Diseases

Crush Syndrome – Causes, Symptoms & Treatment

Crush-Syndrom

Victims of accidents and disasters are particularly affected by crush syndrome . Contusion or injury to the muscles causes necrotization of the muscle tissue as part of the phenomenon and can lead to kidney failure or liver failure in the process. Treatment at the scene of the accident has a significant impact on the prognosis for crush syndrome.

What is crush syndrome?

In crush syndrome, muscle tissue disintegrates as a result of necrotic injury to large sections of the skeletal muscles. The phenomenon is also known as myorenal syndrome or Bywaters disease . In crush syndrome, muscle breakdown leads to acute renal or hepatic insufficiency . Therefore, the syndrome is also referred to as a systemic disease. In this phenomenon, the necrosis affects the entire organism and especially the organ system of the affected person.

Doctors understand necrosis to mean the irreversible destruction of cells in body tissue. This cell death is caused by inflammation of the affected areas, which attract scavenger cells. Apoptosis , i.e. programmed cell death, also takes place in necrotic tissue . The crush syndrome is particularly relevant for accident and emergency medicine as well as disaster relief.

Eric Bywaters described the syndrome in 1941 in patients who had fallen victim to the London Blitz air raid. The Japanese doctor Seigo Minami documented crush syndrome as early as 1923.

causes

Crush syndrome is mainly observed in connection with earthquakes and other environmental disasters. Victims usually suffer muscle bruises that cause muscle necrosis. However, mechanical muscle injuries caused by accidents can also trigger the syndrome. The same applies to an insufficient supply of oxygen, which can occur in the context of carbon monoxide poisoning as a result of a fire scenario.

When muscle tissue is destroyed, the muscle protein myoglobin is released. Although many sources suspect this protein to be the cause of kidney and liver failure, this connection has not yet been conclusively clarified. Systemic organ failure can also be caused by reduced organ perfusion caused by shock.

In the context of states of shock , many accident, earthquake and fire victims suffer, for example, from a lack of circulating blood volume. The pumping capacity of the heart decreases and its vascular tone decreases. In this way, hypoxia can occur in the organs.

Symptoms, Ailments & Signs

The main signs of shock can be seen in patients with crush syndrome. Parts of the skeletal muscles are bruised and develop muscle necrosis. After blood flow is restored, reperfusion trauma occurs . As part of this phenomenon, muscle cells break down, releasing potassium, phosphorus, and myoglobin. Analogously, the blood level of all the substances mentioned increases.

Enormous hyperkalemia often sets in , which can be accompanied by cardiac arrhythmia . In addition, liver cells often die after the restoration of blood flow, causing jaundice in the liver tissue. Kidney tissue is also affected by cell death in crush syndrome. If the person concerned is not treated professionally, death will follow within a very short time. Shortly before death, the patient appears to be almost completely asymptomatic. Therefore, the crush syndrome is often associated with the term smiling death .

Diagnosis & History

Ideally, the first suspected diagnosis of crush syndrome is made by the first responders. At the latest, the emergency physicians recognize the phenomenon through visual diagnostics. In the hospital, blood tests can confirm the first suspected diagnosis. The prognosis for crush syndrome depends primarily on the initial care after the accident.

If treated incorrectly at the scene of the accident or in the hospital, the phenomenon can have a fatal outcome. If there are no signs of kidney failure or liver failure at the scene of the accident, this can change within a very short time. The right treatment prevents serious organ damage as a result of muscle necrosis and thus improves the prognosis.

complications

Various complications can occur during and after the occurrence of crush syndrome. The clinical picture can lead to multiple organ failure, depending on the location and severity of the injuries. Initially, however, muscle necrosis occurs as part of crush syndrome, triggered by the damaged skeletal muscles and other trauma .

When blood flow to muscles is restored, reperfusion trauma can occur, which is associated with muscle cell breakdown and release of potassium, myoglobin, and phosphorus. As a result, the blood level of the substances mentioned increases, which intensifies existing cardiac arrhythmias and other circulatory problems. So-called hyperkalemia, a disturbance in the body’s electrolyte balance, which is associated with blood pressure fluctuations and heart attacks, often occurs.

As a result of larger bruises , the blood flow to vital organs is also restricted, which can lead to jaundice in the liver or kidney tissue over time. If left untreated, crush syndrome leads to the death of the patient within a short period of time. If the affected person is treated before organ failure occurs, crush syndrome can often be treated without serious complications; if kidney failure or liver failure is already present, permanent damage is likely.

When should you go to the doctor?

