If present it should be treated with fasciotomy. Fasciotomies should not be performed if the compartment syndrome has been present for > 24 hours. Open wounds should be treated with antibiotics, tetanus toxoid and debridement of necrotic tissue. [cancertherapyadvisor.com]

Rhabdomyolysis classically presents with myalgia, generalized weakness, and darkened urine (myoglobinuria). Complications include acute kidney injury and crush syndrome, the systemic manifestation of traumatic rhabdomyolysis. [amboss.com]

Their patient presented following a crush injury to the posterior thigh while at work. He had extensive bruising along the distal posterior-medial thigh. [med.emory.edu]

Presentation Left hand crushed by boulder. Open wounds to dorsum over MCPJs and index PIPJ. Patient Data Age: Adult Gender: Female Loading images... Comminuted fractures of left index, middle and ring finger proximal phalanxes. [radiopaedia.org]

Gluteal CS is difficult to diagnose, as peripheral pulses will be present despite the increase in the compartment pressure and, besides, the other injuries that are present tend to divert the attention of the treating physician. [ncbi.nlm.nih.gov]

• Falling

  They include falls, electrocution, crush injuries and falling object injuries. These injuries are not specific to the construction injury, and can happen in almost any workplace. [hasnerlaw.com]

  Falling Objects – Falling objects, such as materials, collapsing structures, and even tools can lead to crushing injuries. Hardhats may protect the workers’ heads, but they do not protect other vulnerable areas of their body, including appendages. [koonz.com]

  Causes of Crush Injuries Heavy object falling on your foot Your foot getting caught between two moving objects Your foot getting run over by a vehicle's tires Symptoms of Crush Injuries A crushed foot requires immediate medical assistance. [nolapodiatry.com]

  Dropped or falling objects: All too often, construction laborers are exposed to crushing injuries when materials such as bricks, planks, tools and equipment fall from heights. [salvilaw.com]

  Common Causes of Caught or Crushed Injuries There are numerous causes of crush injuries in the workplace, including: Being hit by a falling object, such as a large piece of equipment falling off scaffolding Being pinned or struck between two objects, [maineemployeerights.com]

• Fever

  […] idiopathic paroxysmal myoglobinuria Infection: CMV, EBV, adenovirus, Streptococcus pneumoniae, bacteremia, hepatitis, influenza/coxsackie viruses, shigellosis, salmonellosis, gram-negative septic shock, Legionella, leptospirosis, Rocky Mountain spotted fever [anesth.unboundmedicine.com]

  Infection Adverse drug reactions (e.g., neuroleptics, statins ) Malignant hyperthermia References: [2] [3] Pathophysiology Clinical features Rhabdomyolysis Classic triad Myalgia Generalized weakness Darkened urine (red to brown) Nonspecific symptoms : fever [amboss.com]

  […] plaster splint stays wet for more than 24 hours Tightness or pain under the splint gets worse Fingers become swollen, cold, blue, numb, or tingly Redness, warmth, swelling, drainage from the wound, or foul odor from a splint You can’t move your fingers Fever [fairview.org]

  Fever, cardiac arrhythmia, pneumonia, ‘tea or cola’ coloured urine, oliguria and renal failure are the sequence of events. Nausea, vomiting, agitation and delirium are seen in the delayed rescue patients. [ncbi.nlm.nih.gov]

• Hypothermia

  Relative sensitivity of the clotting cascade to hypothermia. Surg Forum 40: 199 - 201. Google Scholar Jurkovich GJ, Greiser WB, Luterman A. et al. 1987. Hypothermia in trauma victims: An ominous predictor of survival. J Trauma 27: 1019 - 24. [journals.sagepub.com]

  Rewarming Patients who have been trapped have a high risk of hypothermia both primary and secondary. [cancertherapyadvisor.com]

  It is also important to keep the patient warm with warm fluids and heating blankets to prevent hypothermia. [emsworld.com]

  Treat patient for either hypothermia or hyperthermia depending on the exposure. 4. [ems1.com]

