Crush injuries in arctic off-shore fisheries: initial treatment to prevent acute renal failure.

Rhabdomylosis following crush injuries represents an occupational hazard in the off-shore fisheries. In northern countries this can be complicated by hypothermia and a long transport time to the nearest hospital. If treatment is delayed, what is initially a local limb injury can result in a potentially life threatening acute renal failure as a result of the nephrotoxic effects of the various intracellular muscle components released into the circulation. Therefore early and aggressive fluid treatment in the field, and during the transport of crush injury victims is very important. Forced alkaline diuresis is the main prophylaxis against hyperkalemia and acute myoglobinuric renal failure. A case history which demonstrates some of the aspects and challenges in the treatment of crush injuries is presented.