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Prevention of Crush Syndrome through Aggressive Early Resuscitation: Clinical Case in a Buried Worker

Published online by Cambridge University Press:  28 March 2016

Alvaro Mardones ,
Pablo Arellano ,
Carlos Rojas ,
Rodrigo Gutierrez ,
Nicolas Oliver  and
Vincenzo Borgna
Alvaro Mardones
Affiliation:
Santiago Fire Department, Urban Search & Rescue Task Force, Santiago, Chile Universidad del Desarrollo, Faculty of Medicine, Santiago, Chile Clínica Alemana, Emergency Department, Santiago, Chile
Pablo Arellano
Affiliation:
Colina Fire Department, Medical Department, Santiago, Chile
Carlos Rojas
Affiliation:
Hospital del Trabajador, Orthopaedics & Traumatology Unit, Santiago, Chile
Rodrigo Gutierrez
Affiliation:
Hospital del Trabajador, Orthopaedics & Traumatology Unit, Santiago, Chile
Nicolas Oliver
Affiliation:
Santiago Fire Department, Urban Search & Rescue Task Force, Santiago, Chile
Vincenzo Borgna*
Affiliation:
Santiago Fire Department, Urban Search & Rescue Task Force, Santiago, Chile Barros Luco-Trudeau Hospital, Urology Unit, Santiago, Chile
*
Correspondence: Vincenzo Borgna, MD, PhD Santo Domingo 978 Santiago, Chile 8320292 E-mail: [email protected]
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Abstract

Introduction

Crush syndrome, of which little is known, occurs as a result of compression injury to the muscles. This syndrome is characterized by systemic manifestations such as acute kidney injury (AKI), hypovolemic shock, and hydroelectrolytic variations. This pathology presents high morbidity and mortality if not managed aggressively by prehospital care.

Clinical Case

A 40-year-old worker was rescued after being buried underground in a ditch for 19 hours. The patient was administered early resuscitation with isotonic solutions and monitored during the entire rescue operation. Despite having increased plasma levels of total creatine kinase (CK), the patient did not develop AKI or hydroelectrolytic variations.

Conclusion

Aggressive early management with isotonic solutions before hospital arrival is an effective option for nephron-protection and prevention of crush syndrome.

MardonesA , ArellanoP , RojasC , GutierrezR , OliverN , BorgnaV . Prevention of Crush Syndrome through Aggressive Early Resuscitation: Clinical Case in a Buried Worker. Prehosp Disaster Med. 2016;31(3):340–342.

Keywords

acute kidney injurycrush syndromerhabdomyolysis
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 3 , June 2016 , pp. 340 - 342
Copyright
© World Association for Disaster and Emergency Medicine 2016 

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References

1. Bywaters, EG. Crushing injury. British Medical Journal. 1942;2(4273):643-646.Google Scholar
2. Sever, MS, Vanholder, R. Recommendation for the management of crush victims in mass disasters. Nephrology, Dialysis, Transplantation. 2012;27(Suppl 1):i1-67.Google Scholar
3. Sever, MS, Vanholder, R. Management of crush syndrome casualties after disasters. Rambam Maimonides Medical Journal. 2011;2(2):e0039.Google Scholar
4. Knochel, JP. Rhabdomyolysis and myoglobinuria. Annual Review of Medicine. 1982;33:435-443.Google Scholar
5. Huerta-Alardin, AL, Varon, J, Marik, PE. Bench-to-bedside review: rhabdomyolysis -- an overview for clinicians. Critical Care. 2005;9(2):158-169.Google Scholar
6. Slater, MS, Mullins, RJ. Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients: a review. Journal of the American College of Surgeons. 1998;186(6):693-716.Google Scholar
7. Aoki, N, Demsar, J, Zupan, B, et al. Predictive model for estimating risk of crush syndrome: a data mining approach. The Journal of Trauma. 2007;62(4):940-945.Google Scholar
8. Ferlay, J, Soerjomataram, I, Dikshit, R, et al. Cancer incidence and mortality worldwide: sources, methods, and major patterns in GLOBOCAN 2012. International Journal of Cancer. 2015;136(5):E359-E386.Google Scholar
9. Yoshimura, N, Nakayama, S, Nakagiri, K, Azami, T, Ataka, K, Ishii, N. Profile of chest injuries arising from the 1995 Southern Hyogo Prefecture Earthquake. Chest. 1996;110(3):759-761.Google Scholar
10. Ashkenazi, I, Isakovich, B, Kluger, Y, Alfici, R, Kessel, B, Better, OS. Prehospital management of earthquake casualties buried under rubble. Prehosp Disaster Med. 2005;20(2):122-133.Google Scholar
11. Brown, CV, Rhee, P, Chan, L, Evans, K, Demetriades, D, Velmahos, GC. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? The Journal of Trauma. 2004;56(6):1191-1196.Google Scholar
12. Gonzalez, D. Crush syndrome. Critical Care Medicine. 2005;33(1 Suppl):S34-S41.Google Scholar
13. Sever, MS, Vanholder, R. Management of crush victims in mass disasters: highlights from recently published recommendations. CJASN. 2013;8(2):328-335.Google Scholar