Crush syndrome

Overview

Crush syndrome, also known as traumatic rhabdomyolysis, is a serious medical condition that occurs after prolonged compression of skeletal muscles. It often results from accidents such as building collapses, earthquakes, or severe traffic collisions where limbs or large muscle groups are trapped under heavy objects for an extended period. The syndrome is characterized by the release of muscle breakdown products—especially myoglobin and potassium—into the bloodstream, leading to potentially life-threatening complications like acute kidney injury, metabolic disturbances, and cardiac arrhythmias.

Causes

Crush syndrome develops due to prolonged mechanical pressure on muscles, which leads to ischemia (lack of blood flow) and muscle cell death. Common causes include:

• Natural disasters: Earthquakes or landslides causing people to be trapped under debris

• Industrial or workplace accidents: Heavy machinery or structural collapses

• Traffic accidents: Entrapment in vehicle wreckage

• Extended immobilization: Drug overdoses or unconsciousness where pressure is exerted on one area of the body for hours

• Combat injuries: Blast injuries or being buried under rubble in military settings

Symptoms

Crush syndrome symptoms typically begin after the trapped individual is extricated and circulation is restored to the compressed area. Common signs and symptoms include:

• Severe pain and swelling: Especially in the affected limb or muscle group

• Muscle weakness or paralysis: Due to nerve and tissue damage

• Dark-colored urine: Due to myoglobinuria (presence of muscle pigment in urine)

• Hypovolemia: Low blood volume leading to shock

• Electrolyte imbalances: High potassium (hyperkalemia), low calcium, and acidosis

• Arrhythmias: Life-threatening heart rhythm disturbances due to hyperkalemia

• Acute kidney injury: Caused by myoglobin blocking kidney tubules

Diagnosis

Crush syndrome is diagnosed based on clinical history, physical findings, and laboratory tests. Key diagnostic steps include:

• Medical history and trauma assessment: Identification of prolonged muscle compression or entrapment

• Blood tests: Elevated creatine kinase (CK), potassium, phosphate, and myoglobin levels

• Urine analysis: Presence of myoglobin leading to dark, tea-colored urine

• Electrocardiogram (ECG): To detect cardiac arrhythmias from electrolyte imbalances

• Renal function tests: Blood urea nitrogen (BUN) and creatinine to monitor kidney damage

Treatment

Crush syndrome is a medical emergency and requires rapid, aggressive treatment to prevent complications, especially kidney failure and cardiac arrest. Treatment includes:

• Intravenous fluids: Large volumes of saline to maintain kidney perfusion and flush myoglobin

• Electrolyte correction: Especially managing hyperkalemia to prevent arrhythmias

• Sodium bicarbonate: To alkalinize urine and reduce kidney damage from myoglobin

• Diuretics: Such as mannitol to increase urine output and flush toxins

• Dialysis: May be required in cases of severe kidney failure or persistent electrolyte imbalances

• Pain control and wound care: For localized muscle injury

• Surgical interventions: Fasciotomy may be needed if compartment syndrome develops

Prognosis

The prognosis of crush syndrome depends on the duration of compression, the timeliness of treatment, and the extent of organ damage. Early and aggressive fluid resuscitation significantly improves outcomes. Without prompt treatment, complications such as acute kidney injury, cardiac arrest, or multi-organ failure can lead to death. With proper management, many patients recover, though long-term kidney damage or muscle dysfunction may persist in some cases. Ongoing monitoring and rehabilitation may be necessary during recovery.