ABSTRACT
UNLABELLED: Introduction Crush syndrome, of which little is known, occurs as a result of compression injury to the muscles. This syndrome is characterized by systemic manifestations such as acute kidney injury (AKI), hypovolemic shock, and hydroelectrolytic variations. This pathology presents high morbidity and mortality if not managed aggressively by prehospital care. Clinical Case A 40-year-old worker was rescued after being buried underground in a ditch for 19 hours. The patient was administered early resuscitation with isotonic solutions and monitored during the entire rescue operation. Despite having increased plasma levels of total creatine kinase (CK), the patient did not develop AKI or hydroelectrolytic variations. CONCLUSION: Aggressive early management with isotonic solutions before hospital arrival is an effective option for nephron-protection and prevention of crush syndrome. Mardones A , Arellano P , Rojas C , Gutierrez R , Oliver N , Borgna V . Prevention of crush syndrome through aggressive early resuscitation: clinical case in a buried worker. Prehosp Disaster Med. 2016;31(3):340-342.
Subject(s)
Crush Syndrome/prevention & control , Disasters , Fluid Therapy , Resuscitation/methods , Adult , Crush Syndrome/physiopathology , Humans , Male , Treatment OutcomeABSTRACT
Reperfusion after severe crush injury is an infrequent, but life-threatening condition. It is a unique aspect of prehospital medicine that occurs in the presence of emergency responders attempting to extricate and treat patients who have suffered a crushing injury. These events are unlikely to occur in the hospital setting and, as a result, remain poorly studied. Some evidence exists regarding prophylaxis, but the efficacy of these treatments has not been clearly established. The use of commercial tourniquets to delay the onset of reperfusion injury has previously been described in theory. Extensive literature now exists supporting the safety of tourniquet use in limb trauma and this potential life-saving measure requires further study in patients with crush injury. We present a case of prehospital tourniquet application to delay reperfusion injury after crush injury that resulted in a reduction in morbidity and complete limb salvage.
Subject(s)
Crush Syndrome/prevention & control , Emergency Treatment/methods , Multiple Trauma/therapy , Reperfusion Injury/prevention & control , Tourniquets/statistics & numerical data , Accidents, Occupational , Adult , Combined Modality Therapy , Crush Syndrome/physiopathology , Follow-Up Studies , Humans , Injury Severity Score , Lower Extremity , Male , Multiple Trauma/diagnosis , Risk Assessment , Treatment Outcome , Wounds and Injuries/diagnosis , Wounds and Injuries/therapyABSTRACT
Crush injury is defined as compression of extremities or other parts of the body that causes muscle breakdown (traumatic rhabdomyolysis). Systemic consequences of crush injuries are as follows: rhabdomyolysis, electrolyte and acid-base abnormalities, hypovolemia, and acute renal failure. Crush injuries are important injuries in disaster situations: earthquakes, hurricanes, mining and road traffic accidents, war, collapse of buildings, etc. In this review article, there are discussed about epidemiology of crush syndrome, risk factors, pathophysiology (mechanisms of muscle cell injury, release of substances from injured muscles, other consequences of reperfusion), clinical features, differential diagnosis, investigations, complications (acute renal failure, hypovolemic shock, hyperkalemia, infection, compartment syndrome), approach to treatment (adequate rehydration, a forced mannitol-alkaline diuresis, intravenous fluids, management of hyperkalemia, wound care, hyperbaric oxygen, etc.), prognosis, the mortality rate and prevention (timely support may reduce morbidity and mortality).
Subject(s)
Crush Syndrome , Acute Kidney Injury/etiology , Crush Syndrome/complications , Crush Syndrome/diagnosis , Crush Syndrome/epidemiology , Crush Syndrome/mortality , Crush Syndrome/physiopathology , Crush Syndrome/prevention & control , Diagnosis, Differential , Humans , Hypovolemia/etiology , Rhabdomyolysis/etiology , Risk FactorsABSTRACT
It brings information about earthquakes and their relation with crush injuries and crush syndrome, including their definitions, causes, complications and managements.
Subject(s)
Earthquakes , Crush Syndrome/etiology , Crush Syndrome/complications , Crush Syndrome/prevention & controlABSTRACT
Crush syndrome in patients rescued from earthquake is a complex clinical syndrome with many medical conditions. The most common complications are hyperkalemia, acute kidney injury, shock, infection, ARDS, malnutrition and multiorgan dysfunction. Managing these critical issues appropriately is essential for effective treatment of the crush syndrome.