Crush injury
Crush injury | |
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Specialty | Emergency medicine |
A crush injury is
Presentation
Complications
- Hypovolaemic shock. Loss of plasma volume across damaged cell membranes and capillary walls can lead directly to severe hypovolaemia.[4] Shock can develop from myocardial depression following release of intracellular electrolytes. In addition, as a result of the mechanism of injury, blood loss from pelvic or long bone fractures may also co-exist.
- hypocalcaemia, which may worsen disruption of clotting abilities and shock. Metabolic acidosis may result from reperfusion injuryand hypoperfusion related to shock.
- oedematous tissue injury, redistribution of fluid into the intracellular compartment and bleeding. Established compartment syndrome may result in worsened systemic crush syndrome and irreversible muscle cell death.[4]
- Acute kidney injury. 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%.[5] Acute kidney injury leads to a significantly higher mortality.
Pathophysiology
Crush syndrome is a systemic result of skeletal muscle injury and breakdown and subsequent release of cell contents.[4] 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.[4]
Treatment
Early fluid resuscitation reduces the risk of kidney failure, reduces the severity of hyperkalaemia and may improve outcomes in isolated crush injury.[4]
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.[5]
See also
References
- ^ crush injury, Chicago: Encyclopædia Britannica, 2010
- ISBN 978-0-323-05472-0.
- .
- ^ PMID 15015795.
- ^ S2CID 37486772.
Further reading
- Rajasekaran S. (2005). "Ganga hospital open injury severity score - A score to prognosticate limb salvage and outcome measures in Type IIIb open tibial fractures". Indian J Orthop. 39 (1): 4–13. Archived from the original on 2016-09-16. Retrieved 2016-09-06.
External links