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Crush Syndrome

Bywaters' Syndrome


Presentation

  • 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]
  • Pacer spikes are present, and demonstrate an inability to both capture and to sense intrinsic ventricular activity (arrows).[omicsonline.org]
  • The patient may present in a variety of ways. They may be relatively stable, conscious and alert. It may be difficult to determine the extent of injury because of the crushing object involved (rubble, soil, grain, etc.).[ems1.com]
  • Present attempts are aimed at streamlining the early detection of crush syndrome, standardising a fluid regimen pattern and identifying casualties for renal replacement therapy [ 4 ].[ncbi.nlm.nih.gov]
  • Crush syndrome was not well defined until the 1940s when nephrologists Bywaters and Beal provided descriptions of victims trapped by their extremities during the London Blitz who presented with shock, swollen extremities, tea-colored urine, and subsequent[nursingcenter.com]
Crying
  • I thought the whole cast were good and it's a great TV program the cast really knows how to act and makes you laugh and cry at the same time.[imdb.com]
Palpitations
  • Case Description An 81-year-old female presented to the emergency room complaining of a one month history of near syncope, palpitations and weakness. She stated that she had a pacemaker placed in Armenia in 2008, likely due to sick sinus syndrome.[omicsonline.org]
Cervical Radiculopathy
  • The existence of double crush syndrome was further substantiated by Massey's (1981) study of nineteen cases of carpal tunnel syndrome co-existing with a cervical radiculopathy.[physio-pedia.com]
Oliguria
  • 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]
Kidney Failure
  • Depending on medical direction, the use of bicarbonate and mannitol to prevent kidney failure has been called into question.[ems1.com]

Workup

Prolonged PR Interval
  • Moderate hyperkalemia (7 – 8 mmol/l) – flattened P wave, prolonged PR interval, depression of ST segment, peaked T wave. Severe hyperkalemia (8 – 9 mmol/l) – atrial standstill, prolonged QRS duration, further peaking T waves.[ems1.com]

Treatment

  • Note: - Confined space and a MVI situation may compromise treatment.[jointemsprotocols.com]
  • This article will cover four areas: basic pathophysiology, patient assessment, management and treatment and ECG changes. 1.[ems1.com]
  • Treatment In scenario of crush injuries, we are dealing with rescue, resuscitation, recognition of the syndrome, treatment and rehabilitation.[ncbi.nlm.nih.gov]
  • Physiotherapy treatment Needs to be tailored to specific client and progressed as appropriate. Treatment may include all or some of the below. Education and rest from aggravating activities.[physio-pedia.com]
  • Specific Treatment Extrication Extrication should be prompt as the time of entrapment of a limb is directly proportional to the development of crush syndrome.[cancertherapyadvisor.com]

Prognosis

  • 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 Physiological[cancertherapyadvisor.com]

Etiology

  • The etiology of her symptoms was presumed to be secondary to a non-functional device due to the non-functional lead.[omicsonline.org]

Epidemiology

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

Pathophysiology

  • This article will cover four areas: basic pathophysiology, patient assessment, management and treatment and ECG changes. 1.[ems1.com]
  • Pathophysiology The pathophysiology begins with muscle injury and muscle cell death. Immediate cell disruption. Direct pressure on muscle cells: The direct pressure causes muscle cells to become ischemic.[cancertherapyadvisor.com]
  • This article reviews the epidemiology, pathophysiology, diagnosis, and early management of crush syndrome.[nursingcenter.com]
  • Pathophysiology It is recorded that upto 80% of crush injury patients die due to severe head injuries or asphyxiation. Of the 20% that reach hospital, 10% make an uneventful recovery. The other 10% go into crush syndrome [ 1 ].[ncbi.nlm.nih.gov]

Prevention

  • It also prevents neutrophil adhesion and prevents secondary injury. It is directly bactericidal to anaerobic organisms.[cancertherapyadvisor.com]
  • Depending on medical direction, the use of bicarbonate and mannitol to prevent kidney failure has been called into question.[ems1.com]
  • Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes. J Am Soc Nephrol. 2004; 15 :1862–1867. [ PubMed ] [ Google Scholar ] 5.[ncbi.nlm.nih.gov]
  • Although difficult to achieve, alkalinization of the urine may be beneficial in preventing renal failure and can be started with initial volume resuscitation.[nursingcenter.com]

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