Crush syndrome occurs from high-pressure injuries leading to muscle tissue damage and systemic rhabdomyolysis, resulting in metabolic abnormalities and potential renal failure. Causes include direct injuries, drug intoxication, and improper positioning during surgery, while clinical features involve pain, swelling, and myoglobinuria. Treatment focuses on fluid resuscitation, metabolic correction, and may include fasciotomy to relieve compartment syndrome, but complications such as acute renal failure can arise.

1. CRUSH SYNDROME

2. CRUSH INJURIES
It occurs when a body part subjected to high
degree of force or pressure,after being squeezed
between two heavy or immobile objects.
Results in
Lacerations,fractures,bleeding,bruising,compart
ment syndrome crush syndrome.

3. CRUSH SYNDROME
 Systemic manifestation of rhabdomyolsysis
caused by prolonged continuous pressure on
muscle tissue

4. CONT
It involves series of metabolic changes
produced due to severe injury of skeletal
muscles after prolonged continous pressure
which causes disruption of cellular integrity
and release of its contents into circulation.
It results in electrolyte disturbance, fluid
sequestration, myoglobinuria

5. CAUSES
 Direct injury(natural disasters and accidents)
 Drugs/alcohol intoxication
 Carbonmonoxide poisoning
 Improper positioning of surgical patient
 CVA/head trauma with coma
 Pneumatic antishock garments

6. PATHOGENESIS
Crush injury
Soft tissue injury
ischemia
Compartment
syndrome
Muscle
necrosis

7. Rhabdomy
olysis
Third
space
fluid loss
Myoglobi
nuria
Hypovole
mic
schock
Acute
renal
failure
Muscle necrosis

8.  Metabolic abnormalities
Hyperkalemia,hypocalcemia,hyperphosphate
mia,metabolic acidosis.
 Reperfusion injury
 DIC

10. CLINICAL FEATURES
 Pain
 Swelling
 Blisters
 Loss of sensation
 Loss of muscle power

11. MYOGLOBINURIA RESULTS IN
-Cola coloured urine
-Oliguria
-Renal failure
METABOLIC DISTURBANCE RESULTS IN
-Agitation,delirium,vomiting
-Metabolic acidosis
-CARDIAC ARREST(Hyperkalemia)

12. Symp of compartment syndrome
-Pulselessness
-Pallor
-Pain
-Paresthesias
-Poikilothermia
-Paralysis

13. INVESTIGATIONS
 Complete hemogram
 ECG
 ABG,Myoglobin levels in urine
 Serum creatinine kinase level(>1000
IU/L,peaks in 1 to 3 days)
 Intracompartmental pressure

14. TREATMENT
 IV FLUIDS
 O2 SUPPORT
 CORRECTION OF METABOLIC ABNORMALITIES
 DIALYSIS IN RENAL FAILURE

15. IV FLUIDS:
- IV fluids before extrication is
preferrable.
- Cathetarisation-to monitor urine
output
-Saline infusion of 1-1.5 lit/hr is given

16.  CORRECTION OF METABOLIC
ABNORMALITIES:
- IV FLUIDS
- Sodium bicarbonate (for acidosis
and helps in alkanisation of urine)
-Alkanisation increases solubility of
acid hematin and aids in it excretion
-Correction of hyperkalemia.

17.  Mannitol
-Given to eliminate Myoglobin from the
kidney and prevent renal failure.
-May also be used to initiate diuresis in a
patient who has not achieved adequate urine
output after 4 hrs of start of treatment.
(Dose = 0.25 grams per kg IV over 10 – 30 mins.
Diuresis should start within 15-30 mins)

18.  Fasciotomy is done in early hours of injury
 Since fasciotomy in necrosed muscle can
result in release of large myoglobin,free
radicals in circulation which causes
worsening of syndrome.

19.  Complications:
-Compartment syndrome
-Acute renal failure
-Acute tubular necrosis
-Gas gangrene