Crush injuries occur when a person is caught between
objects, run over by a moving vehicle, or compressed by machinery.
The patient is observed for the following:
Hypovolemic shock resulting
from extravasation of blood and plasma into injured tissues after compression
has been released
Paralysis of a body part
Erythema and blistering of
Damaged body part (usually an
extremity) appearing swollen, tense, and hard
Renal dysfunction (prolonged
hypotension causes kidney damage and acute renal insufficiency; myoglobinuria
sec-ondary to muscle damage can cause acute renal failure)
In conjunction with
maintaining the airway, breathing, and cir-culation, the patient is observed
for acute renal insufficiency. Injury to the back can cause severe kidney
damage. Severe mus-cular damage causes a significant release of myoglobin,
which can result in acute tubular necrosis. Additionally, major soft tissue
in-juries are splinted early to control bleeding and pain. Again, the serum
lactic acid concentration is monitored; a decrease to less than 2.5 mmol/L is
an indication of successful resuscitation (Blow, Magliore, Claridge, Butler,
& Young, 1999).
If an extremity is
involved, it is elevated to relieve swelling and pressure. To restore
neurovascular function, the physician may perform a fasciotomy (surgical incision to the level of the fascia).
Medications for pain and anxiety are then administered as pre-scribed, and the
patient is quickly transported to the operating suite for wound débridement and
fracture repair. Then, a hyper-baric chamber (if one is available) can be used
for hyperoxygena-tion of the crushed tissue, if indicated.