Transcript CRUSH INJURIES & COMPARTMENT SYNDROME

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?
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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
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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
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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
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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