What Is Crush Syndrome
Crush syndrome develops when muscle is compressed for prolonged periods, typically over 4 hours. Damaged muscle releases myoglobin, potassium, and other toxins. When pressure is released, these substances flood the circulation.
Reperfusion Dangers
Hyperkalemia can cause life-threatening arrhythmias, such as peaked T waves, wide QRS complexes, and cardiac arrest. Myoglobin can injure the kidneys, causing acute renal failure. Hypovolemia and acidosis add to the danger.
Management
Start IV fluids before release when possible, often normal saline at a high rate. Monitor the ECG, and follow local protocols for calcium, sodium bicarbonate, or albuterol in suspected hyperkalemia. Consider a tourniquet if the patient is at risk of deterioration after release, and keep the patient warm.