What are the symptoms of crush syndrome?

Some people were found to have crush syndrome after going to the hospital for examination after being squeezed at noon or staying in a small space for a long time. In fact, if the squeezing is continued for a long time, it is easy to cause a series of changes in the body. For example, we can find that after squeezing, their limbs will be injured and swollen, and they may also suffer from acute renal failure, and the most serious ones may even lead to death. So what does crush syndrome manifest itself?

Crush syndrome refers to a series of pathological and physiological changes in the body after the muscle-rich parts of the human body, such as the limbs or trunk, are squeezed for a long time by heavy objects (such as stones, earth, etc.). The main clinical manifestations are acute renal failure characterized by limb swelling, myoglobinuria and hyperkalemia. If not treated promptly, the consequences are often serious and may even lead to the death of the patient.

1. Local manifestations

Due to damage to the skin and flesh, blood leaves the blood vessels, blood stasis accumulates, Qi and blood stagnate, and meridians are blocked, local pain occurs, limb swelling, skin indentations and hardening, subcutaneous congestion, increased skin tension, and blisters form around the compressed skin. When checking the blood circulation status of the limbs, it is worth noting that if the distal pulse of the limb is not weakened, the muscle tissue is still at risk of ischemic necrosis. Pay attention to checking the muscle and nerve function of the limbs. Active movement and passive traction may cause pain, which is helpful to determine the affected fascial compartment muscle groups.

2. Systemic manifestations

Due to internal injuries to Qi, blood, meridians, and internal organs, patients experience symptoms such as dizziness, loss of appetite, dull complexion, chest tightness, abdominal distension, and constipation. The accumulation of blood stasis and heat may manifest as fever, red face, yellow urine, red tongue, greasy yellow tongue coating, and rapid pulse. In severe cases, patients may experience palpitations, shortness of breath, and even pale face, cold limbs, and oily sweat (shock).

The main features of crush syndrome are as follows:

(1) Shock: Some casualties may not experience shock in the early stages, or the shock period may be so short that it is not discovered. Some casualties may experience shock rapidly and the condition may worsen due to strong nerve stimulation, extensive tissue damage, and massive blood volume loss caused by crush injuries.

(2) Myoglobinuria: This is an important condition for diagnosing crush syndrome. If the patient develops brown urine or self-reports hematuria within 24 hours after the pressure on the injured limb is released, myoglobinuria should be considered. The concentration of myoglobinuria in the blood and urine reaches a peak 3 to 12 hours after the pressure on the injured limb is released, and then gradually decreases and can clear up on its own after 1 to 2 days.

(3) Hyperkalemia: Due to muscle necrosis, a large amount of intracellular potassium enters the circulation. In addition, renal failure makes it difficult to excrete potassium. During the oliguric period, blood potassium can rise by 2 mmol/L per day, and even rise to a fatal level within 24 hours. Hyperkalemia is accompanied by hyperphosphatemia, hypermagnesemia and hypocalcemia, which can aggravate the myocardial depression and toxicity of blood potassium.

(4) Acidosis and azotemia After muscle ischemia and necrosis, a large amount of acidic substances such as phosphate and sulfate are released, which lowers the pH value of body fluids and causes metabolic acidosis. After severe trauma, tissue decomposition metabolism is vigorous, a large amount of intermediate metabolites accumulate in the body, and non-protein nitrogen increases rapidly. Clinically, a series of manifestations of acidosis and uremia such as confusion, deep breathing, irritability, thirst, nausea, etc. may appear. The daily intake and output should be recorded, and the urine specific gravity should be measured frequently. If the urine specific gravity is below 1.018, it is the main diagnostic indicator.

We have explained the symptoms of crush syndrome very clearly above, and I believe everyone understands it. If you are unfortunately squeezed by a heavy object for a long time, you must pay attention and go to the hospital for a detailed physical examination. This is the best way to prevent the occurrence of crush syndrome.