What is crush syndrome?
Crush syndrome is a condition caused when an excessive force is
applied to a group of muscles for a long time. If the injury
damages, which damages the muscles very severely, a toxic protein
called myoglobin and others like potassium and phosphorus are
released in large quantities in the body. The toxins are released
from the muscles in the area where the load is the maximum. These
toxins enter the blood stream and reach the heart. In most cases,
this degeneration of muscle starts about 20 minutes after the
muscle has been crushed.
These toxins may result in life threatening complications like
acute kidney failure, heart attack and blockage of blood vessels.
Kidney failure is caused due to blockage of the tubules that
filter the waste. These toxins block the tubules destroying the
kidney cells. This can result in kidney failure requiring
dialysis.
What are the other causes?
Apart from being caused by injury to the muscle, crush syndrome
may have other causes:
1. Hereditary causes – there may be inherent defects in the body's
carbohydrate digesting mechanism.
2. It may be caused due to excessive exertion or heat stroke.
Alcoholism induced coma or seizures.
3. Some drugs and toxins may also cause this syndrome. These
include some cholesterol lowering drugs like clofibrate and
gemfibrozil.
What are the symptoms?
The syndrome is generally marked by very specific symptoms that
can be easily detected by the doctor. Some of them are:
* Decreased blood supply to the brain due to shock (hypovolaemic
shock) resulting in altered consciousness or even coma.
* Muscular weakness due to increased potassium in the blood
* Pale, cold and clammy skin
* Weak and rapid pulse
* Absence of pain in the affected region
* Decreased urine output.
How is it diagnosed?
The condition is diagnosed by conducting certain tests like urine
myoglobin, serum CPK and a host of chemical test including serum
creatinine, BUN and a total bilirubin count.
How is it treated?
The simplest form of treatment is to make the patient consume a
lot of water and other liquids. This helps to dilute the acid
concentration of the blood and also helps the kidneys to excrete
myoglobin better. This ensures adequate availability of fluids and
oxygen to all the tissues.
Before medical aid arrives, some first aid may be provided to the
victim. This includes pulling away excessive load from the
victim's head, chest and abdomen. The patient should be constantly
reassured till medical help is available and should be treated for
any other minor injuries. However, treatment measure is primarily
surgical in case the limb is crushed very badly and has lost the
ability to function.
Fluids may need to be given into the vein. The crushed tissues
need to be removed urgently by an operation. If there is kidney
failure, the patient may need dialysis.
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