 Welcome to Nursing School Explained and this video on Rhabdomyolysis. So again if we look at the meaning of the word, Rhabdomyolysis usually pertains to like a rod or a wand, myo is muscle and lysis is the destruction of muscle. So Rhabdomyolysis occurs when there is severe muscle trauma and examples are crush injuries, long distance running where there is prolonged effort on the muscles mostly of the legs, severe infections as well as electric shock damaging that muscle tissue, status epilepticus where there is just such intense force of muscle contraction for prolonged periods of time or fall not found for several days and this can be an elderly person or really anybody at home who has a fall and just lays there and has any kind of muscle trauma and just does not move for several days and then they get to be in Rhabdomyolysis. So pathophysiology when there is this severe muscle trauma from any of these causes the muscle gets ischemic it can lead to infarction and then eventually it will become necrotic. And this is really the same physiology that occurs in the myocardial infarction except in NMI it pertains to cardiac muscle here we're talking about skeletal muscles and with that ischemia and necrosis of the muscle tissue the myoglobin that gets lysed, myolysis gets released into the circulation and remember that muscle tissue are proteins large molecules that then get lodged in the kidneys the kidneys can't filter out these large particles it leads to acute tubular necrosis and then eventually to acute renal failure. So science and symptoms here are swollen painful and bruised muscles just imagine somebody who had a crush injury what that muscle would look like when it has been compressed and there's all this hematoma severe achemosis and bruising there swollen and certainly painful and then with this myoglobin that's being released and they get stuck in the kidney it causes damage and therefore we have dark and reddish brown discolored urine because of that myoglobin that's leaking through and then the patient might also have some flank pain because the kidneys get inflamed and this acute renal failure can sometimes be evident by flank pain diagnostic tests we certainly want to check cbc because we have all these issues here maybe even an infection cmp check kidney function check liver function all those things and then specifically here for rhabdomyoelosis we can check myoglobin ck and ckmb note that we are not checking troponin here because that is cardiac specific and the cardiac muscle has not received or had any damage here so these three muscle markers or tissue damage markers is what we what we can measure here complications from rhabdomyoelosis acute renal failure and amputation if the necrosis is so severe that the muscle damage cannot be reversed maybe the limb will have to be amputated in terms of treatment so we want to make sure we treat the underlying cause if this was electric shock we want to make sure we get the burn center involved and have the appropriate wound care there if this was status epilepticus make sure we stop the seizure if this was from major trauma crush injuries maybe fix the underlying broken bone dislocation things like that and then fluids and fluids to help flush out those myoglobin molecules get that urine a little bit more dilute make sure it's not so dark brown anymore and get those kidneys back to health diuretics to help pull the fluid off steroids to help with the inflammation that occurs in the kidneys and then as we know with acute renal failure anything that pertains to the kidney can lead to hyperkalemia as well as metabolic acidosis so we want to reverse those and I have separate videos on hyperkalemia and acidosis metabolic acidosis where you can see what's what's being done there if fluids and diuretics and steroids are not enough the patient might have to go on temporary hemodialysis until the kidneys can recover from this insult the patient might need a fasciotomy if there is so much hematoma or bleeding inside the muscle inside that fascia that it compresses and causes necrosis so we can open up that muscle fascia and give it some more room so that swelling can expand and then certainly wound debridement would help in getting that that muscle tissue back to health nursing care nursing indications here identify patients at risk so elderly patients identify them before they fall at home and lay there for several days and then come in injured identify patients at seizures with history of seizures so they don't experience status epilepticos and those things we want to educate our patients about the risks that they might have with long distance running if they're not experienced for example check level of consciousness because we know that anything that has to do with the kidneys not filtering everything out properly can lead to mental status changes certainly we want to check the labs and then trend those myoglobin ck and ck and b labs to make sure they're slowly coming down check the wounds check vital signs for sure especially with this risk for hyperkalemia as we know hyperkalemia can lead to this rythmia so we always want to have the patient on a hard monitor and then as anything with kidney issues we always want to be very particular about checking urine output and logging strict eyes and nose to make sure we're not fluid overloading the patient because that certainly is a risk here when the kidneys are not able to filter and the treatment is to give them fluids so then the patient can't excrete it and now we have fluid volume overload or excess so please also check out the other videos that pertain to this here up make sure to put them in the link below give me a thumbs up if you've enjoyed the video thanks for watching nursing school explain see you soon