Musculoskeletal Complications

Question 1

Crush Syndrome

Answer 1

• Multiple fractures & muscle damage
• Life-threatening systemic injury
• Huge concerns: Major shock & renal failure
  > hypovolemia (caused by shock)
  > hyperkalemia (due to crushing: body/muscles will release intracellular potassium)
  > acute tubular necrosis/renal failure (myoglobinuric); Rhabdomyolysis
  > msucle weakness & pain

Question 2

Rhabdomyolysis

Answer 2

• Striated muscle splitting/cell death
• Myoglobin from muscle in circulation
  > excess circulating protein makes kidney work extremely hard = renal failure

Question 3

Crush Syndrome - Risk Factors

Answer 3

• Twisting injuries
• Natural disaster victims
• Industrial accidents
• Overdose:
  > limb compressed by body weight
• Age: older adults fall/immobile
• Medical Management:
  > prevent renal failure
  > cardiac dysrhythmias

Question 4

Acute Compartment Syndrome

Answer 4

• Surgical emergency
• Internal or external causes
• Compression of muscle, nerves, & blood vessels; ischemia; tissue death in 4-12 hours
• Commonly lower leg & forearm
• S/S: edema, pain, paresthesia, pale, pulseless, cool (poikilothermia)
• Necrosis (if not corrected)/infection (high risk)/loss of func or limb/or life

Question 5

Acute Compartment Syndrome - Medical Treatment

Answer 5

• Fasciotomy
• Large incision down tissue to release fascia
• Make room for swelling & take pressure off muscles & allow blood to flow

Question 6

Acute Compartment Syndrome - Nursing Care

Answer 6

• Monitor at risk pts
• Report S/S to HCP
• Monitor development of crush syndrome
  > frequently found together
• Care of surgical site