Earthquake Rescue Manual-After the Earthquake (3)

Crush injury and crush syndrome: basic knowledge of clinicians

background

When a terrorist attack occurs, the collapse of the building after the explosion may cause crush injuries and crush syndrome. Crush injury is defined as compression of limbs or other parts of the body, causing muscle swelling and / or neurological disease of the affected body part.

Typical affected areas of the body include the lower extremities (74%), upper extremities (10%), and trunk (9%). Crush syndrome is a local crush injury with systemic manifestations. The cause of these systemic effects is traumatic rhabdomyolysis (muscle breakdown) and releases potentially toxic muscle cell components and electrolytes into the circulatory system. Crush syndrome can cause local tissue damage, organ dysfunction, and metabolic abnormalities, including acidosis, hyperkalemia, and hypocalcemia.

Earthquakes can cause a lot of building damage. Past experience has shown that the incidence of crush syndrome is 2 to 15%, of which about 50% of patients with crush syndrome have acute renal failure, and more than 50% of patients need to undergo fasciotomy Operation. In patients with renal failure, 50% require dialysis.

Clinical manifestations

Sudden release of the compressed limb may cause reperfusion syndrome — acute hypovolemia and metabolic abnormalities. This situation can cause fatal arrhythmias. In addition, the sudden release of toxins from necrotic muscles into the circulatory system can cause myoglobinuria, which can cause kidney failure if left untreated.

Hypotension

. A large number of third gaps occur, and many fluids need to be replenished within the first 24 hours; within 48 hours, the patient may be isolated at the pressure site (third gap)> 12 liters of fluid. The third gap may cause secondary? ⒅ⅲ? ⒑ 盁 糁 ⒑ 蛉 海? 馐 鳳 峁 ⒑ 蛉 海? 馐 鳥 糙 缙 慕 餉 遃? The guilty gambling stains stop suffering 糥 糁 ⒑ 蛉 壕? P 枰 ?? salary 钅 で zinc ?? BR>. Hypotension can also cause renal failure

Renal Failure

Rhabdomyolysis releases myoglobin, potassium, phosphorus, and creatinine into the circulation. Without treatment, myoglobinuria may cause tubular necrosis. Electrolytes released by ischemic muscles cause abnormal metabolism

Metabolic abnormalities

. Calcium flows into muscle cells through the leaky cell membrane, causing systemic hypocalcemia. Potassium is released from ischemic muscles into the systemic circulation, causing hyperkalemia. Lactic acid is released from ischemic muscles into the systemic circulation, causing metabolism Acidosis. Potassium and calcium imbalances can cause life-threatening arrhythmias, including cardiac arrest; metabolic acidosis can exacerbate this condition

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. Septal syndrome may occur, which can further aggravate vascular damage

Initial treatment

Disposal before hospitalization:

. Give intravenous fluids before loosening the squeezed object. (This step is especially important during long-term squeeze [> 4 hours]; however, the squeeze syndrome will appear within <1 hour of squeeze)
If this procedure is not possible, consider using a tourniquet on the affected limb for a short period of time until intravenous (IV) fluid replacement can begin

Hospital organization:

Hypotension

. Start (or continue) IV fluid replacement-up to 1.5 liters per hour

Renal Failure-

. To prevent kidney failure through proper fluid replacement, use IV fluid and mannitol to maintain a urine volume of at least 300 ml per hour. If necessary, choose hemodialysis

Metabolic abnormalities

Acidosis: Alkaliization of urine is essential; IV sodium bicarbonate is given until the pH of the urine reaches 6.5 to prevent the deposition of myoglobin and uric acid in the kidney

. Hyperkalemia / Hypocalcemia: Consider the following drugs (adult dose): calcium gluconate (calcium gluconate) 10% 10 ml or calcium chloride (calcium chloride) 10% 5 ml, IV within 2 minutes ; Sodium bicarbonate (sodium bicarbonate) 1 mg equivalent per kilogram, IV slow push; regular insulin (5 to 10 U and D5O 1 to 2 amps, IV bolus); polysulfonyl (kayexalate) 25 to 50 grams Add sorbitol 20% 100ml, PO or PR

. Arrhythmia: monitor arrhythmia and cardiac arrest, and treat according to the situation

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. Monitor the injured for septal syndrome; monitor the compartment pressure if a device is available; consider emergency fasciotomy for the septal syndrome. Use antibiotics and tetanus toxoid, and debridement of necrotic tissue to treat open wounds. Apply ice to the injured area and perform 5P monitoring: pain, pallor, parasthesias, pain without passive movement, and pulselessness
. Observe all crush injuries, even those who have no abnormal appearance. Delayed fluid replacement> 12 hours can increase the incidence of renal failure; delayed onset of renal failure can occur

intention

Patients with acute renal failure may require up to 60 days of dialysis treatment, unless there is sepsis, otherwise the patient is hopeful to recover? Camel? 5 nanoscale δ? / P>

U.S. Department of Health and Human Services Center for Disease Control and Prevention