What is Crush Syndrome?

From crush syndrome especially accident victims and disaster victims are affected. A bruise or injury to the muscles can be as part of the phenomenon of muscle tissue necrosis and may cause during kidney failure or liver failure. Treatment at the scene of the accident has a major impact on the prognosis for crush syndrome.

What is crush syndrome?

In crush syndrome, the muscle tissue breaks down as a result of a necrotic injury in larger sections of the skeletal muscles. The phenomenon is also known as myorenal syndrome or Bywaters disease. In crush syndrome, the breakdown of the muscles results in acute kidney or liver failure. Therefore, the syndrome is also referred to as a systemic disease. In this phenomenon, the necrosis affects the entire organism and above all the organ system of the person affected.

The medical professional understands necrosis to be the irreversible destruction of cells in body tissue. This cell death is caused by inflammation of the affected areas, which attract phagocytes. Apoptosis, i.e. programmed cell death, also takes place in necrotic tissue. The crush syndrome is particularly relevant for accident and emergency medicine as well as disaster relief.

Eric Bywaters described the syndrome in 1941 in patients who had fallen victim to the London Blitz air raid. The Japanese doctor Seigo Minami documented the crush syndrome as early as 1923.

Causes

Crush syndrome is mainly observed in connection with earthquakes and other environmental disasters. Victims usually suffer from bruised muscles that cause muscle necrosis. Mechanical muscle injuries caused by accidents can also trigger the syndrome. The same applies to insufficient oxygen supply, as can occur in the context of carbon monoxide poisoning due to a fire scenario.

When muscle tissue breaks down, the muscle protein myoglobin is released. Although many sources suspect this protein to be the cause of kidney and liver failure, this relationship has not yet been conclusively clarified. Systemic organ failure can also be caused by a shock-related reduced blood flow to organs.

In the context of shock, many accident, earthquake and fire victims suffer, for example, from a lack of circulating blood volume. The heart’s pumping capacity decreases and its vascular tone decreases. This can lead to hypoxia in the organs.

Symptoms, ailments & signs

The main signs of shock are those who suffer from crush syndrome. Parts of the skeletal muscles are bruised and develop muscle necrosis. After the blood flow is restored, a reperfusion trauma occurs. As part of this phenomenon, the muscle cells break down, releasing potassium, phosphorus and myoglobin. Analogously, the blood level of all substances mentioned increases.

There is often enormous hyperkalemia, which can be associated with cardiac arrhythmias. In addition, liver cells often die after the restoration of blood flow, causing jaundice in the liver tissue. The kidney tissue is also affected by cell death as part of the crush syndrome. If the person concerned is not properly cared for, death will occur within a very short time. Shortly before death, the patient appears to be almost entirely symptom-free. Therefore, the crush syndrome is often associated with the term smiling death.

Diagnosis & course

Ideally, the first suspected diagnosis of crush syndrome is made by the first aiders. At the latest, the emergency doctors recognize the phenomenon by visual diagnosis. In the hospital, blood tests can confirm the first suspected diagnosis. In the case of crush syndrome, the prognosis depends primarily on the first aid provided after the accident.

If treated incorrectly at the scene of the accident or in the hospital, the phenomenon can be fatal. If there are no signs of kidney failure or liver failure at the scene of the accident, this can change within a very short time. The right treatment prevents serious organ damage as a result of muscle necrosis and thus improves the prognosis.

Complications

Various complications can arise during and after the onset of crush syndrome. The clinical picture can lead to multiple organ failure, depending on the location and severity of the injuries. Initially, however, muscle necrosis occurs as part of the crush syndrome, triggered by the damaged skeletal muscles and other trauma.

If the blood supply to the muscles is restored, reperfusion trauma can occur, which is associated with a breakdown of muscle cells and the release of potassium, myoglobin and phosphorus. As a result, the blood level of the substances mentioned increases, which exacerbates existing cardiac arrhythmias and other circulatory problems. Often there is also what is known as hyperkalemia, a disturbance in the body’s electrolyte balance that is associated with fluctuations in blood pressure and heart attacks.

As a result of major bruises, the blood flow to vital organs is also restricted, which can lead to jaundice in the liver or kidney tissue. If left untreated, the crush syndrome leads to the death of the patient within a short time. If the affected person is treated before organ failure occurs, crush syndrome can often be treated without serious complications; if kidney failure or liver failure has already occurred, permanent damage is likely.

When should you go to the doctor?

In the event of an accident with serious injuries, the emergency doctor must be called immediately. First aiders should first check whether the injured person is conscious and then initiate appropriate first aid measures or wait for medical help. In the case of visible muscle or bone injuries, the crush syndrome may be present – in this case, self-treatment must be avoided. If you have not already done so, a doctor must be called in immediately, especially if there are signs of cardiac arrhythmias or multiple organ failure.

