Crush Injury and Syndrome part 2

Signs of Crush Syndrome:

As discussed earlier, the clinician will need to take account of patient history, MOI, surrounding factors, and the 3 elements determining the severity of crush syndrome. Depending on the environment, it may be impossible to review the physical symptoms of the patient due to the surroundings, e.g. a building collapse and no view whatsoever of the patients’ crushed legs. If you are able to review the patient, some physical signs of crush syndrome can include:

  • Mottled/Blistered skin of the affected area
  • Oedema in the affected area
  • Reddish/Brown urine
  • Absent/Diminished pulses distally from the crush
  • Paralysis/Paresis in the affected areas
  • Pain

Crush management:

A crush incident would likely require multiple staff and agencies to provide the best possible care for the patient. There are several considerations that need to be made:

  • Safety will be of initial importance as the likelihood is that a patient or patients suffering crush injuries/syndromes will be in a hazardous environment. Consider further specialist support such as the Hazardous Area Response Team (HART) and Fire and Rescue Services.
  • A primary survey of the patient is required to identify and treat any life-threatening injuries/symptoms that the patient may be suffering with. Due to the nature of the event, it is likely that there will be multiple significant injuries that will need correcting to keep the patient haemodynamically stable. Where possible, manage and reverse primary survey deficits to the best of your ability in the situation.
  • Consider Catastrophic tourniquets loosely applied above trapped limbs in a readied position for potential haemorrhage for when the patient is released.
  • IV fluids prior to release are also important as a measure to help against any hypovolaemia, hyperkalaemia, and metabolic acidosis. There are multiple guidelines available regarding fluid treatment and crush syndrome depending on your trust and local guidelines, usually involving a large bolus of fluid prior to release of the compressive force. Review your Ambulance Services guidelines for fluid therapy in crush
  • Consider discussion with specialist/advanced support prior to the release as they may be able to give further advice, also, specialist services on scene may be able to give advanced medications to help with the crush syndrome such as calcium chloride, or advanced analgesia such as ketamine.
  • After releasing the patient from the compressive object, their condition can deteriorate very suddenly. It is important to have completed a primary survey and treated deficits, have given fluids, have monitoring equipment and extrication devices/route ready. Analgesia may assist with the extrication process and will help with the patient’s comfort.
  • If the event is a major or significant incident, such as a building collapse, specialist clinical support and services would likely be on scene/heading to scene. If not, specialist support request would be recommended.