Ischaemic Reperfusion Injury (Crush Syndrome)

Question 0

Causes

Answer 0

• Extensive soft tissue trauma (community assault)
• Compartment syndrome
• Snake bite

Question 1

Definition

Answer 1

Systemic muscle injury after direct trauma or ischaemic reperfusion
(including but not limited to crush injury)

Question 2

Clinical findings

Answer 2

• Metabolic acidosis
• Circulatory shock
• Dark, tea-colored urine (impending renal failure)
• Tense, oedematous, painful limb

Question 3

Diagnosis

Answer 3

• Signs of rhabdomyolisis
• Elevated plasma CK levels
• Elevated serum myoglobin levels
• Elevated urine myoglobin levels

Question 4

Management

Answer 4

Local:

• Early fasciotomy
• Restore blood flow promptly during surgery (< 6hrs)

Systemic:

• Forced diuresis (aim for 200-300ml/hr)
• Alkalization of urine (ph > 6.5)
• Crystalloid can dilute myoglobin (stop when < 300 nanograms/ml)