The person affected should be taken to the nearest hospital immediately or the emergency services should be alerted. A longer stay in hospital is necessary in any case, as the crush syndrome is almost always caused by severe internal and external injuries. The affected person needs comprehensive medical and physiotherapeutic treatment. In most cases, psychological counseling or trauma therapy is also necessary. It is advisable to plan the necessary steps together with the responsible doctor and a person of trust. Close monitoring of injuries is indicated in crush syndrome.

Treatment & Therapy

Treatment of crush syndrome begins at the scene of the accident. The behavior of the first aiders and emergency doctors is crucial for the prognosis of the victims. The bruised limbs must be tied off as quickly as possible. As a replacement for blood volume, the patient is administered an infusion which preferably does not contain any potassium. If the victims are buried or heavy objects on their limbs cause the necrosis, the affected body areas are ligated before the victims are freed.

The same applies to the supply of the potassium-free infusion solution and the administration of sodium hydrogen carbonate. If these principles are not observed, “smiling death” can occur immediately after the liberation. By restoring the blood flow, the cardiovascular system is overwhelmed in the worst case and experiences a fatal shock. In the emergency room, patients are monitored by an ECG.

Your blood electrolytes are regularly checked in a blood gas analysis and your infusion continues at around 1.5 liters every hour. In this way the victims will be saved from hypotension, renal insufficiency, acidosis and hyperkalemia or hypocalcaemia. Wounds are treated surgically in the hospital. Surgical care is combined with the administration of antibiotics and tetanus protection.

Outlook & forecast

The prognosis for crush syndrome varies from case to case. The rapid onset of correct treatment and care of the wounds as well as the amount of damaged tissue are relevant. Damage to the kidneys caused by crush syndrome can have different effects. Both kidneys can fail completely, or at least one kidney can still function.

The same is true of the liver: some people’s livers survive the effects of rhabdomyolysis better than others. The same applies to the effects of any resulting shock.

Whether and to what extent the externally injured areas can be restored – insofar as the crush syndrome is based on such a cause – also depends on the extent of the compression. From surgical restoration to medically indicated amputation, anything is possible.

Patients recovered quickly should be cared for in such a way that their bodies are not overloaded with the products of the necrosis. If the various strategies are used here, the chances of survival are good. However, the aspects to be monitored extend to the circulatory system, kidney function, possible consequential damage, trauma and much more. In combination with the trigger of a crush syndrome, it is also not uncommon for the compartment syndrome to occur in retrospect.

Prevention

Theoretically, crush syndrome can occur after any type of accident-related muscle necrosis. Tying off the affected limb immediately after the accident is a crucial step in prevention. The administration of blood volume should also be mentioned as an important preventive measure in this context.

Aftercare

In most cases, those affected with crush syndrome have no or very few follow-up measures available. The further measures and also the further treatment in most cases very much depend on the exact accident and the severity of the injuries, so that no general prediction can be made here.

Often the life expectancy of those affected is extremely reduced due to the crush syndrome. First and foremost, the victim must be treated and cared for directly at the accident so that there are no further complications or other complaints. Treatment of the syndrome itself is primarily carried out through the administration of medication.

The person concerned should always pay attention to regular intake and the appropriate dosage so that the symptoms can be alleviated. Regular examinations of the internal organs must also be carried out so that damage to the internal organs can be detected at an early stage.

Since the crush syndrome often requires taking antibiotics, those affected should be careful not to take them with alcohol. Hourly blood tests are also necessary to prevent kidney insufficiency.

You can do that yourself

Crush syndrome can cause serious complications and long-term symptoms. The most important self-help measure is to support the recovery in consultation with the doctor through physiotherapy and physiotherapy. The patient can also participate in moderate sport, as long as this is compatible with the state of health and the individual injuries.

In general, all measures that take place apart from medical treatment should first be discussed with the family doctor. This means that self-help can be optimally tailored to any drug, surgical or physiotherapeutic treatment.

After an operation, strict adherence to medical guidelines applies. Whether and to what extent physical activity is possible must be decided by the doctor on the basis of the individual recovery process. Crush syndrome often occurs in connection with an accident.

A trauma therapy can help to process the triggering event and thereby also give courage for a physical self-help. If this is not possible because of severe injuries, long-term therapy is necessary.

Discussions with other affected persons are helpful. The doctor can establish contact with a self-help group and give further tips on how to deal with the ailment. The crush syndrome itself usually confronts those affected with physical complaints for a lifetime, which must always be recognized and treated individually.

Crush Syndrome