer routine.

## Clinical scenario

K 6.4, creatinine 2.4, CK 88,000. EKG with peaked T waves.

## Key concepts

- **rhabdomyolysis** — Skeletal muscle breakdown releasing myoglobin, K, phosphate, creatine kinase.
- **myoglobinuria** — Myoglobin in urine producing tea-colored or red-brown appearance.
- **crush syndrome** — Systemic effects of massive muscle injury including AKI, hyperkalemia, shock.

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