Скачать или смотреть How to Recognize and Treat Crush Syndrome After Building Collapse, War, and Disaster Injuries

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Crush syndrome occurs due to crushing accidents, such as those seen in war zones, industrial accidents, natural disasters, drug overdose, or positioning during lung surgery.

When the muscle is crushed, it results in muscle necrosis, rhabdomyolysis, and myoglobinuria. The crush injury causes muscle breakdown, and the toxic muscle cell components and electrolytes are released into the bloodstream, causing third-spacing of fluids and acute renal failure.

Crushing of the limbs or trunk can create a very harmful systemic effect, and that is known as crush syndrome.

Crush injuries occur more often in the lower extremities than in the upper extremities or the trunk. It is common in earthquakes.

Some of these patients with crush injuries will develop acute renal failure, and some will require dialysis and fasciotomy.

The three main conditions associated with crush syndrome are: local muscle damage, organ dysfunction, and metabolic abnormalities.

If not treated promptly, the patient could die within days.

Etiology and common causes of crush syndrome: drug overdose, trunk compression or compression of the forearm and leg, surgical knee or chest positioning, compression of the legs (especially the anterior compartment), and crushing accidents.

Pathogenesis of crush syndrome: the crushing injury and limb compression will lead to soft tissue injury and ischemia, which can cause compartment syndrome, or the ischemia can cause muscle necrosis.

This muscle necrosis occurs due to prolonged pressure and muscle ischemia, and it will lead to the following:

Rhabdomyolysis, which will cause myoglobinuria and/or myoglobinemia.

Third-space fluid loss, which will cause hypovolemic shock.

Both myoglobinuria and hypovolemic shock will lead to acute renal failure.

Metabolic abnormalities, which will cause ventricular fibrillation.

Metabolic acidosis and hyperkalemia will cause cardiac arrhythmia.

Disseminated intravascular coagulation, which will result in coagulation deficiency.

Other complications, such as compartment syndrome. Microcirculation is affected. The muscles become swollen, with irreversible damage to the muscles and nerves.

Clinical picture: you will see hypotension, crushed limbs, acute renal failure, disseminated intravascular coagulation, and compartment syndrome (while pulses may not be affected). You may also observe respiratory depression, ventricular fibrillation, hyperkalemia, and metabolic acidosis.

Treatment of crush syndrome: a multidisciplinary approach involving both medical and surgical teams is needed.

Medical management: provide fluid replacement (the ideal fluid is normal saline), ventilatory support, correction of metabolic acidosis, and consider dialysis.

Surgical management: perform emergency fasciotomy. Compartment syndrome can occur even if the patient is trapped for less than one hour. It can occur even without a fracture, and it can occur even when circulation appears good. Early fasciotomy must be done. Debridement of necrotic tissue should be performed, and delayed vacuum-assisted closure (VAC) application and skin grafting should be considered.

Mortality, can be early or late. Early mortality is due to hypovolemia and hyperkalemia. Late mortality occurs due to multi-organ failure and sepsis.
Quizzes
1. What is a common cause of crush syndrome?
a) Paper cut
b) Crushing accidents in disasters
c) Minor ankle sprain
d) Small skin laceration
Correct answer: b) Crushing accidents in disasters
Explanation: Crush syndrome occurs after severe muscle compression, often seen in disasters.

2. Which muscle condition is associated with crush syndrome?
a) Muscle necrosis
b) Muscle hypertrophy
c) Muscle spasm
d) Muscle strain
Correct answer: a) Muscle necrosis
Explanation: Prolonged compression leads to muscle death (necrosis).

3. Which substance causes kidney damage in crush syndrome?
a) Myoglobin
b) Hemoglobin
c) Insulin
d) Cholesterol
Correct answer: a) Myoglobin
Explanation: Myoglobin released from damaged muscle injures the kidneys.

4. Which electrolyte abnormality is life-threatening in crush syndrome?
a) Hyperkalemia
b) Hypokalemia
c) Hyponatremia
d) Hypercalcemia
Correct answer: a) Hyperkalemia
Explanation: Elevated potassium can cause dangerous heart arrhythmias.

5. What is the ideal fluid for resuscitation in crush syndrome?
a) Dextrose 5%
b) Normal saline
c) Whole blood
d) Lactated Ringer’s only
Correct answer: b) Normal saline
Explanation: Normal saline is preferred to support circulation and kidney function.
6. What cardiac complication may occur in crush syndrome?
a) Ventricular fibrillation
b) Atrial flutter
c) Bradycardia
d) First-degree AV block
Correct answer: a) Ventricular fibrillation
Explanation: Metabolic derangements can lead to life-threatening arrhythmias.
7. Which compartment is commonly involved in crush injuries?
a) Anterior leg compartment