Lecture 13.

Crush syndrome develops when the limbs are subjected to prolonged pressure or tightly restrained and the patient is rescued alive. This syndrome is sometimes referred to as "traumatic rhabdomyolysis".

Crush syndrome is a condition in which rhabdomyolysis develops rapidly after the skeletal muscles are released from prolonged pressure, resulting in shock, acute renal failure, and other systemic symptoms. Crush injuries may result from many situations, including vehicle accidents, workplace accident, falling debris or by prolonged pressure to a part of the body due to their own body weight in an immobile casualty. The likelihood of developing acute crush syndrome is directly related to the compression time, therefore the casualty should be released as quickly as possible, irrespective of how long they have been trapped. Crush syndrome results from the disruption of the body’s chemistry and can cause heart, breathing & kidney failure.

First aid care of a crush injuries

• Ensure the scene is safe, and that there is no risk of injury to the rescuer or bystanders.
• Call an ambulance
• The scene is safe and EMS response is organized 
  • If the object is restricting the person’s breathing, or the object is crushing the person’s head, neck, chest, or abdomen, remove the object if it can be safely removed.
  • If it is crushing another body part, leave the object where it is until EMS personnel arrive.
  • DO NOT leave the casualty except if necessary to call an ambulance
  • DO NOT use a tourniquet for the first aid management of a crush injury
• There is no organized EMS response in the region (for example, if the injury occurs in a very remote area or the scene of the emergency becomes dangerous)
  • If the length of entrapment is less than 2 hours remove all crushing forces from the casualty as soon as possible.
  • If the length of entrapment exceeds 2 hours apply a tourniquet proximal to the injury immediately before extrication and remove crushing forces
    • If a limb is cool, insensate, tensely swollen, and pulseless is likely dead. Leave the tourniquet on a limb
    • If a limb is alive apply a tight bandage to the limb and remove the tourniquet 
• Treat any bleeding and wounds.
• Keep the casualty warm
• Continue to monitor the casualties condition.
• If the casualty becomes unresponsive and is not breathing normally, start CPR.

Note: A crushing force which is applied to the head, neck, chest or abdominal area’s can cause death from breathing or heart failure. The crushing force must be removed immediately.

Pay attention! This recomendation is the first aid management of a crush injury. The recommendation of medical care management of a crush syndrome for medical and rescue staff is different of the first aid management. These recommendations include pain relief and infusion therapy until the limb is released, as well as in some cases the use of a tourniquet. Tourniquets may delay the life-threating complications of a reperfusion injury if immediate fluid resuscitation or monitoring is not initially available. Consider tourniquet placement for crush injury before extrication if the length of entrapment exceeds 2 hours and crush injury protocol cannot be initiated immediately.