Crush syndrome

Crush syndrome
Crush syndrome
Classification and external resources
ICD-10 T79.5
ICD-9 958.5
DiseasesDB 13135
MeSH D003444

Crush syndrome (also traumatic rhabdomyolysis or Bywaters' 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 earthquakes, in which victims that have been trapped under fallen masonry.

Contents

Pathophysiology

The syndrome was discovered by British physician Eric Bywaters in patients during the 1941 London Blitz.[1][2] 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 kidneys is not understood completely, but may be due partly to nephrotoxic metabolites of myoglobin.

Seigo Minami, a Japanese physician, first reported the crush syndrome in 1923.[3][4][5] 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 tourniquet 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.[6] St John Ambulance Australia First Responders are trained in the same manner.


References

  1. ^ synd/3870 at Who Named It?
  2. ^ Bywaters, E. G.; Beall, D. (1941). "Crush injuries with impairment of renal function". Br Med J 1: 427–432. 
  3. ^ Minami, Seigo (1923). "Über Nierenveränderungen nach Verschüttung". Virchows Arch. Patho. Anat. 245 (1). doi:10.1007/BF01992107. 
  4. ^ Medical discoveries - Who and when- Schmidt JF. Springfield: CC Thomas, 1959. p.115.
  5. ^ Morton's medical bibliography -An annotated check-list of texts illustrating History of medicine (Garrison-Morton). Aldershot: Solar Press; 1911. p.654.
  6. ^ "Emergency Management of a Crushed Victim". Australian Resuscitation Council. March 2001. http://www.resus.org.au/policy/guidelines/section_9/guideline-9-1-7march2001.pdf. Retrieved 20 July 2011. 

External links

v · d · eCertain early complications of trauma (T79, 958)
Certain early complications
of trauma

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Look at other dictionaries:

  • crush syndrome — krəsh n the physical responses to severe crushing injury of muscle tissue involving esp. shock and partial or complete renal failure also the renal failure associated with such responses * * * kidney failure following massive trauma to, and… …   Medical dictionary

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  • crush syndrome — noun : the physical responses to severe crushing injury of muscle tissue involving especially shock and partial or complete renal failure; also : the renal failure associated with such responses * * * crush syndrome noun A medical condition in… …   Useful english dictionary

  • crush syndrome — kidney failure following massive trauma to, and necrosis of, muscle. It results from acute necrosis of the renal tubules associated with the presence in the blood of myohaemoglobin, released from the damaged muscle …   The new mediacal dictionary

  • Syndrome des loges — Classification et ressources externes Une fasciotomie lors d un syndrome des loges. CIM 10 …   Wikipédia en Français

  • Syndrôme de Volkman — Syndrome des loges Le syndrome des loges est une ischémie musculaire provoquée par une augmentation anormale de pression au sein d une loge anatomique. Ce syndrome anatomo clinique est le résultat d’un conflit entre un contenant ostéo… …   Wikipédia en Français

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  • Crush-Syndrom — (n), Bywaters Syndrom (n) eng crush syndrome, Bywaters syndrome …   Arbeitssicherheit und Gesundheitsschutz Glossar

  • Crush — [krʌʃ] der; [es] <verkürzt aus gleichbed. engl. crush (syndrome) zu crush »das (Zer)quetschen«, dies zu to crush »zerquetschen«> durch Zerfall größerer Muskelmassen nach schweren ↑Traumen ausgelöstes Krankheitsbild (Med.) …   Das große Fremdwörterbuch

  • double crush syndrome — compression or other damage of the same nerve at two different points, such as carpal tunnel syndrome with cervical radiculopathy. Some authorities believe that damage at one point makes a nerve group more vulnerable to injury somewhere else …   Medical dictionary

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