Management of crush syndrome casualties after disasters

Abstract

After direct impact of the trauma, crush syndrome is the second most frequent cause of death after mass disasters. However, since crush syndrome is quite rare in daily practice, mistakes are frequent in the treatment of these cases. This paper summarizes the etiopathogenesis of traumatic rhabdomyolysis and of crush syndrome-based acute kidney injury. The clinical and laboratory features, prophylaxis, and treatment of crush cases are described as well. The importance of early and energetic fluid resuscitation is underlined for prophylaxis of acute kidney injury. Since there is chaos, and an overwhelming number of victims, logistic drawbacks create a specific problem in the treatment of crush victims after mass disasters. Potential solutions for logistic hurdles and disaster preparedness scenarios have also been provided in this review article.

Keywords: Crush syndrome; kidney; rhabdomyolysis; trauma.

Figure 1

Pathogenesis of pressure-induced rhabdomyolysis (based on reference 1).

Figure 2

Pathogenesis of crush syndrome-related acute kidney injury (adapted from references –21). ARF, acute renal failure; ATN, acute tubular necrosis; DIC, disseminated intravascular coagulation; IVV, intravascular volume.