Trauma: crush syndrome: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Trauma: crush syndrome

Sample item

A man is rescued after 8 hours under a collapsed wall with a crushed thigh. Shortly after release he becomes hypotensive, passes dark brown urine and his ECG shows tall peaked T waves. What is the most appropriate immediate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Aggressive intravenous isotonic saline with cardiac monitoring and treatment of hyperkalaemia

Crush injury releases myoglobin, potassium, phosphate and lactic acid from damaged muscle on reperfusion, causing hypovolaemia from third spacing, rhabdomyolysis with acute kidney injury, and fatal hyperkalaemia. Early aggressive intravenous isotonic saline (often started before release), ECG monitoring, calcium and insulin-glucose for hyperkalaemia, and fasciotomy for compartment syndrome are the main measures.

Option by option

  • A. Immediate amputation of the limb before any resuscitation

    Amputation is reserved for unsalvageable limbs and does not replace resuscitation.

  • B. Intravenous furosemide alone

    Diuretics alone in a hypovolaemic patient would worsen hypotension.

  • C. Aggressive intravenous isotonic saline with cardiac monitoring and treatment of hyperkalaemia (correct)

    Correct. Large volumes of fluid and hyperkalaemia treatment are the priority.

  • D. Restrict fluids to prevent pulmonary oedema

    Fluid restriction would cause renal failure from myoglobin and worsen shock.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Aggressive intravenous isotonic saline with cardiac monitoring and treatment of hyperkalaemia. Crush injury releases myoglobin, potassium, phosphate and lactic acid from damaged muscle on reperfusion, causing hypovolaemia from third spacing, rhabdomyolysis with acute kidney injury, and fatal hyperkalaemia.

Why is "Immediate amputation of the limb before any resuscitation" not the answer?

Amputation is reserved for unsalvageable limbs and does not replace resuscitation.

Why is "Intravenous furosemide alone" not the answer?

Diuretics alone in a hypovolaemic patient would worsen hypotension.

Why is "Restrict fluids to prevent pulmonary oedema" not the answer?

Fluid restriction would cause renal failure from myoglobin and worsen shock.

What concept does this question test?

It tests Trauma: crush syndrome in Orthopaedics. Early aggressive intravenous isotonic saline (often started before release), ECG monitoring, calcium and insulin-glucose for hyperkalaemia, and fasciotomy for compartment syndrome are the main measures.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Trauma: crush syndrome?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.