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  • Print publication year: 2013
  • Online publication date: November 2013

Section 11 - Environmental emergencies

Summary

This chapter discusses the diagnosis, evaluation and management of rhabdomyolysis. Physical examination of a patient with rhabdomyolysis may reveal muscle swelling and tenderness, with occasional skin changes including discoloration, induration, and blistering. It is possible for rhabdomyolysis to present without any of these signs or symptoms, making serum markers essential to the diagnosis. Severe cases may present with hypovolemic shock, acute kidney injury (AKI), metabolic acidosis, disseminated intravascular coagulation (DIC), compartment syndrome, hyperkalemia, and cardiac arrhythmias. Compartment syndrome occurs due to swelling and edema of the injured muscle: classic physical examination findings include pain, paresthesias, paralysis, pallor, and pulselessness. The cornerstone of management includes discontinuation of inciting factors and aggressive management of fluid and electrolyte abnormalities. Intravenous fluids enhance renal perfusion and increase urinary flow in order to prevent AKI and increase potassium excretion.

References

AnchorJ, SettipaneRA. Appropriate use of epinephrine in anaphylaxis. Am J Emerg Med. 2004; 22: 488–90.
GavalasM, SadanaA, MetcalfA. Guidelines for the management of anaphylaxis in the emergency department. J Accid Emerg Med. 1998; 15: 96–8.
KanwarM, IrvinCB, FrankJJ, et al. Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution. Ann Emerg Med. 2010; 55: 341–4.
MarxJA, HockbergerRS, WallsRM, AdamsJ, RosenP, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th edn. Philadelphia, PA: Mosby Elsevier; 2010.

References

BeckerJA, StewartLK. Heat-related illness. Am Fam Physician. 2011; 83: 1325–30.
BoyerEW, ShannonM.The serotonin syndrome. N Engl J Med. 2005; 352: 1112–20.
GlazerJL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005; 71: 2133–40.
KennyGP, YardleyJ, BrownC, et al. Heat stress in older individuals and patients with common chronic diseases. CMAJ. 2010; 182: 1053–60.
KhoslaR, GuntupalliKK. Heat-related illnesses. Crit Care Clin. 1999; 15: 251–63.
MaromT, ItskovizD, LavonH, et al. Acute care for exercise-induced hyperthermia to avoid adverse outcome from exertional heat stroke. J Sport Rehabil. 2011; 20: 219–27.

References

ClineDM. Tintinalli’s Emergency Medicine Manual. 7th edn. New York: McGraw Hill; 2012.
MarxJA, HockbergerRS, WallsRM, AdamsJ, RosenP, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th edn. Philadelphia, PA: Mosby Elsevier; 2010.
McCulloughL, AroraS. Diagnosis and treatment of hypothermia. Am Fam Physician. 2004; 70: 2325–32.
MulcahyA, WattsM. Accidental hypothermia: an evidence based approach. Emerg Med Pract. 2009; 11: 1.
SawamotoK, TannoK, TakeyamaY, AsaiY.Successful treatment of severe accidental hypothermia with cardiac arrest for a long time using cardiopulmonary bypass – report of a case. Int J Emerg Med. 2012; 5: 9.

References

BoehnertMT, LovejoyFH. Value of the QRS duration versus the serum drug level in predicting seizures and ventricular dysrhythmias after an acute overdose of tricyclic antidepressants. N Engl J Med. 1985; 313: 474–9.
LevineM, NikkanenH, PallinDJ. The effects of intravenous calcium in patients with digoxin toxicity. J Emerg Med. 2011; 40: 41–6.
MarxJA, HockbergerRS, WallsRM, AdamsJ, RosenP, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th edn. Philadelphia, PA: Mosby Elsevier; 2010.
NelsonL, LewinNA, HowlandMA, HoffmanRS, GoldfrankLR, FlomenbaumNE, eds. Goldfrank’s Toxicologic Emergencies. New York: McGraw-Hill Medical; 2010.
RumackBH, MatthewH. Acetaminophen poisoning and toxicity. Pediatrics. 1975; 55: 871–6.
SmilksteinMJ, KnappGL, KuligKW, et al. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med. 1988; 319: 1557–62.
TintinalliJE, StapczynskiJS, ClineDM, et al. eds. Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill Medical; 2011.