MCQ - crush injury

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Posted by Shreya from IP on April 27, 2012 at 18:09:03:

A 27 year old female was admitted last night by your fellow resident while on call. The pt had a crush injury to the right thigh yesterday afternoon at a construction site. Her initial labs include WBC 9000, Hb 14.5 , Hct 40, plt 450,000,Na 140, K 4.9 ,Cl 112 ,Co2 23 creatinine 1.3 ,uric acid 10.2. and CT of head is negative.On your exam this morning she has tenderness of the thigh with a bluish discoloration and moderate swelling of the right thigh. She was monitored overnight and is now ready for discharge. The nurse tells that she had a dark colored urine this morning which dipped positive for blood.What will you do now?

1. 0.9% normal saline 250cc/hr ,obtain a complete urin analysis.
2. 2.0.9% normal saline 250cc/hr stat EKG and order electrolytes
3. Discharge and follow up in 2 days
4. send urine for cultures and discharge
5. start on ciprofloxacin

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