When the body is exposed to force or pressure for a long period of time ranging from four to six hours, as a result of events such as earthquakes, hurricanes, building collapses, or being trapped in storage places, a person may become susceptible to crush syndrome. In this Dalili Medical  we will learn about the symptoms of crush syndrome and available treatment methods.

What is crush syndrome?

 

Crush syndrome is a medical condition that occurs as a result of the body being exposed to severe pressure or continuous pressure on the muscles for a long period. This pressure can result from accidents such as earthquakes, car accidents, or construction accidents, where the muscles or soft tissues are crushed. When the muscles are exposed to this strong pressure, they may be damaged and begin to leak harmful substances into the bloodstream, such as potassium, myoglobin, and hemoglobin. When these substances enter the blood in large quantities, they can lead to serious health problems.

How long does crush syndrome last?

 

In general, crush syndrome is a serious medical condition that occurs as a result of severe injuries that lead to significant destruction of muscle and tissue, usually as a result of an accident in which the body is exposed to continuous pressure or stress. The time it takes for the syndrome to develop depends on its severity and the surrounding factors that affect its development. Symptoms usually appear between 4 to 6 hours after exposure to pressure, but can also occur after being trapped for more than one hour. Pressure on the muscles damages the muscle sheath, which surrounds the muscle fibers. The function of the muscle sheath is to retain certain contents within the cell and prevent their leakage. When this sheath is damaged, the permeability of the membrane increases, leading to leakage of cellular contents, which can have devastating effects on the body.

**What is crush syndrome?**

 

Many people may be confused about the meaning of the term "crush", so many people seek to constantly search for this syndrome to be aware of what is happening around them. The following is an explanation of this condition:

Crush syndrome is a condition that occurs as a result of continuous and severe pressure on one of the lower body organs in particular. This pressure can occur in the trunk or any other part of the limbs, causing muscle damage, especially rhabdomyolysis, as well as muscle dysfunction.

Pressure on tissues can also lead to crush syndrome, such as in earthquake accidents when a person remains under rubble for more than 4 to 6 hours. Car accidents or injuries on construction sites can also cause this syndrome.

This condition is also known as traumatic rhabdomyolysis or Biowaters syndrome, a medical condition characterized by shock. The individual may also suffer from kidney failure as a result of the crushing effect on the skeleton and muscles. Crush injury occurs as a result of pressure on the limbs or any other part of the body, which leads to muscle swelling or disorders.

***Symptoms of crush syndrome***

 

Symptoms of crush syndrome may not appear immediately upon examination of the patient, as the patient may appear relatively well until the pressure is removed. Symptoms of crush syndrome include:

- Respiratory problems

- Low blood pressure due to fluid loss

- Heart rhythm disturbances

- Pain

- Psychological trauma

- Sensory and motor disturbances in the compressed extremities

- Swelling and puffiness in the extremities

- Change in urine color and decreased amount

- Nausea and vomiting

- Confusion

**Causes of crush syndrome**

Crush syndrome occurs as a result of direct pressure on the muscles, often affecting the legs or arms. This syndrome is associated with traffic accidents, industrial accidents, construction accidents, earthquakes, and any accident that causes severe stress on the body. Lack of perfusion leads to the breakdown of skeletal muscles, causing the release of myoglobin, phosphorus, and potassium from the cells.

**History of Crush Syndrome**

After reviewing the concept of crush syndrome, let us review the history of this syndrome through the following points:

Crush syndrome was discovered by British physician Eric Bywaters in 1941 during the London Blitz events, and it is a condition resulting from fluid perfusion injury that appears after severe pressure is removed from the injured person.

Crush syndrome is believed to be related to blood re-pumping, which leads to the release of muscle breakdown products into the bloodstream, especially potassium, myoglobin, and phosphorus, which are the result of rhabdomyolysis.

This condition occurs as a result of the collapse of the skeletal and muscle damaged by lack of blood perfusion.

Although the mechanism of action of the syndrome in the kidneys is still not fully understood, it is believed that it is partly due to the production of hemoglobin in the kidneys. Japanese physician Seigo Minami also first referred to crush syndrome in 1923.

**Treatment of crush syndrome**

Here we review the mechanism of treatment for crush syndrome:

. **Fluid resuscitation** Treatment for crush syndrome involves carefully administering fluids to the victim to maintain blood pressure and kidney function. A special saline solution is used to replace the large loss of fluids. If there are imbalances in electrolyte levels (minerals in the blood and other body fluids that carry an electrical charge) as a result of the crush injury, treatment may require the use of specialized amounts of electrolytes.

**. Monitoring Electrolytes**Careful monitoring of electrolytes is a vital step in ensuring the body’s electrical balance is stable and controlling the levels of various salts in the blood. By performing regular blood tests to measure levels of electrolytes such as potassium, sodium, and calcium, as well as evaluating kidney and liver function, changes can be monitored and treated as needed.

**. Urine Alkalinity**When the body is subjected to prolonged force or pressure (four to six hours), such as heavy weight due to earthquakes, hurricanes, building collapses, or confinement in storage facilities, the patient may become susceptible to crush syndrome.

What is crush syndrome?

