Crush Injury HARRT 2004

Crush Syndrome A panoply of systemic manifestations that arises once a victim sustains a compressive force of sufficient duration and severity to cause muscle crush injury and cell death A panoply of systemic manifestations that arises once a victim sustains a compressive force of sufficient duration and severity to cause muscle crush injury and cell death Principal complications are associated with heart and kidney Principal complications are associated with heart and kidney Heart Effects: Result of Hyperkalemia Heart Effects: Result of Hyperkalemia Kidney Effects: Result of myoglobin and uric acid precipitation in renal tubules, decreased glomerular filtration, and nephrotoxic effect of ferrihemate (a dissociation of myoglobin in the acidic environment of the renal parenchyma.) Kidney Effects: Result of myoglobin and uric acid precipitation in renal tubules, decreased glomerular filtration, and nephrotoxic effect of ferrihemate (a dissociation of myoglobin in the acidic environment of the renal parenchyma.)

Earthquake Ernie

Right Leg Right Leg Crushed, poor arterial flow, little or no venous return Crushed, poor arterial flow, little or no venous return Regional ischemia due to impaired macro- and microcirculation Regional ischemia due to impaired macro- and microcirculation Rest of him Rest of him Dazed, in pain

Earthquake Ernie Right Leg Right Leg Muscle cells injured heading toward death (Rhabdomyolysis) Muscle cells injured heading toward death (Rhabdomyolysis) Derangements of oxidative- glycolytic pathways Derangements of oxidative- glycolytic pathways ATP depletion ATP depletion Profound changes in intracellular electrolyte composition Profound changes in intracellular electrolyte composition K+ leaves cell K+ leaves cell Ca++ enters cell Ca++ enters cell Na+ enters cell Na+ enters cell Exit of internal proteases Exit of internal proteases Myoglobin exits Myoglobin exits Rest of him Rest of him Glad to be alive! Except for leg pain, rest is okeedokee Damn it! Help!

Earthquake Ernie Right Leg Right Leg Hours later, more myocytes inevitably go from ischemic to dead. It is a gradual process because: Hours later, more myocytes inevitably go from ischemic to dead. It is a gradual process because: Speed of Ca++ shift is slowed due to vascular occlusion Speed of Ca++ shift is slowed due to vascular occlusion Superoxides and H2O2 are low due to ischemic mitochondria Superoxides and H2O2 are low due to ischemic mitochondria Surrounding acidosis is cyto-protective Surrounding acidosis is cyto-protective Rest of him Rest of him Hungry, thirsty Can’t feel leg