Crush syndrome

Crush syndrome is caused by long-term compression or massive contusion of soft tissues (mainly muscles) → their ischemia and damage occurs.

After the pressure is removed, myoglobin, acid metabolites and potassium are released from the damaged tissues ; fluid ( plasma ) transudates into the damaged tissue, causing edema. Loss of plasma intravascularly leads to the development of hypovolemic shock, shock kidney and acute renal insufficiency.

Signs

 * myoglobinuria, hypovolemia → acute renal insufficiency to acute renal failure
 * hyperkalemia → risk of arrhythmia
 * transudation of fluid into tissues with subsequent swelling
 * local skin damage

Form biochemical examinations, ↑ creatine kinase in the serum and myoglobin in the urine are typical.

Stages of crush syndrome
Stages of crush syndrome
 * 1) acute (1–2 days) – hypovolemic shock, hyperkalemia, limb edema (vessel and nerve compression), skin damage
 * 2) subacute (2 weeks) – acute renal failure (oliguria to anuria, hyperazotemia, hyperkalemia), demarcation of necrosis
 * 3) late – recovery of kidney functions (polyuria, hyposthenuria)

Treatment

 * 1) pain relief
 * 2) infusion of alkalizing crystalloids, diuretics
 * 3) treatment of hyperkalemia (CaCl2, NaCl, glucose with insulin, hemodialysis)
 * 4) in case of severe limb injury – amputation
 * 5) in the development of compartment syndrome – decompressive fasciotomy

Crush syndrome and compartment syndrome have some symptoms in common (result of muscle ischemia), but in compartment syndrome the symptoms are mainly local, in crush syndrome they are 'general'. Total muscle damage can occur with blast syndrome - blast injury

Perthes syndrome (blue mask syndrome) – a special type of burial injury, when chest compression restricts breathing movements, and at the same time, petechiae appear on the head and under the conjunctivae

Related articles

 * Injury
 * Blast injury
 * Compartment syndrome
 * Compartment syndrome of the lower leg
 * Rhabdomyolysis
 * Hyperkalemia
 * Hypovolemic shock