For victims of crush injury, or patients strongly suspected of having rhabdomyolysis and prolonged extrication/transport times, IV rehydration with normal saline should be initiated as soon as possible. In one small series, aggressive infusion of crystalloids at a rate of approximately 1.5 L/h helped prevent the development of ARF in seven crush-injury victims.16 The addition of sodium bicarbonate to each liter of crystalloid may be considered, but there are no controlled studies in the preshospital setting to confirm its benefit.
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