Review Question - QID 106383

This patient presents with a likely crush injury following prolonged stasis after traumatic injury. Hyperkalemia must be treated immediately with calcium gluconate.

Traumatic patients often have multiple injuries, and thus the role of the emergency physician and trauma team is often to triage what must be managed first. Occasionally, the most gruesome injuries (ex: open fractures) may not actually be the most life threatening. In patients with crush injury, hyperkalemia is often present, and must be dealt with immediately and often in parallel with resuscitation efforts, as if left untreated it can result in deadly cardiac arrhythmias. Treatment of hyperkalemia includes immediate cardiac stabilization with calcium carbonate followed by potassium reduction via agents such as insulin (with glucose), beta agonists, and kayexalate.

Figure A demonstrates an open tibia-fibula fracture. Figure B demonstrates the typical EKG findings with peaked T waves seen in hyperkalemia.

Incorrect answers:
Answer 1: While an open fracture is indeed an orthopedic emergency and thus will require prompt surgical fixation, cardiac stabilization and treatment of hyperkalemia must be completed prior to surgical correction.
Answer 3: Surgery is not the first step in management. Furthermore, consent is not needed in emergency situations.
Answer 4: While an open fracture is indeed an orthopedic emergency and thus will require prompt stabilization and ultimately surgical fixation, cardiac stabilization and treatment of hyperkalemia must be completed prior to surgical correction.
Answer 5: While insulin is used to treat hyperkalemia and will reduce potassium, calcium gluconate must be given first to stabilize the cardiac membranes.