The association between crush injury , rhabdomyolysis
acute renal failure was first reported in victims trapped during the London
Blitz . It is seen in earthquake and mining accidentsurvivor and in battlefield
casualties . Prolong crushing of muscle release myoglobin and vasoactive
mediators into the circulation . It also sequesters many litres of fluid ,
reducing the intravascular volume and resulting in renal vasoconstriction and
ischaemia . The myoglobinurea leads to
tubuar obstruction .
The
treatment of crush casualties should begin as soon as they are discovered .
Aggressive volume loading of the patients preferably before extrication is the
best treatment . the patient should be catheterised to measure the urine output
. In adult a saline infusion of 1000-
1500 ml/hour should be initiated . Manitol administration can reduce the
reperfision component of this injury . Intensive care is required with close
attention to fluid balance and renal replacem
ent
therapy if required .
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