Presentation
Topic Images Snapshot A 60-year-old man presents to the emergency room after an earthquake. His right leg had been trapped under his truck for an hour. [step2.medbullets.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]
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]
Clinical Presentation Sudden release of a crushed extremity may result in reperfusion syndrome—acute hypovolemia and metabolic abnormalities. This condition may cause lethal cardiac arrhythmias. [acep.org]
Entire Body System
- Ecchymosis
On physical exam, there is a large ecchymosis and abrasion on the right thigh. The right thigh is severely tender to palpation and the muscles feel tense. Laboratory evaluation reveals hyperkalemia and significantly elevated creatine kinase. [step2.medbullets.com]
- Asymptomatic
The classic description of double crush syndrome (DCS) describes a clinical entity of multiple sites of compression along a single peripheral nerve.1 It was first described in 1973 by Upton and McComas,1 who theorized that asymptomatic compression at [journals.lww.com]
Musculoskeletal
- Back Pain
Besides the mentioned pain in my arm, I also suffered from pain in the spine, being a bit smashed, but then in March month, after having read Bowles, Jeff T.: “Vitamin D3 Miracle”, and increasing the D3 to 5,000 IU, a day, in 1 week my back pain disappeared [amazon.fr]
- Arthritis
Semin Arthritis Rheum 1984;14(2):134–140. 9. Baba H, Maezawa Y, Uchida K, et al.: Cervical myeloradiculopathy with entrapment neuropathy: A study based on the double-crush concept. Spinal Cord 1998;36(6):399–404. 10. [journals.lww.com]
Neurologic
- Irritability
Cervical nerve root compression may be initially treated with oral steroids, avoidance of irritating movements, a short period of immobilization with a soft collar, and physical therapy. [journals.lww.com]
Urogenital
- Kidney Failure
[citation needed] The progressive acute kidney failure is because of acute tubular necrosis. [en.wikipedia.org]
Crush syndrome, which occurs when blood circulation to a limb is cut off by heavy debris, can lead to kidney failure even if the victim is successfully extricated. [fr.bab.la]
Depending on medical direction, the use of bicarbonate and mannitol to prevent kidney failure has been called into question. [ems1.com]
This syndrome is associated with rhabdomyolysis and this can cause kidney failure. We must take this into account to act accordingly. Each patient is different, and the treatment must be individualized as much as possible to achieve a better result. [dialnet.unirioja.es]
- Oliguria
[…] injury (prerenal) [4] Reperfusion syndrome → compartment syndrome 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]
Workup
PR Interval
- Prolonged PR Interval
These include peaking of the T wave, flattening of the P wave, prolongation of the PR interval, ST segment depression, prolongation of the QRS complex, and, eventually, progression to a sine wave pattern [8, 9]. [ems1.com]
On the 12-lead you should initially look for peaked T-waves and prolonged PR intervals. As the potassium levels increase, you will notice a widening of the QRS complexes into sine waves, which can then deteriorate into ventricular fibrillation. [emsworld.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]
The syndrome of rhabdomyolysis: Complications and treatment. Eur J Intern Med. 2008; 19 (8): p.568-574. doi: 10.1016/j.ejim.2007.06.037. | Open in Read by QxMD [amboss.com]
In patients with dual compression, surgical treatment may be less effective than that performed for those with only one site of compression if both sites are compressed. Surgical outcomes for the treatment of DCS are difficult to study. [journals.lww.com]
Hyperkalaemia will need treatment. Hypocalcaemia does not generally need treatment. Renal dialysis may be needed. DIC will need treatment with fresh frozen plasma, cryoprecipitate and platelets. [patient.info]
Prognosis
Prognosis Adequate fluid support improves prognosis[12]. The mortality rate for crush syndrome following the earthquake in northern Turkey in 1999 was 15.2%[13]. [patient.info]
Giannoudis et al26 reported an increased risk and poor prognosis for patients with acetabular fractures with proximal and distal nerve injury. [journals.lww.com]
Etiology
Introduction Clinical definition syndrome of shock, rhabdomyolysis, and acute renal failure after prolonged crush injury Epidemiology Risk factors natural disasters e.g., earthquakes trauma cave-ins ETIOLOGY Pathogenesis ischemia causes breakdown of skeletal [step2.medbullets.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 [2] Infection [amboss.com]
The etiology of her symptoms was presumed to be secondary to a non-functional device due to the non-functional lead. [omicsonline.org]
Table 1: Various Etiologies Contributing to Nerve Dysfunction Pathophysiology The pathophysiology of peripheral neuropathy is complex, and controversy surrounds the exact underlying mechanisms of DCS. [journals.lww.com]
Epidemiology
He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. [litfl.com]
Introduction Clinical definition syndrome of shock, rhabdomyolysis, and acute renal failure after prolonged crush injury Epidemiology Risk factors natural disasters e.g., earthquakes trauma cave-ins ETIOLOGY Pathogenesis ischemia causes breakdown of skeletal [step2.medbullets.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 and Risk Factors Little consensus exists about the epidemiology, characteristics, risk factors, and pathophysiology regarding DCS. [journals.lww.com]
Pathophysiology
Table 1: Various Etiologies Contributing to Nerve Dysfunction Pathophysiology The pathophysiology of peripheral neuropathy is complex, and controversy surrounds the exact underlying mechanisms of DCS. [journals.lww.com]
Nontraumatic Seizures Overexertion (e.g., ultramarathon) Intoxication (e.g., cocaine, heroin, alcohol, carbon monoxide, phencyclidine) Skeletal muscle ischemia [2] Infection Adverse drug reactions (e.g., neuroleptics, statins) Malignant hyperthermia Pathophysiology [amboss.com]
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]
Prevention
Department of Health and Human Services Centers for Disease Control and Prevention, June 2009 [acep.org]
It also prevents neutrophil adhesion and prevents secondary injury. It is directly bactericidal to anaerobic organisms. [cancertherapyadvisor.com]
[…] hypotension for all patients maintain consistent urinary output calcium gluconate indication iLn the case of hyperkalemia sodium bicarbonate indication prevent myoglobin and uric acid deposition in kidneys Complications Compartment syndrome Acute tubular [step2.medbullets.com]
Use intravenous sodium bicarbonate to keep the urine pH at 6.5 or greater, to prevent myoglobin and uric acid deposition in kidneys. [en.wikipedia.org]
It is also important to keep the patient warm with warm fluids and heating blankets to prevent hypothermia. [emsworld.com]