  Hachimi Idrissi S, Yang X, Nguyen DN, Huyghens L: Combination of therapeutic mild hypothermia and delayed fluid resuscitation improved survival after uncontrolled haemorrhagic shock in mechanically ventilated rats. [ccforum.biomedcentral.com]

• Gangrene

  […] myoglobinuria Infection: CMV, EBV, adenovirus, Streptococcus pneumoniae, bacteremia, hepatitis, influenza/coxsackie viruses, shigellosis, salmonellosis, gram-negative septic shock, Legionella, leptospirosis, Rocky Mountain spotted fever, trichinosis, tetanus, gangrene [anesth.unboundmedicine.com]

  Physiological disorders Compartment syndrome Paralysis of the crushed limb Amputation to prevent gangrene or death Why Crush Injuries Are Dangerous & Potentially Fatal When a crush injury occurs, abnormal compression forces disrupt the normal chemical [arnolditkin.com]

  By trying to preserve the limb, doctors run the risk of infection, gangrene and rhabdomyolysis. "Removing a limb could mean saving a life," he said. [edition.cnn.com]

  Bell E: Arthrosclerotic gangrene of the lower extremities in diabetic and non-diabetic persons. Am J Clin Path 28:27, 1957. 34. Entin M: Roller and wringer injuries: clinical and experimental studies. Plast Reconstr Surg 15: 290-312, 1955. 35. [podiatrytoday.com]

• Surgical Procedure

  Most patients had muscle that appeared nonviable at the time of the first surgical procedure, although some of these patients eventually regained muscle function. [newswise.com]

  It improves wound healing and reduces the need for multiple surgical procedures in these patients. [ncbi.nlm.nih.gov]

  procedures, decreases the rate of failure and increases the rate of bone union.1,5,38 One must debride all non-viable tissue before performing definitive wound closure or coverage. [podiatrytoday.com]

• Vomiting

  […] drug reactions (e.g., neuroleptics, statins ) Malignant hyperthermia References: [2] [3] Pathophysiology Clinical features Rhabdomyolysis Classic triad Myalgia Generalized weakness Darkened urine (red to brown) Nonspecific symptoms : fever ;, nausea, vomiting [amboss.com]

  This leads to a condition called rhabdomyolysis, which results in low blood pressure and vomiting. [arnolditkin.com]

  Nausea, vomiting, confusion and agitation may occur as consequences of disturbed body chemistry; urea, creatinine, uric acid, potassium, phosphate and creatine kinase are elevated. There may also be hypocalcaemia. [patient.info]

  Nausea, vomiting, agitation and delirium are seen in the delayed rescue patients. Investigations Serum creatinine kinase (CKMM) levels greater than 1000 IU/l with associated clinical features is generally taken as an indicator of crush syndrome. [ncbi.nlm.nih.gov]

  Treatment should be based on clinical findings such as anxiety, numbness and tingling, nausea/vomiting, ECG abnormalities suggestive of elevated potassium levels, or actual laboratory values. [nursingcenter.com]

• Nausea

  Adverse drug reactions (e.g., neuroleptics, statins ) Malignant hyperthermia References: [2] [3] Pathophysiology Clinical features Rhabdomyolysis Classic triad Myalgia Generalized weakness Darkened urine (red to brown) Nonspecific symptoms : fever ;, nausea [amboss.com]

  Nausea, vomiting, confusion and agitation may occur as consequences of disturbed body chemistry; urea, creatinine, uric acid, potassium, phosphate and creatine kinase are elevated. There may also be hypocalcaemia. [patient.info]

  Nausea, vomiting, agitation and delirium are seen in the delayed rescue patients. Investigations Serum creatinine kinase (CKMM) levels greater than 1000 IU/l with associated clinical features is generally taken as an indicator of crush syndrome. [ncbi.nlm.nih.gov]

  Treatment should be based on clinical findings such as anxiety, numbness and tingling, nausea/vomiting, ECG abnormalities suggestive of elevated potassium levels, or actual laboratory values. [nursingcenter.com]

  Indications for hemodialysis included serum creatinine level above 8 mg/dl, BUN above 100 mg/dl, serum potassium above 7 mmol/l, serum bicarbonate below 10 mEq/l, or/and clinical symptoms of ARF, such as edema, hypertension, heart failure, nausea, and [ccforum.biomedcentral.com]

