Crush syndrome

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Crush syndrome
ICD-10 T79.5
ICD-9 958.5
DiseasesDB 13135
MeSH D003444

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Bywaters' syndrome; traumatic rhabdomyolysis

Overview

Being a common occurrence in victims of natural disasters and human wars, crush syndrome is still a rare finding in daily practice. Falling short to direct-fatal trauma, crush syndrome is the second most common cause of mortality after a disaster.[1] It is the sequalae that follows when an individual or a part of him/her has been crushed between two heavy objects and although it has a wide range of presentation like shock, trouble breathing, electrolyte disturbances and irregular beating of the heart, the main culprit behind these findings is the extensive damage to the kidneys as a result of the trauma the person was subjected to. This can be prevented with aggressive fluid resuscitation, but the sheer number of incoming trauma patients during a calamity plays a major role in creating logistic problems for the response teams and hence it becomes important to diagnose it earlier rather than later.

Definition and related terms

  • Crush syndrome : also known as traumatic rhabdomyolysis or reperfusion syndrome, it is defined as the systemic features of a crush injury leading to renal failure.[2]
  • Crush injury : the damage caused to muscle cells due to pressure applied on them locally, for a prolonged period of time.[3]
  • Rhabdomyolysis : the breakdown and release of muscular tissue (myoglobin) into the bloodstream resulting in renal damage and the subsequent build up of toxic compounds in the blood.[4]
  • Compartment syndrome : the raised pressure (>20 mm of Hg) within a localized region causing decreased local circulation which can lead to ischemia and necrosis of that osteo-musculo-fascial compartment.[5] This can later lead to release of necrosed muscle tissue into the blood which damages the kidney and can present with features similar to crush syndrome.
  1. Sever MS, Vanholder R (2011). "Management of crush syndrome casualties after disasters". Rambam Maimonides Med J. 2 (2): e0039. doi:10.5041/RMMJ.10039. PMC 3678930. PMID 23908797.
  2. Michaelson M. (2009) Crush Injury, Crush Syndrome. In: Shapira S.C., Hammond J.S., Cole L.A. (eds) Essentials of Terror Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-09412-0_20
  3. Michaelson M. (2009) Crush Injury, Crush Syndrome. In: Shapira S.C., Hammond J.S., Cole L.A. (eds) Essentials of Terror Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-09412-0_20
  4. Torres PA, Helmstetter JA, Kaye AM, Kaye AD (2015). "Rhabdomyolysis: pathogenesis, diagnosis, and treatment". Ochsner J. 15 (1): 58–69. PMC 4365849. PMID 25829882.
  5. Torlincasi AM, Lopez RA, Waseem M. Acute Compartment Syndrome. [Updated 2021 Feb 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448124/