Case 2

The same patient with electrical burns to his hands and foot has been receiving treatment in the resuscitation room for approximately one hour. During this time he has received 1000 mls of normal saline. His ECG (shown here) demonstrates sinus tachycardia. A primary survey with log role has not identified any other injuries.

His observations are as follows:

• HR 145 bpm
• BP 85 / 60 mmHg
• RR 30 bpm
• Temp. 36.2 °C

How would you describe this man’s circulatory status?

More aggressive fluid resuscitation is commenced and a urinary catheter and right internal jugular line inserted. The patient begins to complain of increasing pain in his left leg despite regular doses of morphine. What potential complication is developing and what is the management?

An arterial blood gas is performed with the patient on 15 litres O₂. The results are shown.

The results indicate a metabolic acidosis with respiratory compensation. This patient is deteriorating. Further fluid resuscitation and haemofiltration may be necessary. Fasciotomy and debridement are required followed by transfer to the intensive care unit.

Which of the following are suggestive of rhabdomyolysis?