• Hypotension

  The release of lactic acid can also cause metabolic acidosis, which can result in hypotension if the levels get too high. [emsworld.com]

  Ischaemic renal dysfunction secondary to hypotension and diminished renal perfusion results in acute tubular necrosis and uraemia." [ 1 ] It is also known as Bywaters' syndrome. [patient.info]

  The influx of water results in intravascular volume depletion, leading to hypotension. 2 With the continued entrapment of the patient’s limb, hypoperfusion worsens, contributing to tissue hypoxia. [jems.com]

  Yet following inadvertent calf compression and intra-operative hypotension, intra-compartmental calf pressures in excess of 35mmHg have been controlled by prompt HBO treatment without the need for fasciotomy (Van Poucke S). [ddrc.org]

  Clinical features Some or all of the following clinical signs and symptoms may be present: Cardiovascular instability Hypotension and hypovolemic shock. [cancertherapyadvisor.com]

• Fracture

  Comminuted fractures of left index, middle and ring finger proximal phalanxes. Index finger fracture has significant volar angulation. Minimally displaced longitudinal fracture of middle phalanx of third digit. No articular involvement. [radiopaedia.org]

  Crush injuries of the foot can be associated with fractures and dislocations. [podiatrytoday.com]

  In forearm fractures where open fractures are more common than closed [ 18 ], Gustillo type I, II and IIIA are safely fixed internally, while with IIIB and IIIC fractures, there is still debate [ 19 ]. [intechopen.com]

  When crush injuries are severe, the rate of complications including infection, non-healing of fractures and amputations range up to 50 percent. [virginiamason.org]

  Indeed, after crush injury there is a formation of a structure similar to the callus, which is normally formed where there is tissue motility around the fracture site during mammalian fracture repair. [bio.biologists.org]

• Flushing

  Treatment consists of massive quantities of IV fluids to help flush the cellular waste from the blood stream. Other supportive measures such as oxygen, blood transfusion, pain medication, etc may also be given. [pagelaw.com]

  If not hydrated regularly, the person is unable to flush out the myoglobin. [edition.cnn.com]

• Paresthesia

  Early examination findings will show pain disproportionate to the injury and paresthesia. Pain is worse with passive stretching of the muscles in the compartment (e.g., dorsiflexion of the foot for a compartment syndrome of the calf). [emsworld.com]

  Metabolic acidosis with lactic acidosis Disseminated intravascular coagulopathy Hypothermia Myoglobinuria Skin injury and swelling Paralysis and paresthesia Pulses may or may not be present. [cancertherapyadvisor.com]

  They may experience paresthesia — or numbness — that can actually mask their true level of pain. 3. [ems1.com]

  The signs and symptoms of compartment syndrome in an extremity include pain out of proportion to the injury or with passive motion, pallor, paresthesia, pulselessness, and paralysis of the affected extremity. [nursingcenter.com]

  Pain out of proportion to the injury or precipitated by passive movement of the extremity or fingers; a pale and swollen affected extremity; paresthesia of the extremity, with the first sensation to be lost being the sense of vibration;[ 8 ] and pulselessness [ncbi.nlm.nih.gov]

• Tingling

  Crush injuries can cause ongoing symptoms such as: Chronic pain Weakness in the affected limb Tingling Numbness Stiffness Permanent paralysis In some cases, damage is so severe that doctors may elect to amputate the affected limb. [hasnerlaw.com]

  The muscle may feel tight, or there may be burning or tingling in the skin. Acute compartment syndrome is a medical emergency that requires immediate surgery. Rhabdomyolysis. [attorneystevelee.com]

  […] ischemia muscle degeneration may be more common and severe than tourniquet-induced ischemia. (21, 22) Recognition of Compartment Syndrome The 5 (or 6) Ps of Compartment Syndrome are often used as a diagnosis: P ain P allor P aresthesia - numbness or tingling [realfirstaid.co.uk]

