Crush Syndrome

Crush syndrome is a condition that is associated with serious injuries. It is very dangerous and directly threatens the patient's life. The essence of the problem is discussed below.


The crush syndrome is caused by a longer-lasting compression of soft tissues (especially muscles) by some external force. Is typical for wounded, who were buried under some material such as soil, sand or rubble.


Massive external compression force damages the tissues. When the person is saved and pulled out from the compressing material, the crush syndrome begins to manifest. The blood supply to the (drained of blood) tissues restores, but local blood vessels are damaged and the blood fluid leaks to nearby tissues causing their swelling. The swollen tissues further compress the blood vessels and worsen the blood and nutrient supply. In addition, the blood fluid is misses in the circulatory system and the situation may quickly progress into hypovolemic shock. In addition, the damaged muscle fibers may disintegrate (so-called rhabdomyolysis) and release a substance known as myoglobin located within the muscle fibers. Myoglobin molecules enter the bloodstream and when they reach kidneys, the clog in their filtration units, the glomeruli. The obstruction of multiple glomeruli together with failing circulatory system may easily cause acute kidney failure. And if that was not enough, there occurs a problem with potassium. Dying cells of damaged tissue release large amount of potassium and impaired kidneys are unable to excrete it from the body. This situation results in hyperkalemia.


The person looks seemingly uninjured as one has no visible wounds or internal bleeding. However, the condition begins to deteriorate rapidly, the affected tissue swell, hurt and the signs of shock begin to develop (rapid heart rate, low blood pressure, pallor, unconsciousness and death).


Every person buried under any solid material for more than 15 minutes should be immediately (after the rescue) taken to a hospital for examination and monitoring.


The main thing is to keep the patient alive for the critical period of several days. The patient in a crush syndrome should be hospitalized in the ICU, monitored and the circulatory system must be maintained by intravenous infusions. Acute renal failure needs to be solved by acute temporary dialysis. When the patient survives, the prognosis is very good as the damaged kidney tissue tends to recover. When any part of the body (typically the lower extremity) is severely damaged by the crush syndrome, its amputation may be necessary.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources