1. CRUSH SYNDROME ICD 10: T79.5 Mohit Chhabra Roll no. : 47

2. OBJECTIVES Define and understand the pathophysiology of Crush Syndrome Clinical diagnosis and relevant investigation Management

3. A Case of Crush Syndrome….

4. Clinical Features Lower limb injury with pain and swelling, which later on developed anesthesia and motor disturbance Signs of hypovolemic shock Tea-colored urine, maybe oliguria Nausea and confusion Pathophysiology

6. On Investigating further…. Hyperkalemia & hypocalcaemia ECG changes secondary to hyperkalemia Metabolic acidosis Raised Creatine Kinase Elevated UREA and CREATININE Myoglobinuria Evidence of D.I.C.

7. Diagnosis: Crush Syndrome Definition: ◦ A severe, often fatal condition that follows a severe crushing injury, particularly involving large muscle masses, characterized by fluid and blood loss, shock, hematuria, and renal failure. Also known as compression syndrome. (McGraw Hill Dictionary) ◦ In a nutshell: TRAUMATIC RHABDOMYOLYSIS due to crushing ◦ Also known as Bywaters Syndrome/ Reperfusion injury

8. PATHOPHYSIOLOGY Crushing injury Ischaemic damage to muscles Release of toxic metabolites Clinical Features

9. KIDNEY IS IN DANGER AS SOON AS WE RELIEVE THE COMPRESSION Renal hypoperfusion + Renal Tubular Necrosis = Renal Failure

10. MANAGEMENT Initial Management: 1.Follow the usual criteria of A-B-C as injuries are massive and high chances of poly-trauma 2.Early and rapid rehydration 3.Venous access preferably before the limb is decompressed 4.CVP and urinary catheterization for monitoring

11. Further Management 1.Large amount of saline infusion with forced diuresis 2.Debridement of crushed tissue and a fasciotomy for compartment syndrome 3.Dialysis if renal failure sets in 4.Amputation as the last resort if massive limb injury is there and we have to prevent crush syndrome