CRUSH SYNDROMEICD 10: T79.5

Mohit Chhabra Roll no. : 47

OBJECTIVESy

Define and understand the pathophysiology of Crush Syndrome Clinical diagnosis and relevant investigation Management

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A Case of Crush Syndrome.

Clinical FeaturesLower limb injury with pain and swelling, which later on developed anesthesia and motor disturbance y Signs of hypovolemic shock y Tea-colored urine, maybe oliguria y Nausea and confusiony

Pathophysiology

On Investigating further.y Hyperkalemia & hypocalcaemia y ECG changes secondary to hyperkalemia y Metabolic acidosis y Raised Creatine Kinase y Elevated UREA and CREATININE y Myoglobinuria y Evidence of D.I.C.

Diagnosis: Crush SyndromeDefinition:A severe, often fatal condition that follows a severe crushing injury, particularly involving large muscle masses, characterized by fluid and blood loss, shock, hematuria, and renal failure. Also known as compression syndrome. (McGraw Hill Dictionary)

In a nutshell: TRAUMATIC RHABDOMYOLYSIS due to crushing Also known as Bywaters Syndrome/ Reperfusion injury

PATHOPHYSIOLOGYCrushing injury

Ischaemic damage to muscles

Release of toxic metabolites

Clinical Features

KIDNEY IS IN DANGER AS SOON AS WE RELIEVE THE COMPRESSIONRenal hypoperfusion + Renal Tubular Necrosis = Renal Failure

MANAGEMENTy

Initial Management:1. Follow the usual criteria of A-B-C as injuries are massive and high chances of poly-trauma 2. Early and rapid rehydration 3. Venous access preferably before the limb is decompressed 4. CVP and urinary catheterization for monitoring

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Further Management1. Large amount of saline infusion with forced diuresis 2. Debridement of crushed tissue and a fasciotomy for compartment syndrome 3. Dialysis if renal failure sets in 4. Amputation as the last resort if massive limb injury is there and we have to prevent crush syndrome