Download CRUSH SYNDROME

CRUSH SYNDROME
ICD 10: T79.5
Mohit Chhabra
Roll no. : 47
OBJECTIVES

Define and understand the pathophysiology
of Crush Syndrome

Clinical diagnosis and relevant investigation

Management
A Case of Crush Syndrome….
Clinical Features
Lower limb injury with pain and swelling,
which later on developed anesthesia and
motor disturbance
 Signs of hypovolemic shock
 Tea-colored urine, maybe oliguria
 Nausea and confusion

Pathophysiology
On Investigating further….
 Hyperkalemia & hypocalcaemia
 ECG changes secondary to hyperkalemia
 Metabolic acidosis
 Raised Creatine Kinase
 Elevated UREA and CREATININE
 Myoglobinuria
 Evidence of D.I.C.
Diagnosis: Crush Syndrome
Definition:
◦ A severe, often fatal condition that follows a severe
crushing injury, particularly involving large muscle
masses, characterized by fluid and blood loss, shock,
hematuria, and renal failure. Also known as
compression syndrome. (McGraw Hill Dictionary)
◦ In a nutshell: TRAUMATIC RHABDOMYOLYSIS
due to crushing
◦ Also known as Bywaters Syndrome/
Reperfusion injury
PATHOPHYSIOLOGY
Crushing injury
Ischaemic
damage to
muscles
Release of toxic
metabolites
Clinical
Features
KIDNEY IS IN DANGER AS SOON AS WE
RELIEVE THE COMPRESSION
Renal hypoperfusion + Renal Tubular Necrosis = Renal Failure
MANAGEMENT

Initial Management:
1. Follow the usual criteria of A-B-C as injuries are
massive and high chances of poly-trauma
2. Early and rapid rehydration
3. Venous access preferably before the limb is
decompressed
4. CVP and urinary catheterization for monitoring

Further Management
1. Large amount of saline infusion with forced
diuresis
2. Debridement of crushed tissue and a
fasciotomy for compartment syndrome
3. Dialysis if renal failure sets in
4. Amputation as the last resort if massive
limb injury is there and we have to prevent
crush syndrome