A 22-year-old male just disentangled from debris in a house collapse. He denies head or neck pain but has severe hip pain; BP 88/40, P 120, R 16. Which treatment should you administer?

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This scenario points to crush injury and the risk of rhabdomyolysis after entrapment. When muscle tissue is crushed, cellular contents, including myoglobin, are released into the bloodstream. Myoglobin can travel to the kidneys and form obstructive casts, leading to acute kidney injury, especially if perfusion is compromised and acidosis develops. The goal is to prevent this renal damage while supporting circulation. Administering sodium bicarbonate helps by alkalinizing the urine, which increases myoglobin solubility and reduces its precipitation in the renal tubules, and it also helps correction of acidosis from tissue hypoxia. While volume resuscitation with IV fluids is essential to maintain renal perfusion in shock, bicarbonate specifically targets the crush syndrome-related renal risk, making it the best choice among the options given. Ketorolac is avoided due to bleeding risk in trauma, epinephrine isn’t indicated here, and a normal saline bolus addresses perfusion but does not mitigate the nephrotoxic potential of myoglobin in crush injuries.