Crush Syndrome

Crush Syndrome (traumatic rhabdomyolysis) develops after prolonged compression of muscle tissue, commonly seen in disasters, traffic accidents, or entrapment injuries.

⚠️ Pathophysiology:

• Muscle breakdown → release of myoglobin, potassium, phosphate

• Leads to hyperkalaemia, metabolic acidosis, hypovolaemia

• Myoglobinuria causes renal tubular obstruction → acute kidney injury (AKI)

🚑 Clinical Features:

• Swollen, tense limbs

• Dark-coloured urine (myoglobinuria)

• Hypotension, arrhythmias, AKI

💉 Management:

• Early and aggressive IV fluid resuscitation (isotonic saline)

• Avoid potassium-containing fluids

• Consider mannitol & bicarbonate to prevent AKI

• Monitor and treat hyperkalaemia

• Dialysis may be required

🧪 Key Labs:

• Elevated CK, myoglobin

• Hyperkalaemia, metabolic acidosis

• Rising creatinine and urea

🩺 Prevention:

• Fluid resuscitation even before extrication in disaster settings

• Fasciotomy only if clear compartment syndrome, not prophylactically