HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

CRUSH SYNDROME

Gül Meral Kocabeyoğlu

Ankara Etlik City Hospital, Department of Intensive Care, Ankara, Türkiye

Kocabeyoğlu GM. Crush Syndrome. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.8193.

ABSTRACT

Crush syndrome, also known as traumatic rhabdomyolysis, is a serious medical condition that occurs when muscle tissue is compressed for an extended period, leading to muscle breakdown and the release of cellular contents into the bloodstream.

Although this condition is usually seen in victims of natural disasters such as earthquakes, it may also occur in cases such as traffic accidents,intoxication, stroke causing longterm immobilisation of the extremities. The extravasation of intracellular components such as myoglobin, potassium, phosphorus, creatinine phosphokinase may result in serious complications such as acute kidney damage, electrolyte disturbances, cardiac complications, acute respiratory distress syndrome, disseminated intravascular coagulation and compartment syndrome. Cardiovascular complications such as cardiac arrest and dys function due to hyperkalaemia are the primary causes of death in crush syndrome.

Proactive and aggressive treatment approaches are necessary for the effective management of crush syndrome in order to address muscle compression injuries and avoid systemic complications. Since the treatment of the patient with crush syndrome should be initiated at the scene, it is extremely important that prehospital healthcare teams are knowledgeable. Standard trauma approach protocol should be applied. Airway, respiration and circulation should be rapidly evaluated and necessary support should be provided. Complications can be reduced with onsite and rapidly initiated fluid therapy, especially after vascular access has been established. In natural disasters that affect a large number of people, such as earthquakes, a triage system should be used to ensure access to the hospital for patients in need of treatment. Trauma protocol should be applied in patients who reach the hospital, and physical examination should be repeated after being sent to the service and intensive care units. It is extremely important to continue fluid therapy continuously and to regulate it according to urine output and addi tional comorbidities. Considering metabolic disorders and clinical status of the patient, haemodialysis should be considered.

The possibility of compartment syndrome should always be considered and frequent examination should be performed. The need for fasciatomy, hyperbaric oxygen therapy and amputation should be considered.

Crush syndrome is a complex condition with significant historical and clinical implications. Early diag nosis and evaluation of crush syndrome are vital for reducing mortality and morbidity. Understanding its pathophysiology and implementing effective treatment strategies are crucial for improving patient outcomes.

Keywords: Crush syndrome; Rhabdomyolysis; Compartment syndrome; Fasciotomy; Hyperbaric oxygen therapy

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