  Treatment should be based on clinical findings such as anxiety, numbness and tingling, nausea/vomiting, ECG abnormalities suggestive of elevated potassium levels, or actual laboratory values. [nursingcenter.com]

• Irritability

  A very recent product in the market is the absorbable JuggerKnot® soft Anchor 1.0 mm mini where there is no metal implant hence no chance of irritation to adjacent tendons ( Figure 17 ). Figure 17. [intechopen.com]

• Oliguria

  It was found that removal of the extremity from the press after five hours was followed by swelling of the thigh, an increase in the concentration of the blood, a decline in blood pressure, oliguria, abnormal urinary findings, elevated blood creatine [jamanetwork.com]

  Malignant hyperthermia References: [2] [3] Pathophysiology Clinical features Rhabdomyolysis Classic triad Myalgia Generalized weakness Darkened urine (red to brown) Nonspecific symptoms : fever ;, nausea, vomiting Complications Acute kidney injury : oliguria [amboss.com]

  The appearance, duration and gravity of oliguria and kidney damage are not related to the severity of muscle damage [ 6 ]. The muscles are grossly swollen, hard, cold, insensitive and necrotic. [ncbi.nlm.nih.gov]

  Dialysis and Hemofiltration Oliguria or anuria responsive to treatment, fluid therapy, volume overload, and a rising serum potassium (47 mEq/L) are indicators of the need for dialysis. [cancertherapyadvisor.com]

  There may be oliguria with profound hypovolaemic shock. Nausea, vomiting, confusion and agitation may occur as consequences of disturbed body chemistry; urea, creatinine, uric acid, potassium, phosphate and creatine kinase are elevated. [patient.info]

• Anuria

  […] hyperthermia References: [2] [3] Pathophysiology Clinical features Rhabdomyolysis Classic triad Myalgia Generalized weakness Darkened urine (red to brown) Nonspecific symptoms : fever ;, nausea, vomiting Complications Acute kidney injury : oliguria or anuria [amboss.com]

  CAUTION: Mannitol should not be given to patients with anuria. Blood osmolar gap should be maintained below 55 mOsm/kg (less than 1000 mg/d mannitol in blood). [cancertherapyadvisor.com]

  If extrication is delayed by several days, however, a more conservative approach that considers the likelihood of established anuria is needed. [cjasn.asnjournals.org]

  Eleven (34.38%) patients with proper indications received hemodialyses: all of them had different degrees of ARF symptoms, 5 had hyperpotassemia, 7 had anuria, and 4 had combined hyperpotassemia, anuria, and elevated creatinine. [ccforum.biomedcentral.com]

  The important predictive factors for dialysis include anuria, fluid overload, serum creatinine levels, BUN and bicarbonate levels [ 4 ]. Potassium levels above 7 meq/1 is an independent and important predictive factor of dialysis [ 11 ]. [ncbi.nlm.nih.gov]

• Renal Injury

  Renal injury occurs mainly due to two mechanisms: first, myoglobin causes obstruction of the renal tubules and, second, the nephrotoxicity of myoglobin leads to renal vasoconstriction. Acute renal failure results if this is not treated. [ncbi.nlm.nih.gov]

[…] hyperbaric treatment (21% O2 at 1.1 ATA, identical treatment schedule). [ddrc.org]

Treatment- Firstly, any wounds that are present will need to be cleaned and bandaged to prevent infection. Treatments for a foot crush injury may also include medication, casting, kinesiology taping, ice and heat, physical therapy, or surgery. [lakeridgefootankle.com]

Conclusion Now that we have reviewed the syndrome and its treatment, let’s get back to our patient who's trapped in the structural collapse. [emsworld.com]

Standard treatment modalities such as calcium, insulin, dextrose, and an exchange resin may temporize the situation; however, dialysis may be needed for definitive treatment. Table 2 provides a review on the treatment of hyperkalemia. Table 1. [nursingcenter.com]

Prognosis Crush injuries have a high death rate. They are associated with multi-organ damage at times that may not be reversible. Function of the injured muscle should return if the tissue did not die. [pagelaw.com]

