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Managing Crush Injuries on Arrival
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Sarvdeep Singh Dhatt, Deepak Neradi
Release of crushing force can cause sudden haemodynamic collapse and cardiac arrest due to reperfusion injury, which can be prevented by initiating resuscitation/monitoring with the patient still trapped. Basic life support should be provided at the earliest, and the patient should be transported to a definitive medical care facility as quickly as possible. Patients with crush injury should be monitored for basic observations (blood pressure, respiratory rate, heart rate, temperature, oxygen saturation). Urine output and continuous cardiac monitoring should be started as early as possible. Blood electrolytes and gases should be measured every 6 hrs. Hyperkalaemia, hypocalcaemia and oliguria are early signs which can precipitate arrhythmias and cardiac arrest. Venous bicarbonate < 17 mmol/L in presence of myoglobinuria is associated with the development of acute renal failure (ARF). Due to the high risk of hypothermia in crush victims, aggressive rewarming should be achieved with warm IV fluid administration, warm air blankets, warmers, bladder/peritoneal lavage, warm enemas, etc. Slow rewarming is associated with a sevenfold increase in mortality in trauma patients. Blood loss should be replaced by transfusion of whole blood or blood components in a 1:1:1 ratio of packed red blood cells:plasma:platelets. Various principles of management of crush injuries are depicted in Table 27.1.
Mechanism of Injury
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
As a mechanism of injury, crush is directly related to the anatomical area of the body sustaining trauma. While a much higher proportion of injuries may result from crushing mechanisms in situations of building collapse, particularly those seen in natural disasters or earthquakes, the majority of crush injuries are sustained in the context of motor vehicle collisions or occupational accidents. Crush injury may also occur in equestrian or agricultural related incidents, where patients sustain injury as a result of falling under large animals.50, 51
Musculoskeletal and Soft-Tissue Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Refer every severe crush injury involving a limb, hand or foot to the orthopaedic team, including patients suspected of having a compartment syndrome. Management will include consideration of compartment pressure monitoring, the use of vasodilator agents, mannitol and sodium bicarbonate, or operative fasciotomy.
Comparison of the effects of methylprednisolone, hyperbaric oxygen and hesperidin + diosmin on the facial nerve injury: an experimental animal model
Published in Acta Oto-Laryngologica, 2023
Yaşar Özbuğday, Mehmet Erkan Kahraman, Abdullah Arslan, Ilknur Küçükosmanoğlu
Experimental FN injury models are frequently used to study post-injury changes and to develop new treatments for nerve healing [10,11,17–19]. Crush injury to the peripheral nerve causes immediate tissue damage in the lesion area, leading to deterioration of nerve fibers. Peripheral nerves have a delicate microvascular system for impulse conduction and axonal transport. When the endoneural microcirculation is disrupted as a result of crushing, nerve conduction also fails [19,20]. All these events show potential targets for pharmacological treatments. Many drugs and methods with neuroprotective, antiedema, antioxidant and anti-inflammatory properties have been tried to increase recovery after peripheral nerve injury. Some of these agents are HBO [10,11], lipoic acid [17], memantine [19].
Causal mediation analysis of the impacts of distracted driving on crash injury risks
Published in International Journal of Injury Control and Safety Promotion, 2022
Guopeng Zhang, Ying Cai, Xinguo Jiang, Tangwei Yao, Yingfei Fan
The limitations of the study include: 1) the information on the physical condition and hazardous action of each driver is derived directly from the crash database, which was investigated and recorded by police officers. It is impossible for us to verify the validity of the information, which may lead to the bias of the safety evaluation; 2) driver distraction involves many types as mentioned. The corresponding mediation effects may not necessarily be consistent for different distraction types. However, the discrepancy of the mediation effects has not been unveiled because the distraction is not further classified in the Michigan crash database; and 3) there may exist many mediators that related to distracted driving and crash injury severity other than the hazardous driving actions, which has not been fully discussed in the study. Further work can be directed to examine the discrepancies of the effects of different distraction types and explore more mediator variables contributing to the crush injury, which serves to pinpoint the specific countermeasures for alleviating the crash risks. In addition, it is also desirable to conduct the driving experiments to reveal the causal effects of distracted driving on the crash injury risk, which poses the advantage of obtaining the information on the driving performance (e.g., traveling speed, acceleration, and lateral displacement) that related to the distraction.
Mouse models of hemostasis
Published in Platelets, 2020
Bassem M. Mohammed, Dougald M. Monroe, David Gailani
The nails of many mammals contain a vascular central region called the quick. Cutting into the quick produces bleeding that can be measured. The original model was developed to study therapeutic agents in hemophiliac dogs, and showed a correlation between intensity of therapy and reduced bleeding [84,85]. It has been adapted for other species, most notably rabbits and, less frequently, mice. In mice, the entire cuticle of the middle digit is removed with sharp scissors, and blood is collected with filter paper [86,87]. It is difficult to determine if a consistent injury is being inflicted in mice because of the small size of the digits. There is probably a component of crush injury in addition to the laceration. Furthermore, it is not clear that this model is more reproducible than other models, and some of the groups that reported its initial use have transitioned to other models for subsequent studies.