A crush injury is

injury Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants. Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with ...

by an object that causes compression of the body. This form of injury is rare in normal civilian practice, but common following a

natural disaster A natural disaster is the very harmful impact on a society or community brought by natural phenomenon or Hazard#Natural hazard, hazard. Some examples of natural hazards include avalanches, droughts, earthquakes, floods, heat waves, landslides ...

. 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 violence against non-combatants to achieve political or ideological aims. The term is used in this regard primarily to refer to intentional violence during peacetime or in the context of war aga ...

incidents.

Presentation

Complications

* Hypovolaemic shock. Loss of plasma volume across damaged cell membranes and capillary walls can lead directly to severe hypovolaemia. 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 convent ...

that can precipitate

cardiac arrest Cardiac arrest (also known as sudden cardiac arrest CA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly Circulatory system, circulate around the body and the blood flow to the ...

. Sequestration of plasma calcium into injured tissue can lead to a relative hypocalcaemia, which may worsen disruption of clotting abilities and shock. Metabolic acidosis may result from reperfusion injury 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. * Acute kidney injury. Release of

myoglobin Myoglobin (symbol Mb or MB) is an iron- and oxygen-binding protein found in the cardiac and skeletal muscle, skeletal Muscle, muscle tissue of vertebrates in general and in almost all mammals. Myoglobin is distantly related to hemoglobin. Compar ...

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 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 Nociception, respond normally to Pain, painful stimuli, light, or sound, lacks a normal Circadian rhythm, sleep-wake cycle and does not initiate ...

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 Causes of amputation Medical emergencies {{musculoskeletal-disease-stub