 

Crush syndrome isA medical condition that occurs when the body is subjected to extreme stress or continuous pressure on the muscles for a long period of time. This pressure can be caused by crushing the muscles or soft tissues due to accidents such as earthquakes, car accidents, or construction accidents. When the muscles are subjected to this intense pressure, they may become damaged and begin to leak harmful substances into the bloodstream. These harmful substances include potassium, myoglobin, and hemoglobin. When these substances enter the blood in large quantities, they can lead to serious health problems.

**Symptoms of Crush Syndrome**

 

Symptoms of crush syndrome may not be immediately apparent when examining the patient, as the patient may appear to be in relatively good condition until the pressure is removed. Possible symptoms of crush syndrome include:

- Respiratory problems

- Low blood pressure due to fluid loss

- Heart rhythm disturbances

- Pain

- Psychological trauma

- Sensory and motor disturbances in the compressed extremities

- Swelling and puffiness in the extremities

- Changes in urine color and decreased amount

- Nausea and vomiting

- Confusion

***Causes of crush syndrome***

Crush syndrome occurs as a result of direct pressure on the muscles, often affecting the legs or arms. This syndrome is associated with traffic accidents, industrial accidents, construction accidents, earthquakes, and any accident that causes severe stress on the body.

Lack of perfusion causes skeletal muscle to deteriorate, causing the release of myoglobin, phosphorus, and potassium from the cells.

**Treatment of crush syndrome**

**Fluid resuscitation**Treatment of crush syndrome involves carefully administering fluids to the injured person to maintain blood pressure and kidney function. A special saline solution is used to replace the significant fluid loss. If there are imbalances in the electrolyte composition (minerals in the blood and other body fluids that carry an electrical charge) as a result of the crush injury, treatment may require the use of special amounts of electrolytes.

. Monitoring Electrolytes** Monitoring electrolytes is a vital step in ensuring the body’s electrical balance is stable and controlling the levels of various salts in the blood. This is done through regular blood tests to measure electrolyte levels (such as potassium, sodium, and calcium) as well as evaluating kidney and liver function. These tests help detect changes and treat them if needed.

. Urine Alkalinity** Treatment for crush syndrome also involves carefully monitoring the alkalinity of the urine. This occurs when damaged muscle leaks into the bloodstream, causing creatinine levels to rise, which can cause the blood to become more acidic and the urine to become less alkaline. Urine alkalinity can be monitored and corrected through the following procedures:

Performing urine tests requires regular urine samples to be analyzed to measure the level of alkalinity. If urine alkalinity drops to dangerous levels, measures can be taken to raise it.

If there is an increase in blood acidity due to high creatinine levels, blood acidity can be corrected using specialized solutions.

It is important to monitor urine alkalinity and blood acidity levels regularly to ensure they are stable and to address any changes promptly.

**. Wound Care**Effective recovery from crush syndrome depends on the severity of the injury. To improve healing, your wound may be evaluated and treated by a wound care specialist. The wound care specialist will monitor the wound for signs of potential infection. The specialist will also help you maintain the appropriate balance between moisture and dryness to ensure proper wound healing.

**. Renal Support**Intravenous fluid resuscitation is the mainstay of treatment and should be started before the onset of recovery and reperfusion syndrome. Intensive resuscitation with warm saline is recommended to reverse metabolic acidosis, improve clotting, and prevent kidney failure. Ringer’s lactate should be avoided as it contains potassium.

Due to the seriousness of crush syndrome, the UK First Aid Guidelines recommend that victims who have been trapped for more than 15 minutes should not be released.

Treatment involves rapid and sustained bleeding control, with the patient being given plenty of fluids, including 4,000 IU of dextran.

The victim who has been under pressure is released gradually, and after release the fluid intake is reduced, along with a reduction in the protein content of the diet.

In March 2001, the Australian Resuscitation Council recommended that paramedics release pressure as soon as possible, avoiding stopping bleeding and monitoring the patient's vital signs.

**Field management**

A critical case can be treated by relieving pressure in the field. The following is an overview of the management of the case in this context:

It is not wise to allow a lenient drop in blood pressure, especially when the patient has been under pressure for more than 4 hours.

In most cases, pressure is continued for more than an hour, so fluids should be increased with intravenous sodium bicarbonate.

The San Francisco Emergency Services protocol recommends that the initial dose for adults is 2 liters of saline at a rate of 500 mL/hour.

The dose is limited for children or patients with renal impairment or a history of heart failure.

The patient’s inability to tolerate fluids may be a strong indication that bleeding needs to be stopped until appropriate measures are taken.

**Initial Hospital Management**

The physician should take measures to protect the patient from renal failure, hypotension, acidosis, or hyperkalemia with hypocalcemia.

When the patient is admitted to the intensive care unit, the patient should be monitored by physicians experienced in trauma medicine. Patients who appear stable should also be monitored.

Open wounds are treated as required by the surgical condition with antibiotics or tetanus vaccine.

Ice packs are placed on the patient’s skinThe affected person should be given about 1.5 liters of water every hour to prevent hypotension.

Urination should be at a rate of at least 300 ml/hour, with mannitol and intravenous fluids. If the desired urine rate is not achieved, dialysis is performed.

Urine acidity should be maintained by adding sodium bicarbonate intravenously at a concentration of 6.5, to prevent the deposition of uric acid and myoglobin in the kidneys, thus avoiding the occurrence of hyperkalemia or hypocalcemia.