Complications and emergencies: crush injury resuscitation: practice question

A Anaesthesia 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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Anaesthesia · Complications and emergencies: crush injury resuscitation

Sample item

A man has been trapped under rubble for six hours, with both legs swollen, cold and pulseless. Rescuers are about to free him. Which measure should be started before the limbs are released?

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

The answer and the reasoning

A. Rapid intravenous isotonic saline infusion

Reperfusion of crushed muscle releases potassium, myoglobin and acid into the circulation and sequesters fluid in the injured limbs. Aggressive isotonic fluid resuscitation started before release protects against hypovolaemia, hyperkalaemia and myoglobin-induced renal failure.

Option by option

  • A. Rapid intravenous isotonic saline infusion (correct)

    Correct. Early large-volume isotonic fluid prevents shock and myoglobin deposition in the kidneys when blood flow is restored.

  • B. Intravenous furosemide to force a diuresis

    Diuretics given to a hypovolaemic patient worsen hypotension and renal injury.

  • C. Fluid restriction until urine output is established

    Restricting fluid leaves the patient hypovolaemic and promotes pigment nephropathy.

  • D. A single sodium bicarbonate bolus with no fluids

    Bicarbonate may be an adjunct, but without volume expansion it does not prevent shock or renal injury.

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.

More Anaesthesia questions

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Rapid intravenous isotonic saline infusion. Reperfusion of crushed muscle releases potassium, myoglobin and acid into the circulation and sequesters fluid in the injured limbs.

Why is "Intravenous furosemide to force a diuresis" not the answer?

Diuretics given to a hypovolaemic patient worsen hypotension and renal injury.

Why is "Fluid restriction until urine output is established" not the answer?

Restricting fluid leaves the patient hypovolaemic and promotes pigment nephropathy.

Why is "A single sodium bicarbonate bolus with no fluids" not the answer?

Bicarbonate may be an adjunct, but without volume expansion it does not prevent shock or renal injury.

What concept does this question test?

It tests Complications and emergencies: crush injury resuscitation in Anaesthesia. Aggressive isotonic fluid resuscitation started before release protects against hypovolaemia, hyperkalaemia and myoglobin-induced renal failure.

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 Complications and emergencies: crush injury resuscitation?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia 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.