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[edit | edit source]

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[edit | edit source]

Stages of crush syndrome

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

Treatment[edit | edit source]

pain relief
infusion of alkalizing crystalloids, diuretics
treatment of hyperkalemia (CaCl₂, NaCl, glucose with insulin, hemodialysis)
in case of severe limb injury – amputation
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

Links[edit | edit source]

Source[edit | edit source]

PASTOR, J. Langenbeck's medical web page [online]. [cit. 18. 1. 2010]. <https://www.freewebs.com/langenbeck/>.

References[edit | edit source]

ZEMAN, Miroslav. Chirurgická propedeutika. 2. edition. Grada, 2000. 524 pp. ISBN 80-7169-705-2.