A crush injury is injury by an object that causes compression of the Human body.
Presentation
Complications
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Hypovolemia. Loss of plasma volume across damaged cell membranes and capillary walls can lead directly to severe hypovolaemia.
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Hyperkalaemia and electrolyte imbalance. Disruption of cell membranes can result in a significant release of potassium, which is a largely intracellular cation that can precipitate cardiac arrest. Sequestration of plasma calcium into injured tissue can lead to a relative hypocalcaemia, which may worsen coagulopathy and shock. Metabolic acidosis may result from reperfusion injury and hypoperfusion related to shock.
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Compartment syndrome. Compartment syndrome is a common complication of crush injury as a consequence of tissue injury, redistribution of fluid into the intracellular compartment and bleeding. Established compartment syndrome may result in worsened systemic crush syndrome and irreversible muscle necrosis.
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Kidney failure. Release of myoglobin by injured muscle leads to rhabdomyolysis coupled with shock leads to a significant rate of acute kidney injury, estimated as up to 15%.
Pathophysiology
Crush syndrome is a systemic result of
rhabdomyolysis and subsequent release of cell contents.
The severity of crush syndrome is dependent on the duration and magnitude of the crush injury as well as the bulk of muscle affected. It can result from both short-duration, high-magnitude injuries (such as being crushed by a building) or from low-magnitude, long-duration injuries such as
coma or drug-induced immobility.
Treatment
Early fluid resuscitation reduces the risk of kidney failure, reduces the severity of hyperkalaemia and may improve outcomes in isolated crush injury.
For casualties with isolated crush injury who are haemodynamically stable, large-volume crystalloid fluid resuscitation reduces the severity of and reduces the risk of acute kidney injury.
See also
Further reading
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