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Crush Injury

Crush Injury. HARRT 2004. Crush Syndrome. A panoply of systemic manifestations that arises once a victim sustains a compressive force of sufficient duration and severity to cause muscle crush injury and cell death Principal complications are associated with heart and kidney

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Crush Injury

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  1. Crush Injury HARRT 2004

  2. Crush Syndrome • A panoply of systemic manifestations that arises once a victim sustains a compressive force of sufficient duration and severity to cause muscle crush injury and cell death • Principal complications are associated with heart and kidney • Heart Effects: Result of Hyperkalemia • Kidney Effects: Result of myoglobin and uric acid precipitation in renal tubules, decreased glomerular filtration, and nephrotoxic effect of ferrihemate (a dissociation of myoglobin in the acidic environment of the renal parenchyma.)

  3. Earthquake Ernie

  4. Right Leg Crushed, poor arterial flow, little or no venous return Regional ischemia due to impaired macro- and microcirculation Rest of him Dazed, in pain Earthquake Ernie

  5. Right Leg Muscle cells injured heading toward death (Rhabdomyolysis) Derangements of oxidative-glycolytic pathways ATP depletion Profound changes in intracellular electrolyte composition K+ leaves cell Ca++ enters cell Na+ enters cell Exit of internal proteases Myoglobin exits Rest of him Glad to be alive! Except for leg pain, rest is okeedokee Damn it! Help! Earthquake Ernie

  6. Right Leg Hours later, more myocytes inevitably go from ischemic to dead. It is a gradual process because: Speed of Ca++ shift is slowed due to vascular occlusion Superoxides and H2O2 are low due to ischemic mitochondria Surrounding acidosis is cyto-protective Rest of him Hungry, thirsty Can’t feel leg Earthquake Ernie

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