Soft Tissue Case 10 ED Management

ED treatment is primarily focused on aggressive fluid resuscitation with the goal of maintaining urine output at 2mL/kg/hr or 200-300mL/hr in order minimize acute ischemic kidney injury and limit intratubular cast formation. Other priorities are to identify and treat electrolyte abnormalities and complications like DIC and compartment syndrome. Urine alkalinization with sodium bicarbonate to prevent intratubular casts can be considered, however no trials have demonstrated benefit. Mannitol is not recommended, nor are loop diuretics unless there is concomitant hypervolemia.

Except for the mildest scenarios, admit cases for continued fluid administration and to monitor electrolytes, renal function, urine output, and CK clearance.