In the event of an accident with serious injuries, the emergency doctor must be called immediately. First responders should first check whether the injured person is conscious and then initiate appropriate first aid measures or wait for medical help. In the event of visible muscle or bone injuries, crush syndrome may be present – in this case, self-treatment should be avoided. If you have not already done so, a doctor must be consulted immediately, especially if there are signs of cardiac arrhythmia or multiple organ failure.

The person concerned should be taken to the nearest hospital immediately or the emergency services will be alerted. A longer hospital stay is necessary in any case, since crush syndrome is almost always caused by severe internal and external injuries. The affected person requires comprehensive medical and physiotherapeutic treatment. In most cases, psychological counseling or trauma therapy is also necessary. It is advisable to plan the necessary steps together with the doctor responsible and a person you trust. Close monitoring of injuries is indicated in crush syndrome.

Treatment & Therapy

Treatment of crush syndrome begins at the scene of the accident. The behavior of the first responders and emergency physicians is crucial for the prognosis of the victims. The bruised limbs must be tied off as quickly as possible. As a blood volume replacement, the patient is given an infusion that preferably does not contain any potassium. If victims are buried or heavy objects on their limbs cause necrosis, the affected body parts are tied off before the victims are freed.

The same also applies to the supply of the potassium-free infusion solution and the administration of sodium bicarbonate . If these principles are not observed, the “smiling death” can occur immediately after the liberation. In the worst case, the cardiovascular system is overwhelmed by the restoration of blood circulation and experiences a fatal shock. In the emergency room, patients are monitored by EKG.

Her blood electrolytes are regularly checked in a blood gas analysis and her infusion continues at around 1.5 liters every hour. In this way, the victims will be saved from hypotension , renal insufficiency , acidosis and hyperkalemia or hypocalcemia . Wounds are treated surgically in the hospital. Surgical care is combined with the administration of antibiotics and tetanus protection.

Outlook & Forecast

The prognosis for crush syndrome varies from case to case. The rapid onset of proper treatment and care of the wounds as well as the amount of damaged tissue are relevant. Damage to the kidneys caused by crush syndrome can have different effects. Both kidneys can fail completely , or at least one can still function properly.

Similarly, with the liver, some people’s livers survive the effects of rhabdomyolysis better than others. The same applies to the effects of any resulting shock.

Whether and to what extent the externally injured areas can be restored – insofar as the crush syndrome is based on such a cause – also depends on the extent of the compression. From surgical repair to medically indicated amputation, anything is possible.

Patients who are rescued quickly should be cared for in such a way that their bodies are prevented from being overloaded with breakdown products from the necrosis. If the various strategies are applied here, the chances of survival are good. However, the aspects to be monitored extend to the circulatory system, kidney function, possible consequential damage, trauma and much more. In combination with the trigger of a crush syndrome, it is not uncommon for compartment syndrome to occur afterwards .

prevention

Theoretically, crush syndrome can occur after any type of accidental muscle necrosis. For prevention, tying off the affected limb immediately after the accident is a crucial step. Blood volume administration is also an important preventive measure in this context.

aftercare

In most cases, sufferers of crush syndrome have no or only very few follow-up measures available. The further measures and also the further treatment in most cases depend very much on the exact accident and the severity of the injuries, so that no general prediction can be made here.

The life expectancy of those affected is often extremely reduced as a result of crush syndrome. First and foremost, the victim must be treated and cared for directly at the accident site so that there are no further complications or other complaints. The treatment of the syndrome itself is primarily through the administration of drugs.

The person concerned should always ensure that they take it regularly and also pay attention to the appropriate dosage so that the symptoms can be alleviated. Regular examinations of the internal organs must also be carried out so that damage to the internal organs can be detected at an early stage.

Because crush syndrome often requires antibiotics, sufferers should be careful not to take them with alcohol. Hourly blood tests are also necessary to prevent kidney failure.

You can do that yourself

Crush syndrome can cause serious complications and long-term problems. The most important self-help measure is to support the recovery in consultation with the doctor through physiotherapy and physiotherapy . The patient can also engage in moderate exercise, as long as this is compatible with the health status and individual injuries.

In general, all measures that take place outside of medical treatment should first be discussed with the family doctor . In this way, self-help can be optimally coordinated with any drug, surgical or physiotherapeutic treatment.

After an operation, the medical guidelines must be strictly adhered to. Whether and to what extent physical activity is possible must be decided by the doctor based on the individual course of recovery. Crush syndrome often occurs in connection with an accident.

Trauma therapy can help to process the triggering event and thus give courage for physical self-help. If this is not possible due to serious injuries, long-term therapy is required.

Talking to other people affected can help. The doctor can establish contact with a self-help group and give further tips for dealing with the condition. The crush syndrome itself usually presents those affected with physical complaints for the rest of their lives, which must always be individually recognized and treated.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.