Crush Syndrome Protocol
Crush syndrome is a medical condition that occurs when significant portions of the body are subjected to crushing force for an extended period of time. Large numbers of crush syndrome cases are often seen after serious earthquakes, when people are trapped under falling rubble and sometimes have to wait several hours for rescue. The most serious complications of crush syndrome result from the death of large numbers of muscle cells and the release of the contents of these cells into the blood. Crush syndrome protocol is a set of treatments aimed largely at minimizing these complications.
Pathology of Crush Syndrome
1. While some muscle cells are ruptured by the actual pressure of the crushing trauma, the most destructive aspect of crush syndrome comes from the disruption of blood flow. When muscle cells are deprived of blood, they eventually die and release their contents to the surrounding tissue (rhabdomyolysis). The most dangerous muscle cell contents are the protein myoglobin and the mineral potassium. When circulation is restored to the surrounding tissue, the myoglobin and potassium spread throughout the blood stream and can cause serious problems.
Consequences of Crush Syndrome
2. The most dangerous aspect of crush syndrome is the increase in potassium in the blood (hyperkalemia). High levels of potassium can disrupt electrical conduction in the heart and potentially cause it to stop beating. The high levels of myoglobin in the blood can cause damage to the kidneys, since they are responsible for filtering excess proteins from the blood. The crush syndrome protocol is designed to minimize these dangers.
Compartment Syndrome
3. Compartment syndrome is an extremely serious condition that can occur as part of crush syndrome. Compartment syndrome occurs when there is so much swelling within an enclosed compartment of a limb that blood can neither enter nor leave. Pressure rapidly builds up inside the compartment and widespread destruction of tissue occurs. Untreated compartment syndrome usually results in the need for limb amputation.
First Responder Protocol
4. First responder protocol for crush syndrome is in many ways similar to that for other types of trauma. The first priorities are still ensuring that there is adequate respiration and blood pressure. The crush syndrome protocol places extra emphasis on IV hydration to help lower the level of potassium in the blood and reduce the filtering work of the kidneys. Tourniquets are usually applied to affected limbs to reduce the risk of compartment syndrome. There is also increased monitoring for rhythm problems in the heart.
Hospital Protocol
5. The hospital protocol for crush syndrome is in some ways a continuation of the first responder protocol. Emphasis is placed on aggressive hydration to relieve the strain on the kidneys, and sodium bicarbonate may be used intravenously to help protect the kidneys. If the kidneys show signs of failing, it may be necessary to resort to dialysis to remove the myoglobin from the blood. Careful monitoring for compartment syndrome is essential, and surgery to relieve the pressure must be performed immediately if it develops
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