CRUSH INJURIES & COMPARTMENT SYNDROME

CRUSH INJURIES – Are a particular type of blunt trauma that applies force which stretches tissues beyond their normal tolerances. (emsworld definition) COMPARTMENT SYNDROME – Is a complication of crush injuries where internal swelling creates pressure within the compartment which may cause tissue damage and inhibit proper perfusion.

What types of incidents do you think may cause crush injuries? MVA Falls Object dropped on foot/toes Shutting your hand/fingers in a door Person caught in machinery Structural collapse Trench collapse Patients who are on the ground for extended periods of time Surgery

VIDEO Abdominal Trauma

Signs and Symptoms of Crush Injury Visual assessment of affected area shows crushed tissue Bruising and indentation Bleeding from wounds and exposed bone, tendons, organs etc. Abdominal cavity may not initially show indications of crush injury Tea colored urine Signs and Symptoms of Compartment Syndrome Tightness and rigidity of the skin Bruising Pain Pathophysiology Muscle injury causes large quantities of potassium, phosphate, myoglobin, creatine and urate to leak into the circulation. Myoglobin levels in the plasma are normally very low. When significant amount of muscle is damaged, excess myoglobin is released into the body and filtered by the kidneys, and can cause kidney damage or failure.

Results of untreated crush injury/compartment syndrome Tissue and organ damage Infection Renal failure (acute kidney issues) Potassium increase (hyperkalamia) Cardiac dysrhythmia Hypovolaemic shock Metabolic Acidosis Amputation of limb DIC (Disseminated intravascular coagulation) Death

Treatment of Suspected Compartment Syndrome High flow O2 IV access with normal saline preferred. Avoid LR Pain management Call for paramedic Cardiac monitoring BGL Paramedics consider sodium bicarbonate for extended time periods TK considered controversial

Special Considerations/Risk Factors for Rhabdomyolysis ETOH withdrawal (with delerium tremors) Compartment syndrome Crush injury Stimulant and depressant drugs Certain genetic muscle diseases Heat emergencies Seizures Severe exertion (long-distance racing or similar) DVT may also cause compartment syndrome Trauma and prolonged periods of down-time in individuals with AMS Examine the scene for clues that may indicate MOI for crush injury