Crush syndrome
Encyclopedia
Crush 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 earthquake
s, in which victims that have been trapped under fallen masonry.
physician
Eric Bywaters in patients during the 1941 London
Blitz
. 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 kidney
s is not understood completely, but may be due partly to nephrotoxic
metabolite
s of myoglobin.
Seigo Minami
, a Japanese physician, first reported the crush syndrome in 1923. He studied the pathology of 3 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.
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. St John Ambulance Australia
First Responders are trained in the same manner.
Skeletal muscle
Skeletal muscle is a form of striated muscle tissue existing under control of the somatic nervous system- i.e. it is voluntarily controlled. It is one of three major muscle types, the others being cardiac and smooth muscle...
. Cases occur commonly in catastrophes such as earthquake
Earthquake
An earthquake is the result of a sudden release of energy in the Earth's crust that creates seismic waves. The seismicity, seismism or seismic activity of an area refers to the frequency, type and size of earthquakes experienced over a period of time...
s, in which victims that have been trapped under fallen masonry.
Pathophysiology
The syndrome was discovered by BritishUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
Eric Bywaters in patients during the 1941 London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
Blitz
The Blitz
The Blitz was the sustained strategic bombing of Britain by Nazi Germany between 7 September 1940 and 10 May 1941, during the Second World War. The city of London was bombed by the Luftwaffe for 76 consecutive nights and many towns and cities across the country followed...
. It is a reperfusion injury
Reperfusion injury
Reperfusion injury is the tissue damage caused when blood supply returns to the tissue after a period of ischemia or lack of oxygen. The absence of oxygen and nutrients from blood during the ischemic period creates a condition in which the restoration of circulation results in inflammation and...
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
Myoglobin
Myoglobin is an iron- and oxygen-binding protein found in the muscle tissue of vertebrates in general and in almost all mammals. It is related to hemoglobin, which is the iron- and oxygen-binding protein in blood, specifically in the red blood cells. The only time myoglobin is found in the...
, potassium
Potassium
Potassium is the chemical element with the symbol K and atomic number 19. Elemental potassium is a soft silvery-white alkali metal that oxidizes rapidly in air and is very reactive with water, generating sufficient heat to ignite the hydrogen emitted in the reaction.Potassium and sodium are...
and phosphorus
Phosphorus
Phosphorus is the chemical element that has the symbol P and atomic number 15. A multivalent nonmetal of the nitrogen group, phosphorus as a mineral is almost always present in its maximally oxidized state, as inorganic phosphate rocks...
—that are the products of rhabdomyolysis
Rhabdomyolysis
Rhabdomyolysis is a condition in which damaged skeletal muscle tissue breaks down rapidly. Breakdown products of damaged muscle cells are released into the bloodstream; some of these, such as the protein myoglobin, are harmful to the kidneys and may lead to kidney failure...
(the breakdown of skeletal muscle damaged by ischemic
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
conditions).
The specific action on the kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
s is not understood completely, but may be due partly to nephrotoxic
Nephrotoxicity
Nephrotoxicity is a poisonous effect of some substances, both toxic chemicals and medication, on the kidneys. There are various forms of toxicity. Nephrotoxicity should not be confused with the fact that some medications have a predominantly renal excretion and need their dose adjusted for the...
metabolite
Metabolite
Metabolites are the intermediates and products of metabolism. The term metabolite is usually restricted to small molecules. A primary metabolite is directly involved in normal growth, development, and reproduction. Alcohol is an example of a primary metabolite produced in large-scale by industrial...
s of myoglobin.
Seigo Minami
Seigo Minami
was a Japanese dermatologist. In 1923, he first reported crush syndrome while he was studying in Germany. He worked as professor of dermatology at Okayama University and Kyushu University. To stimulate dermatological research among young Japanese dermatologists, he offered Minami awards.-Life:*He...
, a Japanese physician, first reported the crush syndrome in 1923. He studied the pathology of 3 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 tourniquetTourniquet
An emergency tourniquet is a tightly tied band applied around a body part sometimes used in an attempt to stop severe traumatic bleeding. Tourniquets are also used during venipuncture and other medical procedures. Severe bleeding means the loss of more than 1,000 ml of blood. This flow of blood...
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. St John Ambulance Australia
St John Ambulance Australia
St John Ambulance Australia is a self-funding charitable organisation dedicated to helping people in sickness, distress, suffering or danger. It is part of an international organisation that consists of eight Priories that form the Order of St John.- History :St John First Aid training centres...
First Responders are trained in the same manner.