Medical conditions causing crush syndrome

[Kenny0471]

5 hours ago, Off Label said:

You might be drifting into the tall weeds here. To break it down, "crush injury" for the purposes here is distinct from blunt trauma, although blunt trauma is obviously a major component in the crush syndrome. Crush syndrome or injury or whatever you want to call it is a constellation of problems that are superimposed on the blunt trauma problem, and, as your question suggests, does not require blunt trauma to set in motion. So....the problems we've identified so far...

1. Massive liberation of muscle protein, myoglobin, into the vascular space leading to renal damage/failure (rhabdomyolysis)

2. Sudden release of severe, blood flow restricting limb/pelvis compression after an extended period of entrapment. Accumulation of anaerobic metabolites and cellular release of potassium from cell death, (to say nothing of vascular injury and thrombus formation) is capable of causing sudden and catastrophic cardiovascular collapse via sudden and profound metabolic acidosis and hyperkalemia.

 

How can these present through a medical mechanism?

1. Rhabdomyolysis can occur when a poorly conditioned athlete attempts an activity that is far out of his depth, ie a marathon. Hyperthermic emergencies, diabetic emergencies, drug reactions, certain infectious diseases can all have the same effect.

2. As far as this goes, a scenario will be instructive...Say a poorly conditioned alcoholic is on a binge one weekend and  spends the weekend on the couch drinking and goes into a fib (maybe has a history of p-afib). He ignores it and continues to drink until Monday when he sobers up. As the week progresses he notices pallor pain in both legs which he ignores for a couple of days until the pain is unbearable. He's admitted to the hospital for pulseless lower extremities 2/2 embolization of thrombus most likely caused by is immobility and a fib. Several days of no flow to both legs from a clot does the same thing as a two ton concrete block on the pelvis.

When the surgeon fishes out those clots and reperfuses the lower half of the body, that "acid wash" will occur and the consequences are the same as if he were extricated from a building collapse...get it?

Obviously, the severity of the syndrome with vary with the situation. While these things can occur, most times the degree to which they present are not clinically significant and resolve on their own with no treatment except rest and fluids.

 

This is perfect. I believe this is my exact form of thinking but put into words that I can digest and fully understand.

 

Thanks so much!

6 hours ago, Just Plain Ruff said:

The fact that you are still asking these awesome questions are going to get you props from all of us here brother.  Shows that you want to learn and just don't want to get it spoon fed to you.  

 

I would definately put the obese patient down as a candidate, especially an extremity that gets caught under their weight after they fall and are unable to get up on their own.  

 

Depressed patients, I'm not so sure.  

What about the stroke patient who falls, lands on the affected extremity and is not found for 2-3 days or even 6-8 hours?  

Hey Plain,

You are right my friend I see not benefit it getting an "answer anyone can cut and paste but it doesn't help me to learn. Imagine showing upto treat a patient and being like huh? Where my cut and paste treatment haha.

 

Stroke patient is definitely a candidate I think anyone that can be immobilized without help is something that is a potential candidate for crush syndrome.

 

Thanks

[paramatt_]

16 hours ago, Just Plain Ruff said:

I would definately put the obese patient down as a candidate, especially an extremity that gets caught under their weight after they fall and are unable to get up on their own.  

Not just the obese. I recall attending a pt, elderly, frail, and quite small that awkwardly fell and landed with most of one thigh basically under her squashed against the ground in what would have been quite an impressive accomplishment if she was doing yoga...unfortunately she wasn't and was found some 8-10 hours later with marked visible discolouration (of what could  be seen) to said limb.

She had multiple co-morbidities including renal  failure. Anyways, we treated her as per crush injury though she ended up having a  cardiac arrest after being moved.

ps. can we start calling you Plain?

And for the OP. there was quite a good topic some time ago on suspension trauma, if you have a chance its probably worth a look.

[Just Plain Ruff]

sure, just call me Plain, it's easier to type.  

[Spock]

Off Label has a great post.  I really do believe that obese patients that fall and can't get up for an extended period of time will exhibit signs and symptoms of crush injury.  How long does that take is unknown but I suspect it depends upon BMI and the amount of tissue compressed.  I've had patients with crush injuries from traditional causes (building collapse) and medical causes and they are very challenging.  Prehospital concerns are acidosis, hyperkalemia, low BP, and pain.  A crushed extremity that does not hurt is a very bad sign and will result in amputation and possibly death.  Saw far to much of that in Haiti.

May the tube be with you.

Spock