A crush injury is
injury by an object that causes
compression 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 animal ...
.
This form of injury is rare in normal civilian practice, but common following a
natural disaster.
Other causes include industrial accidents, road traffic collisions, building collapse, accidents involving heavy plant, disaster relief or
terrorist incidents.
Presentation
Complications
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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 and
electrolyte imbalance. Disruption of cell membranes can result in a significant release of potassium, which is a largely intracellular
cation
An ion () is an atom or molecule with a net electrical charge.
The charge of an electron is considered to be negative by convention and this charge is equal and opposite to the charge of a proton, which is considered to be positive by conven ...
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 possi ...
. Sequestration of plasma calcium into injured tissue can lead to a relative
hypocalcaemia, 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 emerge ...
.
Metabolic acidosis 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 common complication of crush injury as a consequence of
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
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 dis ...
.
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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 cl ...
. 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
A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhi ...
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
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Crush syndrome
Crush syndrome (also traumatic rhabdomyolysis or Bywaters' syndrome) is a medical condition characterized by major shock and kidney failure after a crushing injury to skeletal muscle. Crush ''injury'' is compression of the arms, legs, or other ...
References
Further reading
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External links
Injuries
Causes of death
Medical emergencies
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