Crush and peripheral injury Flashcards
What is the definition of compartment syndrome?
Increased pressure within a fascial compartment due to neuromuscular ischaemia resulting in decreased perfusion.
What is the definition of crush injury?
Damage to skeletal muscle due to compressive force that releases intracellular contents into circulation
What is the definition of crush syndrome?
Life-threatening systemic condition caused by ischaemic reperfusion injury as a result of traumatic rhabdomyolysis.
What are the signs and symptoms of compartment syndrome?
- Increasing pain in compartment despite immobilisation
- Pain on passive stretching of muscles in affected areas
- Tenderness and palpable tension in the muscles of the compartment
- Altered sensation in the dermatomes of the nerves passing through the compartment
- Weakness/paralysis of involved muscles
Describe the management of compartment syndrome
- Elevate affected parts
- Avoid unnecessary constrictive forces
- Release contributing forces if possible
- Provide analgesia (fentanyl)
What are the three mechanisms responsible for muscle injury and muscle cell death in crush syndrome?
- Immediate cell disruption
- Direct pressure on muscle cells
- Vascular compromise
Rapid reperfusion of damaged muscles following release of crushing force leads to …
Release of electrolytes and other substances from the damaged muscles into general circulation and causes severe acidosis, hyperkalaemia, and shock.
What are the three criteria for consideration of crush injury?
NOTE: “general rule”
- Involvement of a muscle mass
- Prolonged compression (as little as an hour, typically 4-6)
- Compromised blood circulation
What are the signs and symptoms of crush syndrome?
- Absent pulse and capillary refill return to distal limb
- Pale, clammy, cool skin
- Weak and rapid pulse
- Usually absence of pain in affected region
- Onset of shock
How much blood may be lost with an ulna/radius #?
500mLs (10%)
How much blood may be lost with a humerous #?
500-1000mLs (10-20%)
How much blood may be lost with a tibia/fibula #?
500-1000mLs (10-20%)
How much blood may be lost with a femur #?
500-2000mLs (10-40%)
How much blood may be lost with closed trauma rib #?
200-3000mLs (5-60%)
How much blood may be lost with a pelvic #?
3000mLs + (60%+)
