Crush syndrome. New data to deal with an emergency situation

Abstract Crush syndrome constitutes a rare but severe multifactorial process presented in approximately 2-5% of crush injuries patients. It was firstly described by Bywater in 1941, after the London bombardment. The aim of this study is to review the recent literature and present the current evidence and concepts with regard to both the pathophysiology and the treatment management of the syndrome. Frequently erupted after prolonged (>2–3 hours) flattening, crush syndrome comes out after building collapses, earthquakes, explosions, however it can also be the result of high energy occupational or road accidents. Hemorrhage within the muscles due to prolonged compression of the skeletal muscles leads to local ischemia with subsequent appearance of compartment syndrome and necrosis of the muscle groups. The mechanism of ischemia-reperfusion consequences to the eruption of several life-threatening systemic processes after release of the affected limb processes, including acute renal failure (rhabdomyolysis-myoglobinuria, hypovolemic shock), lactic acidosis, hypovolemic shock, metabolic acidosis, heart arrhythmias as well as hypokalemia and disseminated intravascular coagulation. Early and immediate therapeutic intervention consists of hemodynamic stabilization, rapid hydration, correction of electrolyte disturbances and acidosis, and maintenance of adequate diuresis. There are several cases where hemodialysis is imperative. Immediate therapeutic intervention is a key point in the management of crush syndrome to avoid life-threatening complications. The clinical signs can provide important diagnostic information however, high clinical suspicion and immediate response of the medical and nursing staff is required for both the diagnosis and for the treatment of the syndrome.

Keywords: Keywords: crush syndrome, acute renal failure, reperfusion injury, hypovolemia, compartment syndrome