The management of shock and local injury in traumatic rhabdomyolysis

Abstract

Rhabdomyolysis (literally "striped muscle dissolution") is a biological and clinical condition that takes to plasmatic release of myoglobin, muscle enzymes and electrolytes, relates to the lysis of stripped muscle fibers. Rhabdomyolysis presents the clinician with two distinct problems: local injury and the systemic effects directly related to that injury. Locally, muscle, vessel and nerve compression are the primary issues. Systemic concerns relate to depleted intravascular volume, electrolyte imbalances and renal injury from myoglobin. Preventing the systemic and renal complications of the crush syndrome requires very early and vigorous treatment to sustain the circulation, preferably started at the site of the catastrophe. During the extrication of an injured person from a collapsed building, wrecked automobile, or other site, isotonic saline solution should be infused at the rate of 1.5 liters per hour as soon one of the trapped person's limbs has been freed. Some authors suggest to do a preventive fasciotomy in any suspicious case of compartmental syndrome, when the patient has severe muscular pain of the muscular cavity, tense swelling, hypoesthesia or anesthesia of the muscular cavity, pain at the passive mobilization of the limb. On the other hand other surgeons suggest doing a fasciotomy only in selected group of patients. Therefore, the traumatic rhabdomyolysis has few diagnostically problems. On the other hand, their treatment is complex and must have a multidisciplinary approach. So the rhabdomyolysis actually remain a severe disease with high mortality caused principally by visceral lesions related to sepsis.