Crush Injury and Crush Syndrome Crush Injury and Crush Syndrome June 2009 Patients Arelikelyto Regainnormalkidneyfunction

Home , Crush injury, Crush syndrome, Rhabdomyolysis

Blast Injuries • Secondary Complications • • • • Metabolic Abnormalities • • • Renal Failure • • • Hypotension systemleadstomyoglobinuria,necrotic muscle intothecirculatory whichcausesrenalfailureifuntreated. abnormalities. This condition may cause lethal cardiac arrhythmias. Further, the sudden releaseSudden releaseofacrushedextremitymayresultinreperfusionsyndrome—acutehypovolemiaandmetabolic of toxins from Clinical Presentation acute renalfailureandover50%needingfasciotomy. Ofthosewithrenalfailure, 50%needdialysis. 50%ofthosewithcrushsyndromedeveloping incidence ofcrushsyndromeis2-15%withapproximately the that hasdemonstrated causedmajorstructuraldamage Previous experiencewithearthquakesthat abnormalities, including acidosis, hyperkalemia, andhypocalcemia. system.the circulatory Crushsyndromecancauselocaltissueinjury, organdysfunction, andmetabolic (muscle andthereleaseofpotentiallytoxicmuscle breakdown) cellcomponentsandelectrolytesinto withsystemicmanifestations.crush injury rhabdomyolysis These systemiceffectsarecausedbyatraumatic includebody extremities(74%), lower upperextremities(10%), andtrunk(9%). Crushsyndromeislocalized and/orneurologicaldisturbancesintheaffectedareasofbody.swelling Typically affectedareas ofthe causesmuscleexplosion. that is definedascompressionofextremitiesorotherpartsthebody Crushinjury afterabombingor In aterroristattack, andcrushsyndromemayresultfromstructuralcollapse crushinjury Background Crush InjuryandSyndrome Compartment syndromemay occur, whichwillfurtherworsenvascularcompromise this situation arrest; metabolicacidosismay exacerbate cardiacarrhythmias,Imbalance ofpotassiumandcalciummaycauselife-threatening including cardiac Lactic acidisreleasedfromischemicmuscle intosystemiccirculation, causingmetabolic acidosis Potassium isreleasedfromischemic muscle intosystemiccirculation, causinghyperkalemia into muscleCalcium flows cellsthroughleakymembranes, causingsystemichypocalcemia Release ofelectrolytesfromischemicmuscles causesmetabolicabnormalities Myoglobinuria mayresultinrenaltubularnecrosisifuntreated Rhabdomyolysis releasesmyoglobin, potassium, phosphorous, intothecirculation andcreatinine Hypotension mayalsocontributetorenalfailure within aclosed space;compartmentsyndromeoftenrequiresfasciotomy anatomical suchascompartmentsyndrome, complications Third spacingmayleadtosecondary whichisswelling sequester (thirdspace)>12Loffluidinthecrushedareaovera48-hourperiod Massive thirdspacingoccurs,patients may requiringconsiderablefluidreplacementinthefirst24hours;

Crush Injury and Crush Syndrome Crush Injury and Crush Syndrome June 2009 patients arelikelyto regainnormalkidneyfunction. patients unlesssepsisispresent,Patients withacuterenalfailuremayrequireupto60daysofdialysistreatment; Disposition • • • • • Secondary Complications • • • Metabolic Abnormalities • • Renal Failure • Hypotension Hospital setting: • • Prehospital setting: Initial Management failure canoccur ofrenal >12hoursmayincreasetheincidenceofrenalfailure; delayed manifestations Delays inhydration allcrushcasualties,Observe eventhosewholookwell and pulselessness icetoinjuredareasandmonitorforthe5P’s:Apply pain, pallor, parasthesias, painwithpassivemovement, Treat openwoundswithantibiotics, tetanustoxoid, anddebridement ofnecrotictissue consider emergency fasciotomyforcompartmentsyndrome Monitor casualtiesforcompartmentsyndrome;monitorcompartmentalpressureifequipmentisavailable; Cardiac Arrhythmias: Monitorforcardiacarrhythmiasandarrest, accordingly andtreat 25-50gwithsorbitol 20%100mLPOorPR insulin 5-10UandD5O1-2ampulesIVbolus;kayexalate push;regular 1 meq/kgIVslow 10cc orcalciumchloride10%5ccIVover2minutes;sodiumbicarbonate Hyperkalemia/Hypocalcemia: (adult doses): Consideradministeringthefollowing 10% calciumgluconate prevent myoglobinanduricaciddepositioninkidneys Acidosis: untilurinepHreaches6.5to ofurineiscritical;administerIVsodiumbicarbonate Alkalinization Triage tohemodialysisasneeded 300 cc/hr hydration,at least Prevent renalfailurewithappropriate usingIVfluidsandmannitoltomaintaindiuresisof to1.5L/hour (orcontinue)IVhydration—up Initiate canbeinitiated (IV)hydration intravenous If thisprocedureisnotpossible, considershort-termuseofatourniquetontheaffectedlimbuntil cases ofprolongedcrush[>4hours];however, crushsyndromecanoccurinscenariosof<1hour) part. fluidsbeforereleasingthecrushedbody Administer intravenous (Thisstepisespeciallyimportantin This fact sheet is part of a series of materials developedbytheCentersforDiseaseControl This factsheetispartofaseriesmaterials and Prevention(CDC)onblastinjuries. For moreinformation, visitCDConthe Web at: