What Happens In Crush Syndrome? Know About Its Causes, Symptoms, Complications And Management

Friday, October 23, 2020, 11:47

Crush syndrome, also termed as traumatic rhabdomyolysis is a condition mostly observed in patients who have shortly experienced injuries. Rhabdomyolysis is a series of metabolic changes that occur shortly due to severe injury to the skeletal muscles. This cause release of contents into the circulation (blood and urine), leading to acute kidney injury.

Crush syndrome is a general manifestation of crush injury, or say, injury to muscles during disaster scenarios. [1] Acute renal failure due to crush syndrome can be avoided by early and proper treatments like fluid therapy or diuresis. Crush syndrome may also cause permanent disability or death of a person if not given early treatment.

A study says that 80 per cent of patients die at the spot due to severe head injury while the remaining 20 per cent only manage to reach the hospital. Out of these 20 per cent, 10 per cent get healthy and fit again while the remaining 10 per cent go into crush syndrome. [2]

Causes Of Crush Syndrome

Several known mechanisms induce crush syndromes such as crush injuries, compartment syndrome (pressure buildup in the legs due to internal bleeding), burns, electrocution and other inquiries that result in damage to the muscles.

People who are victims of natural disasters such as earthquakes, also report of symptoms of crush syndrome. Common events of crush syndrome include vehicular crashes, farming incidents and industrial mistakes.

What Happens In Crush Syndrome?

In crush syndrome, the muscle cells release myoglobin, an iron and oxygen-binding protein in the muscular tissues. Usually, myoglobin is used as an oxygen storage protein that helps bind and release oxygen in the muscles when required.

Though myoglobin does not cause problems or any diseases, it may negatively affect the body when gets leaked to the bloodstream or urine due to injury to muscles. When myoglobin reaches the circulation, it gets toxic by getting converted into metmyoglobin and then, into acids hematin. Also, they raise muscle volume and tension, resulting in muscle vasodilatation and high blood pressure.

Other degradation products of myoglobin include lactic acid, uric acid, ions like sodium and calcium and enzymes like creatinine phosphokinase. [3]

Kidneys usually filter these by-products, however, when the filtration reaches its limit due to its excess production or delay in the treatment, the constituents start precipitating in the kidneys collecting duct (which is responsible for the absorption of ions), resulting in obstruction or failure of the kidneys.

Symptoms Of Crush Syndrome

Muscle pain, especially from the injured body part
Brown coloured urine or tea-coloured urine
Weakness
Numbness on the affected area
Swelling
Acidemia (decreased pH)

Complications Of Crush Syndrome

Delay in the treatment after crush syndrome can cause complications such as:

Loss of muscle power
Mental stress due to extreme pain
Paralysis [4]
Renal failure
Death pale skin or blisters on the compressed body areas
Sepsis

Diagnosis Of Crush Syndrome

Physical examination: Looking out for signs of injury complications such as swelling or muscle pain.
Urine dipstick test: To monitor myoglobin levels in the urine and look out for urine colouration.
Electrodiagnostic: To find out areas of pain, numbness and weakness due to injury.

Management Of Crush Syndrome

Treatment methods depend on the condition of the patient. The foremost treatment methods are the removal of crushing force. They may include:

Intravenous hydration: To correct low blood pressure and fast heart rate.
Monitoring fluid output and electrolyte levels: To provide adequate urine output and prevent congestion to the lungs. [5]
Analgesia: To prevent complications due to low blood pressure.
Hemodialysis: Providing artificial kidneys to filter harmful constituents.

Common FAQs

1. How long does it take for crush syndrome to develop?

Due to extreme compression after an injury, crush syndrome may develop within 4-6 hours.

2. What is the difference between crush syndrome and compartment syndrome?

In crush syndrome, injuries due to compression of particular muscles cause a release of a protein named myoglobin that gets toxic and causes problems to the kidney. In compartment syndrome, swelling and internal bleeding occur in the injured areas, causing disruption to the nerves in the area.

3. How do you stop a crush injury?

In industrial or farming areas, prevent crush injuries by properly reading the safety measures and taking steps to prevent them. Also, regularly check the machinery to prevent any kind of accidents.