In people who have been removed from the debris, the body tries to re-oxygenate the muscles when the exposure is removed. When the pain is under control, the patient smiles. However, if it is not treated appropriately afterwards, the patient will soon die. That's why Crush syndrome is also called smiling death.

Crush Syndrome ( Traumatic Rhabdomyolysis, Bywaters Syndrome)

It refers to the organ damage caused by the muscle damage seen in earthquakes, disasters, and after heavy exercise. It is not a single disease, it is a severe clinical picture. Products such as myoglobin, potassium, phosphate, and magnesium are released due to muscle injury resulting from crushing, squeezing or inactivity. These can cause obstruction in the kidneys and acute renal failure, symptoms due to increased potassium level in the blood, electrolyte imbalances, hypovolemic shock due to fluid loss, heart failure, infections, compartment syndrome due to intramuscular bleeding, coagulation problems, respiratory failure, etc. Crush syndrome is the general name of this whole picture.

It is life-threatening if not promptly and effectively treated. It is one of the most important causes of death, especially after major earthquakes. It is more common in people who are removed days after the disaster.



In people who have been removed from the debris, the body tries to re-oxygenate the muscles when the exposure is removed. When the pain is under control, the patient smiles. However, if it is not treated appropriately afterwards, the patient will soon die. That’s why Crush syndrome is also called smiling death.

Why does kidney failure develop in crush syndrome? 

As a result of crushing the muscles, blood circulation is disturbed. When there is not enough oxygenation, ions such as sodium and calcium are released in the region. Muscle volume increases. Fluid loss increases. The muscles are swollen, stiff, cold and partially necrotic. The released myoglobulin precipitates in the renal tubules and occludes the tubules. It causes contraction and damage to the vessels. Acute failure develops in kidneys that do not function properly.

Why do heart problems occur in crush syndrome? 

In Crush syndrome, potassium released from the muscles causes an increase in the blood level (hyperkalemia). The increase of ions such as potassium and phosphate causes rhythm disorders in the heart. The fluid container that develops in the person under the debris for a while and the hypovolemia associated with it also affect the heart functions. As a result, heart failure develops. For this reason, it is very important to open a vascular access and start giving serum to people who are reached under the wreckage before they are removed from the wreckage.

What is compartment syndrome? 

In general, it is a painful picture in which increased intramuscular pressure and edema are responsible. Apart from being under the debris, it can also be seen in events such as traffic accidents, heavy exercises, where the muscles are exposed to crushing and pressure. Intramuscular bleeding and edema may occur due to crushing, pressure or fractures. Crush, squeezing, fracture, accumulated blood and edema cause narrowing of the muscle vessels, impaired oxygen circulation and ischemia. Surgical treatment should be planned. Intramuscular pressure is lowered.

What are the symptoms of crush syndrome? 

One of the most basic symptoms of crush syndrome is compartment syndrome. Accordingly, the arm and leg muscles are swollen, cold and tense. There is severe pain when moving. There may be drowsiness, difficulty in movement, loss of sensation. If the pulse cannot be taken, the blood supply is thoroughly disturbed and vascular occlusion has developed. It requires urgent intervention.



Signs and symptoms that can be seen outside of compartment syndrome include:

  • Pain in the traumatized area
  • Loss of sensation in the trauma area
  • numbness at the trauma site,
  • Pale color,
  • No heartbeat,
  • drop in blood pressure,
  • Hypovolemic shock signs and symptoms,
  • Acute kidney failure (inability to urinate, dark urine, abdominal pain, etc.)
  • heart rhythm disorders,
  • Respiratory problems etc.

How is Crush syndrome diagnosed? 

Crush syndrome earthquake syndrome is an important picture that should be taken into account for anyone who has been removed from the rubble.

  • Potassium, myoglobulin increased in blood tests.
  • Creatine kinase (CK MM) increases in the blood.
  • Urine tests may show erythrocytes and myoglobulin.
  • The amount of urine has decreased.
  • There may be signs of heart failure on the EKG.
  • Kidney function tests (BUN, creatinine etc.) increase.
  • If necessary, X-ray, computed tomography, magnetic resonance may be requested.

 How should the intervention for crush syndrome be? 

Crush syndrome should be considered for anyone under the rubble. When the person is reached under the debris and there is a suitable area, an intravenous line is opened immediately and sodium chloride (isotonic) is given to the person at a rate of 1.5 liters/hour. As long as the person remains under the debris, intravenous fluid supplementation is continued. It is checked whether there is urine output by inserting a catheter to the person who comes out from under the debris. Their eyes are protected from light as they will be sensitive to light. No food or drink is given by mouth.

If there is no or little urine output, fluid supplementation is increased to determine whether this is due to fluid loss. Mannitol – diuretic treatment is started through the vascular route for patients with a small amount of urine output. This protects it against kidney failure. If needed, dialysis can be applied without losing time.

The patient’s cardiac functions are evaluated. If there are signs of rhythm disorders or heart failure, treatment is started.

If compartment syndrome has developed, the treatment is surgery. It is tried to reduce the pressure in the muscle whose blood supply is impaired.

Is crush syndrome permanent? 

Crush syndrome resolves with appropriate and timely treatment planning. However, recovery varies depending on the extent and duration of the damage. Acute renal failure resolves quickly in most patients. It may take longer for cardiac functions to recover due to being under the debris for a long time. He may also need to receive psychological support for a much longer period of time.

Crush syndrome can cause sudden death, permanent damage and loss of limbs if not treated properly or if treatment is delayed.

 


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