If levels continue to elevate, consider ongoing muscle injury or compartment syndrome. [ 11 ] Prognosis Adequate fluid support improves prognosis. [ 12 ] The mortality rate for crush syndrome following the earthquake in northern Turkey in 1999 was 15.2% [patient.info]

Ce lien vous donne accès à une version de traduction automatique de Google en français: http://bit.ly/34QKX42 In his latest article for Clinics in Plastic Surgery, the Spanish surgeon analyzes the impact of microsurgery in improving the prognosis of the [drpinal.com]

Prognosis Crushed torso – Increases mortality rates Presence of ‘lethal triad of trauma’ (acidosis, coagulopathy, hypothermia) -Increases mortality rates Development of ARF (urine output 40 mg/dL and creatinine >200 mmol/L) -Increases mortality rates [cancertherapyadvisor.com]

Due to the limited parameters we could obtain, observation of urine output served as an important parameter for diagnosis of patients and for predication of prognosis. [ccforum.biomedcentral.com]

After studying the information presented here, you will be able to: List common etiologies of crush injuries Define crush injury, compartment syndrome, and crush syndrome Describe manifestations that accompany compartment syndrome and crush syndrome List [nurse.com]

Definition Etiology Causes of rhabdomyolysis Traumatic Crush injury Direct injury Nontraumatic Seizures Overexertion (e.g., ultramarathon) Intoxication (e.g., cocaine, heroin, alcohol, carbon monoxide, phencyclidine ) Skeletal muscle ischemia Infection [amboss.com]

Etiology/ common causes 1.Drug overdose: trunk compression of forearm and leg. 2.Surgical knee chest position: compression of leg anterior compartment. 3.Crushing industrial accidents. [youtube.com]

This article reviews the epidemiology, pathophysiology, diagnosis, and early management of crush syndrome. [nursingcenter.com]

Epidemiology Crush syndrome has been described in numerous settings, most commonly after earthquakes, during war and after explosions that have caused buildings to collapse. [patient.info]

Epidemiology Rhabdomyolysis occurs in up to 85% of patients with traumatic injuries. 10–50% of patients with rhabdomyolysis develop ARF. Patients with rhabdomyolysis-induced renal failure have a mortality of approximately 20%. [cancertherapyadvisor.com]

A common pathophysiological pathway has been elucidated over the last century describing traumatic rhabdomyolysis leading to myoglobinuric acute renal failure and a systemic ‘crush syndrome’ affecting many organ systems. [semanticscholar.org]

Explore these free sample topics: -- The first section of this topic is shown below -- First Things First (assess & treat for the following) Rhabdomyolysis is a constellation of pathophysiologic changes resulting from injury to skeletal muscle w/ the [anesth.unboundmedicine.com]

(April/June 2007) Crush Injuries: Pathophysiology and Current Treatment. Advanced Emergency Nursing Journal, Volume 29 (2), 145 – 150. Barbera, J. A., & MacIntyre, A. (1996). Urban search and rescue. [limmereducation.com]

Seizures Overexertion (e.g., ultramarathon) Intoxication (e.g., cocaine, heroin, alcohol, carbon monoxide, phencyclidine ) Skeletal muscle ischemia Infection Adverse drug reactions (e.g., neuroleptics, statins ) Malignant hyperthermia References: [2] [3] Pathophysiology [amboss.com]

Pathophysiology [ edit ] Crush injury is damage to the body as a result of being crushed by an object. [en.wikipedia.org]

Workers must be trained in the proper methods of operation, cleaning, and maintenance of the equipment to prevent crushing injury. [arnolditkin.com]

Early resuscitation is imperative to prevent hypovolemia and cardiac dysrhythmias. [jems.com]

[…] of muscle tissue & influx of myoglobin, potassium, and phosphorus into the circulation; - syndrome is characterized by hypovolemic shock and hyperkalemia ; - these results strongly suggest that free-radical scavengers are beneficial in attenuating or preventing [wheelessonline.com]

It also prevents neutrophil adhesion and prevents secondary injury. It is directly bactericidal to anaerobic organisms. [cancertherapyadvisor.com]

It is also important to keep the patient warm with warm fluids and heating blankets to prevent hypothermia. [emsworld.com]