Following prolonged compression of the limbs a distinct clinical syndrome may develop. If not properly managed the patient may develop shock and die.


Situation: prolonged compression of the limbs as seen in natural disasters, mining accidents, train accidents or warfare, when people are buried under large amounts of debris for hours or days before rescue.


At the time of extrication the patient may seem to have only slight injuries and does not complain of pain.


Clinical findings:

(1) muscle damage with rhabdomyolysis

(2) crush injury to nerves, with initial sensory loss and flaccid paralysis, followed by severe pain as nerve function is restored

(3) incisions into the damaged muscle causes profuse bleeding that is very hard to control

(4) marked edema of the injured limbs

(5) acute renal failure

(6) infection in the injured limbs

(7) shock


Laboratory findings:

(1) increased hematocrit due to intravascular hypovolemia

(2) myoglobinuria with dark urine

(3) hyperkalemia

(4) hypercalcemia

(5) hyperphosphatemia

(6) marked increase in CK


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