A crush injury is injury by an object that causes

compression Compression may refer to: Physical science *Compression (physics), size reduction due to forces *Compression member, a structural element such as a column *Compressibility, susceptibility to compression * Gas compression *Compression ratio, of a ...

of the

body Body may refer to: In science * Physical body, an object in physics that represents a large amount, has mass or takes up space * Body (biology), the physical material of an organism * Body plan, the physical features shared by a group of anima ...

. This form of injury is rare in normal civilian practice, but common following a

natural disaster A natural disaster is "the negative impact following an actual occurrence of natural hazard in the event that it significantly harms a community". A natural disaster can cause loss of life or damage property, and typically leaves some econ ...

. Other causes include industrial accidents, road traffic collisions, building collapse, accidents involving heavy plant, disaster relief or

terrorist Terrorism, in its broadest sense, is the use of criminal violence to provoke a state of terror or fear, mostly with the intention to achieve political or religious aims. The term is used in this regard primarily to refer to intentional violen ...

incidents.

Presentation

Complications

Hypovolaemic Shock Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss ...

. Loss of plasma volume across damaged cell membranes and capillary walls can lead directly to severe hypovolaemia. Furthermore, 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. *

Hyperkalaemia Hyperkalemia is an elevated level of potassium (K+) in the blood. Normal potassium levels are between 3.5 and 5.0mmol/L (3.5 and 5.0mEq/L) with levels above 5.5mmol/L defined as hyperkalemia. Typically hyperkalemia does not cause symptoms. Occasi ...

and

electrolyte imbalance Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They help to regulate heart and neurological function, ...

. Disruption of cell membranes can result in a significant release of potassium, which is a largely intracellular cation that can precipitate

cardiac arrest Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...

. Sequestration of plasma calcium into injured tissue can lead to a relative

hypocalcaemia Hypocalcemia is a medical condition characterized by low calcium levels in the blood serum. The normal range of blood calcium is typically between 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L) while levels less than 2.1 mmo ...

, which may worsen disruption of clotting abilities and

shock Shock may refer to: Common uses Collective noun *Shock, a historic commercial term for a group of 60, see English numerals#Special names * Stook, or shock of grain, stacked sheaves Healthcare * Shock (circulatory), circulatory medical emergen ...

Metabolic acidosis Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys ...

may result from

reperfusion injury Reperfusion injury, sometimes called ischemia-reperfusion injury (IRI) or reoxygenation injury, is the tissue damage caused when blood supply returns to tissue ('' re-'' + ''perfusion'') after a period of ischemia or lack of oxygen (anoxia or hy ...

and hypoperfusion related to shock. *

Compartment syndrome Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the ...

. Compartment syndrome is a common complication of crush injury as a consequence of

oedema Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area ma ...

tous 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 Cell death is the event of a biological cell ceasing to carry out its functions. This may be the result of the natural process of old cells dying and being replaced by new ones, as in programmed cell death, or may result from factors such as d ...

. *

Acute Kidney Injury Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine or a decrease in urine output, or both. Causes of AKI are c ...

. 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%. Acute kidney injury leads to a significantly higher mortality.

Pathophysiology

Crush injury is damage to the body as a result of being crushed by an object. Crush syndrome is a systemic result of skeletal muscle injury and breakdown 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.

References

External links

Injuries Causes of death Medical emergencies {{musculoskeletal-disease-stub