When muscle tissue breaks down and cellular contents are released into the circulation, complications can ensue: compartment syndrome, peripheral neuropathy, acute renal failure, metabolic derangements, disseminating intravascular coagulopathy (DIC) and death. Rhabdomyolysis is a clinical and biochemical syndrome that results from acute necrosis of skeletal muscle fibers and the leakage of cellular contents into the circulation (Counselman, 2011).

When should we be considering rhabdomyolysis as part of our patient's clinical picture? There are lots of causes and precipitating factors, including:

Trauma: crush injury, electrical or lightning injury, compartment syndrome, compression injury including prolonged pressure from own body weight (fall and can't get up, coma of any origin, etc)

Exertional: heavy training or contact sports, delirium tremens, psychosis, excited delirium, seizure

Other: hyperthermia, heat stroke, drugs or toxins, infections, electrolyte disorders, sepsis

If your patient is potentially suffering from rhabdomyolysis, then establishing IV access would be an appropriate procedure.

Identifying patients who are at risk for rhanbdomyolysis and by initiating IV access can help prepare for potential complications that can be addressed in the prehospital setting (hypotension, arrhythmias, hyperkalemia).

References: Counselman F.L., Lo B.M. (2011). Chapter 92. Rhabdomyolysis. In Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. Retrieved December 01, 2015 from http://accessmedicine.mhmedical.com/content. aspx? bookid=348& Sectionid=40381560.

Miller, M.L. (2015). Causes of rhabdomyolysis. Up To Date. Retrieved from http://www.uptodate.com/contents/causes-of-rhabdomyolysis?source=search_result&search=rhabdomyolysis&selected Title= 1%7E150#H31738599

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