Many people may not have ever heard of Crush syndrome or know what it is. Crush syndrome is most often seen after major natural events such as earthquakes. Falling or shifting objects during an earthquake may pin a person causing a muscular skeletal crushing injury. Crush syndrome is most often characterized by shock and renal failure.
Crush syndrome or Bywaters’ syndrome as it is also called was first discovered by a physician named Eric Bywaters after a blitz in London in 1941. He noticed that the patients that were released from the crushing pressures exhibited much of the same symptoms; he believed that with the releasing of the patient from the crushing pressure caused a release of muscle breakdown products. The most prominent of these products would be myoglobin, phosphorus, and potassium it is not exactly known why this causes the kidneys to malfunction but it is believed that the toxins released with the myoglobin are the most prominent cause.
The major symptoms associated with Crush syndrome are kidney failure, blood vessel restriction and possible heart attack. Other symptoms that may occur include pale and clammy skin with a rapid but possibly weak pulse, but these symptoms can be associated with many other causes other than Crush syndrome. Crush syndrome has often been referred to as a silent killer as the patient may not exhibit any outwards symptoms until it is too late.
Due to the lack of possible outward symptoms many patients may pass away from their injuries, but other treatments have been initiated since the episodes of earthquakes have more frequently occurred in the last 10 years. The immediate introduction of fluids, once a person is freed from the rubble it is important to start a normal saline solution, not ringers lactate solutions as it contains potassium. It is also advisable to administer a sodium bicarbonate solution with every other bag of saline given to increase the urinary’s Ph balance causes the myoglobin to be more soluble.
Other treatments for crush syndrome depending on its severity may involve surgery to repair damaged nerves. Another treatment that may be used is renal replacement therapy, kidney function is usually diminished one to two days after the injuries occur and in this case the replacement therapy can most often involve hemodialysis.
Hemodialysis is where the blood is run through a filter to remove the build-up of waste products and then the blood will be returned to the body. Since people who experience a crush injury are more likely to have kidney problems, hemodialysis can be used to filter out the harmful amounts of toxins that have built up in their bloodstream. Depending on the levels of toxins that may circulate in the bloodstream daily dialysis may be necessary for the first several days of treatment.