Principles of Operative Treatment
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Colloquially speaking, the indications for amputation are remembered as the three Ds: Dead, Dangerous and Damned nuisance. Dead or dying: peripheral vascular disease accounts for almost 90% of all amputations. Other causes of tissue death are severe trauma, burns and frostbite.Dangerous: ‘dangerous’ disorders are malignant tumours, potentially lethal sepsis and crush injury. In crush injury, releasing the compression may result in renal failure (the crush syndrome).Damned nuisance: retaining the limb may be worse than having no limb at all – because of pain, gross malformation, recurrent sepsis or severe loss of function.
Adult Autopsy
Cristoforo Pomara, Vittorio Fineschi in Forensic and Clinical Forensic Autopsy, 2020
Key PointsCrush syndrome is a complication known to most, but infrequent and, therefore, rarely suspected in the management of the multitrauma patient.In such cases, it is crucial to quickly diagnose in order to avoid the most feared complications: hypovolemic shock and acute renal failure.The diagnosis of crush syndrome must be made on the basis of clinical evidence and data obtained from the laboratory tests.The latter should include the search for biohumoral alterations induced by rhabdomyolysis (myoglobinemia and myoglobinuria, increased creatinine phosphokinase, hydroelectrolyte, and metabolic alterations).
The immune and lymphatic systems, infection and sepsis
Peate Ian, Dutton Helen in Acute Nursing Care, 2020
There are many causes of fever: Infection, e.g., bacterial, viral, fungal or protozoan.Autoimmune diseases such as lupus erythaematous.Inflammatory bowel disease.The breakdown of red blood cells, or haemolysis, from surgery can induce a temperature postoperatively.Myocardial infarction.Crush syndrome as a result of rhabdomyolysis.Drugs can also cause a ‘drug fever’, either as a direct consequence of the drug or as an adverse reaction to the drug (e.g., allergic reaction to antibiotics). Discontinuation of some drugs, for example heroin withdrawal, can induce a fever.
Protective effect of thymol on glycerol-induced acute kidney injury
Published in Renal Failure, 2023
Qinglian Wang, Guanghui Qi, Hongwei Zhou, Fajuan Cheng, Xiaowei Yang, Xiang Liu, Rong Wang
Acute kidney injury (AKI), previously known as acute renal failure (ARF), was first replaced by the emergency medical community and the international society of nephrology [1] and is a syndrome characterized by an accelerating decrease in renal function in a short time. It is a crucial clinical problem with a high mortality rate, prolonged hospital stays and accelerated chronic kidney disease. Generally, the onset of AKI is hidden until the body cannot tolerate natremia [2]. Once diagnosed, the mortality of AKI is as high as 50% in the intensive care unit [3], and effective therapy to reverse or prevent progression is rarely mere. Rhabdomyolysis (RM)-induced AKI is named RM-mediated myoglobinuric renal damage, with 15% of all RM patients accounting for 40% of AKI cases [4]. It often develops after crush syndrome, exhaustive exercise, medications, infections, and toxins [5–8].
Bathroom Entrapment Leading to Cardiac Arrest From Crush Syndrome
Published in Prehospital Emergency Care, 2019
Amy N.H. Whiffin, Jesse D. Spangler, Komal Dhir, Richard Zhang, Jeffrey D. Ferguson
This case is an unusual example of a prolonged extremity entrapment and CS that highlights the speed at which fatal dysrhythmias can occur following release of an entrapped extremity as well as the importance of early treatment of CS. While use of tourniquets prior to release of entrapped extremities is not widespread, there is growing evidence to support this practice. In instances where ischemia and hyperkalemia are both highly likely, the risk of fatal dysrhythmias and cardiovascular collapse outweigh the risk of possible neuromuscular damage or even loss of limb. In our case, the use of a prehospital tourniquet and empiric treatment of crush syndrome, including IV fluids, calcium administration, and potassium shifting medications prior to release of the ischemic limb may have avoided cardiovascular collapse. EMS providers must be aware of this and be prepared to empirically and aggressively treat CS. Medical directors should develop protocols to consider and treat CS. Encouraging increased tourniquet use prior to the release of crushed extremities in instances of prolonged entrapment should be further explored.
Immunomodulatory role of recombinant human erythropoietin in acute kidney injury induced by crush syndrome via inhibition of the TLR4/NF-κB signaling pathway in macrophages
Published in Immunopharmacology and Immunotoxicology, 2020
Jiaojiao Zhou, Yajun Bai, Yong Jiang, Padamata Tarun, Yuying Feng, Rongshuang Huang, Ping Fu
Crush syndrome (CS) is a critical clinical syndrome that is characterized by the prolonged compression of skeletal muscle to cause ischemic necrosis and is accompanied by limb swelling, hyperkalemia, myoglobinuria, and acute kidney injury (AKI) [1]. In all types of massive disasters, such as earthquakes, war, and landslides, life-threatening complications are the leading cause of survivor mortality [2]. AKI is a serious complication of crush injury that can be reversed. When renal failure occurs, the prognosis of AKI deteriorates significantly [3]. The mortality rate of CS-induced AKI is quite high. Previous studies showed that the mortality rate of CS-induced AKI during the Wenchuan earthquake in China was 10.96% (69,197 deaths, 374,176 injuries) [4,5].
Related Knowledge Centers
- Acute Tubular Necrosis
- Amputation
- Kidney Failure
- Nervous System
- Skeletal Muscle
- Rhabdomyolysis
- Myoglobin
- Shock
- Crush Injury
- Physician