#69 & 70
Suggested time: 30 minutes
Crush injuries and compartment syndrome are closely related, but distinct clinical phenomena that may be caused by blasts and structural collapse.
Crush injury is an injury sustained when a body part is subjected to a high degree or prolonged presence of force or pressure. The term “crush injury” is usually applied to both regional (e.g., body part) effects and systemic effects. Lower extremities, upper extremities, and the trunk are the body parts most commonly affected. Acute traumatic ischemia, with or without associated injuries, describes actual insult to tissues.
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Crush Syndrome
#71
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Crush syndrome describes the systemic manifestations of muscle cell damage resulting from crush injury after reperfusion of affected body parts. The systemic effects result from traumatic rhabdomyolysis (muscle breakdown) and release of potentially toxic muscle cell components and electrolytes into the circulation.
By convention, a “syndrome” includes three or more signs or symptoms that when present, indicate with high probability a specific medical disease or condition.
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Compartment Syndrome
#72
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Compartment syndrome is a collection of localized signs and symptoms that result when the perfusion pressure falls below the tissue pressure in a closed anatomic space for a sufficient time that circulation and function of the tissues involved is compromised.
Compartment syndrome occurs in similar settings to crush injury, but may also occur with subacute trauma (e.g., prolonged running).
Compartment syndrome can lead to crush injury syndrome systemic effects if left untreated or inadequately treated.
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Incidence of Crush Injury
#73 & 74
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Five to fifteen percent (5-15%) of mass casualty situations involve crush injuries. These incidents include natural disasters, especially earthquakes and tornadoes, structural collapse (with or without victim entrapment), industrial, farm or transportation accidents, blast events of all types, combat and prolonged immobilization with major vascular or micro-vascular circulation compromise.
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