crush syndrome orthopaedics final year

crush syndrome

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,compartment 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 Compartment syndrome Muscle necrosis

7. Muscle necrosis

8. Metabolic abnormalities Hyperkalemia,hypocalcemia,hyperphosphatemia,metabolic acidosis. Reperfusion injury DIC

9. Clinical features Pain Swelling Blisters Loss of sensation Loss of muscle power

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

11. Symp of compartment syndrome - Pulselessness -Pallor -Pain - P aresthesias - Poikilothermia -Paralysis

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

13. Treatment IV FLUIDS O2 SUPPORT CORRECTION OF METABOLIC ABNORMALITIES DIALYSIS IN RENAL FAILURE

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

15. 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 .

16. 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 )

17. 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.

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