Crush and Compartment Syndrome Flashcards
Define Rhabdomyolysis?
- The breakdown of muscle fibres that stimulates the released of their contents into the blood stream. This result is due to a direct or indirect muscle injury.
What are some causes of Rhabdo?
- Extreme muscle strain
- Crush injury
- Long-lasting muscle compression
- Electrical shock/lightning strike
- Deep burns
- Seizures
- Drugs such as, corticosteroids or statins when given in high doses
List some signs and symptoms of Rhabdo.
- Painful, swollen, bruised or tender areas of the body
- Muscle weakness
- Nausea/vomiting or general unwell feeling
- Alt GCS
- Dark-colour urine or reduce/zero urine output
- ECG changes due to hyperkalaemia
Define Crush injury
- Injury that exposes tissue to a compressive force that is sufficient enough to interfere with the normal structure and metabolic function of the cells and tissue involved.
What factors determine the degree of crush injury?
- Amount of pressure applied to the body
- Amount of time the pressure remains in contact
- The specific region of the body affected
Are crush injuries instantly fatal?
- They have the potential to be, however, if not they may progress into compartment syndrome or crush syndrome.
What occurs for the development of compartment syndrome?
- Crush injury occurs
o This lead to an increase in pressure in deep tissue of the muscle - Pressure builds in this closed deep tissue compartment
o This leads to ischemia forming in the fascia (deep tissue of muscle) - Ischemia
o More muscle swelling - Pressure continues to rise
- Irreversible tissue damage occurs within hours
What pressures need to be exceeded before they become ischemic in compartment syndrome?
- => 40mmHg, normal capillary perfusion pressure is 30mmHg
- Nerves also become necrotic
What are some common causes of compartment syndrome?
- Extreme exertional exercise
- Electrical injury
- Haemorrhage into the compartment
- Circumferential deep burns
- Snake bite
- Vascular occlusion
- High pressure injection injuries
- Immobility with development of pressure necrosis
- Snake bite
What are the general signs and symptoms of compartment syndrome?
- Pain
- Paresis (partial loss of movement)
- Paraesthesia ( alt sensation)
- Pallor
- Pulselessness
- Swelling/tautness
- Tender on palpation
- Weakness of the muscle group
- Pain on passive stretching
What is the treatment of compartment syndrome in the pre-hospital setting?
- Do not elevate the injured site
- Provide analgesia
- Monitor/ECG
What is crush syndrome?
- Systemic manifestation of rhabdomyolysis caused by prolonged continuous pressure on muscle tissue.
What process is occurring for crush syndrome to take affect?
- The sarcolemma membrane becomes leaky; this results in sodium, calcium and water leaking into the sarcoplasm, trapping ECF inside the cell.
What % of patients with Crush syndrome with have Acute renal failure?
- 50% of patients
What may occur to crush syndrome victims when they are released from entrapment?
- Oxygen rich blood will returned to ischaemic areas, reperfusion of the area may lead to shock.
- Toxic substances and anaerobic metabolites are released into the systemic circulation.
- Myoglobin is released and filtered through the kidneys
