Crush Injuries - Emergency Nursing

CRUSH INJURIES

Crush injuries occur when a person is caught between objects, run over by a moving vehicle, or compressed by machinery.

Assessment and Diagnostic Findings

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 skin

·      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)

Management

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.