Prehospital treatment of rhabdomyolysis in people who fall

After completing this module, the paramedic will be able to:

Rhabdomyolysis is a syndrome where skeletal muscle is broken down, resulting in the release of intracellular contents into the bloodstream, which can lead to systemic complications.

This can be caused by direct cellular injury or the depletion of adenosine triphosphate (ATP). Depletion of ATP leads to a failure of the sodium potassium pump in the membrane of the myocyte (muscle tissue cell). Failure of this pump causes an influx of sodium and calcium into the cell, causing the cellular membrane to break down and release its contents. This can be caused by direct cellular injury or depletion of adenosine triphosphate (ATP) due to ischaemia (Nellist and Lethbridge, 2013).

Of people aged >65 years, 30% will have a fall each year, with this rising to 50% in those aged over 80 (Tian et al, 2013). Patients who remain on the floor for a long time are at risk of developing rhabdomyolysis. It is similar to a crush injury but instead of an object ‘pinning’ the person down, tissue necrosis can occur at the point of contact and skeletal muscle is destroyed, releasing its contents into the bloodstream (Falls Action, 2018). This can eventually lead to crush syndrome, which encompasses rhabdomyolysis, lactic acidosis, hyperkalemia, dysrhythmias, renal failure, shock and even death.