Crush syndrome

Crush syndrome (also traumatic rhabdomyolysis or Bywaters' syndrome) is a medical condition characterized by major shock and renal failure after a crushing injury to skeletal muscle. Cases occur commonly in catastrophes such as earthquakes, in which victims that have been trapped under fallen masonry.

Pathophysiology

The syndrome was discovered by British physician Eric Bywaters in patients during the 1941 London Blitz.^[1][2] It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products—notably myoglobin, potassium and phosphorus—that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions).

The specific action on the kidneys is not understood completely, but may be due partly to nephrotoxic metabolites of myoglobin.

Seigo Minami, a Japanese physician, first reported the crush syndrome in 1923.^[3][4][5] He studied the pathology of three soldiers who died in World War I from insufficiency of the kidney. The renal changes were due to methohemoglobin infarction, resulting from the destruction of muscles, which is also seen in persons who are buried alive. The progressive acute renal failure is because of acute tubular necrosis.

Treatment

Due to the risk of crush syndrome, current recommendation to lay first-aiders (in the UK) is to not release victims of crush injury who have been trapped for more than 15 minutes. Treatment consists of not releasing the tourniquet and fluid overloading the patient with added Dextran 4000 iu and slow release of pressure. If pressure is released during first aid then fluid is restricted and an input-output chart for the patient is maintained, and proteins are decreased in the diet.

The Australian Resuscitation Council recommended in March 2001 that first-aiders in Australia, where safe to do so, release the crushing pressure as soon as possible, avoid using a tourniquet and continually monitor the vital signs of the patient.^[6] St John Ambulance Australia First Responders are trained in the same manner.

References

1. ^ synd/3870 at Who Named It?
2. ^ Bywaters, E. G.; Beall, D. (1941). "Crush injuries with impairment of renal function". Br Med J 1: 427–432. 
3. ^ Minami, Seigo (1923). "Über Nierenveränderungen nach Verschüttung". Virchows Arch. Patho. Anat. 245 (1). doi:10.1007/BF01992107. 
4. ^ Medical discoveries - Who and when- Schmidt JF. Springfield: CC Thomas, 1959. p.115.
5. ^ Morton's medical bibliography -An annotated check-list of texts illustrating History of medicine (Garrison-Morton). Aldershot: Solar Press; 1911. p.654.
6. ^ "Emergency Management of a Crushed Victim". Australian Resuscitation Council. March 2001. http://www.resus.org.au/policy/guidelines/section_9/guideline-9-1-7march2001.pdf. Retrieved 20 July 2011. 

• Sever MS, Vanholder R, Lameire N (2006). "Management of crush-related injuries after disasters". N. Engl. J. Med. 354 (10): 1052–63. doi:10.1056/NEJMra054329. PMID 16525142. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=16525142&promo=ONFLNS19. 

External links

• Life or Limb: What happens when your leg gets trapped under a building?