Crushing injuries and crushing syndrome: A fatal combination

One of the most significant injuries a person can suffer is a crushing injury. With a crushing injury, the muscles, tissues, veins, arteries, bones and other parts of the body are compressed, many to the point of cutting off circulation. Depending on the injury itself, there may be little or no blood flow.

While the injury is devastating, one of the bigger problems is the risk of compartment syndrome. This is when increased pressure causes muscle, nerve and tissue damage. The blood vessels may also be significantly impacted.

What is the highest risk of a crushing injury?

Even more risky is crushing syndrome. This syndrome occurs when the body has a major shock. It may enter into renal failure after a significant crushing wound. Even if a patient seems fine while pinned beneath a heavy object, the risk of this syndrome is high. Moving the weight off the victim or even shifting it enough to reduce its impact could cause the body to go into shock. It is a particular risk for patients who have been under crushing weight for four hours or longer.

What happens with crushing syndrome?

With crushing syndrome, there is significant compression. The cells suffer from compression and decreased circulation. Oxygen does not reach the body part. As a result, the body has to switch to the anaerobic metabolism. This leads to a buildup of lactic acid.

Without enough oxygen, the cells struggle to retain their contents. Over time, they become permeable and spill their contents. Some cells begin to die. Toxic substances, myoglobin, potassium and other substances enter the surrounding tissues but do not enter the blood without circulation.

However, when circulation is restored by relieving pressure, it’s possible for the patient to go into shock or to develop other life-threatening conditions. The rush of potassium affects the rhythms of the heart. The toxic substances cause liver damage and respiratory distress. Myoglobin may gather in the kidneys and cause renal failure or rhabdomyolysis.

Even a patient who is alert may rapidly fall ill once the heavy object lifts away. Emergency medical providers at the scene must address the risk of high potassium levels, pain and other conditions before moving an object off a patient and transporting them to the nearest hospital. Not making a plan could result in an extremely ill patient who could, potentially, die from the toxins that built up in the body.

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