Accidents can be of various types- Minor or Major. All these accidents do is end up with you getting injured. As per AIHW, injuries are a significant healthcare issue in Australia. As per ICD–10–AM, injury is defined as a condition coded to ‘External causes of morbidity and mortality’ and ‘Injury, poisoning and certain other consequences of external causes’. In the latest years, falls, contact with objects (like sharp objects) and transport accidents, including vehicle entrapment, suicide, and accidental poisoning, are reported to be the leading causes of both hospitalisations and deaths from injury in Australia. In this blog, we will look into the details of Crush injury.
What is a crush injury?
A crush injury is an injury by any object that causes compression of the body, i.e. physical trauma from prolonged compression on the torso, limb(s), or other body parts. In general, crush injuries occur when a body part gets affected when it gets compressed/squeezed, trapped, pinched, or jammed under or between objects between two heavy objects.
Further, crush injury can occur during natural disasters, industrial accidents, car crashes and collisions, falling debris, building collapse, accidents involving heavy plants, disaster relief or terrorist incidents. A crush injury can affect a worker, driver, or even pedestrian. To add more, crush injuries can also occur in nontraumatic patients, such as patients who are immobile for a long time. The immobilised patient can be unconscious due to stroke, drug overdose, or even just intoxication.
In crush injury, professionals focus on
- The systemic injury
Here, the pathophysiology, clinical and prognostic indicators and treatment options such as forced alkaline diuresis, mannitol therapy, dialysis and haemofiltration are focused.
- The local injury
Here, the fasciotomy of crushed limbs and a comparison of surgical management with conservative techniques are discussed.
Why are crush injuries so dangerous?
Due to the sudden and extreme crushing force causing crush injuries, the victim may have their bones broken and fractured. These open fractures result in the bones splintering and protruding through the body. These can hence develop notorious infections and clots. Prolonged pressure and compression can off the flow of blood in the human body. This can cause the deprivation of oxygen in tissues, and eventually, it causes the tissues to die.
In such cases, if the blood flow isn’t restored within six hours, crush injury victims may lose their arms or legs if any of the human organs gets deprived of oxygen for too long and begins to fail. Due to a crush injury, the victim’s vital organs for pumping blood, the heart and filter toxins, and the kidney get affected severely.
What are two types of crush injuries?
A crush injury can be of two types: compartment syndrome and crush syndrome. Processes including trauma, prolonged compression from body weight, and numerous other factors cause these conditions.
What is Compartment Syndrome?
Compartment syndrome occurs when the pressure within a compartment increases, eventually restricting the blood flow to the area and damaging the muscles and nerves. In addition, compartment syndrome occurs in the legs, feet, arms or hands.
Common Signs and Symptoms of Compartment Syndrome has “5 Ps”:
- Extreme Pain
- Pallor (pale skin tone)
- Paresthesia (numbness feeling)
- Pulselessness (faint pulse)
- Paralysis (weakness with movements)
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What is Crush Syndrome?
Crush syndrome, otherwise known as traumatic rhabdomyolysis or Bywaters’ syndrome, is a medical condition where after a crushing injury to skeletal muscle, major shock, multisystem organ injury and kidney failure [ to be specifically acute kidney injury (AKI)] is witnessed. In crush syndrome, rhabdomyolysis (a medical condition involving rapid dissolution of damaged or injured skeletal muscles) results in AKI (a condition when kidneys suddenly stop working properly).
In fact, in crush syndrome, when the pressure is released, the blood again flows into the area and transports excessive amounts of toxins such as potassium, phosphorus and myoglobin to the rest of the body and alters the body’s chemistry. These toxins affect the functions of the heart, lungs and kidneys. Crush syndrome can occur due to prolonged immobility, burns, electrical injuries, earthquakes, and other factors.
History of Crush Injury Syndrome
In 1923, Seigo Minami, a Japanese physician, was the first person to report Crush Injury Syndrome. He studied the pathology of three soldiers who died in World War I from kidney failure, but Eric Bywaters was the first person to recognise the full scope of renal failure after a crush injury. In 1941, Bywaters and Beall were looking for a patient who appeared unharmed but died of renal failure.
Clinical Manifestation of Crush Injury
Traumatic asphyxia can occur after a severe crush injury. The pressure in the superior vena cava and the thoracic pressure both significantly increase during this asphyxia. Traumatic asphyxia can contribute to injury to the liver, spleen, ribs, pulmonary contusions, and brain injury.
Hypovolemia (when your body loses fluid, like blood or water.
Crush injury patients commonly experience hypovolemic shock. In hypovolemic shock, severe blood or other fluid loss makes the heart unable to pump enough blood to the body.
Extremity crush injury
An extreme crush injury can result in generalised swelling, erythema, blisters and purpura to open fractures and mangled extremities with ischemia.
If you have a crush injury along with blunt injury, then the thorax or abdomen can result in pulmonary contusion, rib fractures, and other blunt solid and hollow viscus injuries. Furthermore, prolonged compression can result in spinal injury.
Sequelae of crush injury
Acute kidney injury (AKI)
Crush-related AKI demonstrates
- Rhabdomyolysis (here breakdown of muscle tissue occurs, and it leads to the release of muscle fibre contents into the blood)
- Hyperkalemia (a condition where a potassium level in a person’s blood is higher than normal)
- Hyperphosphatemia (a condition where there is extra phosphorus in your blood; this is often a sign of kidney damage)
- Myoglobinuria(the condition where the presence of an abnormally excessive amount of myoglobin in the urine.)
Older individuals and those with chronic kidney disease who might suffer crush injuries are at increased risk for mortality.
Acute respiratory distress syndrome
It can occur when fluid builds up in the small, elastic air sacs (alveoli) in your lungs. Contributing factors for Acute respiratory distress syndrome are large-volume crystalloid resuscitation, inflammatory response to injury, etc.
Crush injury signs and symptoms
- Lacerations or Open wounds
- Broken bones and fracture
- Compartment syndrome (increased pressure in an arm or leg that causes severe muscle, nerve, blood vessel, and tissue damage)
- Injuries to the nerves.
- Infection (it is caused by bacteria that enter the body through the wound)
What is crush injury treatment?
If crush injury treatment is not done on time, then it can result in the mortality of the victim. Mortality related to crush syndrome varies depending on the patient and local factors.
How is crush injury treatment done?
First things first, one should know the scene and the patient, and scene safety. Specialised personnel with appropriate PPE and other safety gear enter the scene. The victims must be taken out from the scene safely. Finally, make a patient warm with warm fluids and heating blankets to prevent hypothermia.
Medical personnel must assess hypovolemic shock, acute renal failure, and metabolic abnormalities like acidosis and hyperkalemia.
The next step is pain management to comfort the patient and reduce anxiety. Short-duration medicine can be used to reassess and monitor the patient frequently.
As per the medical sector, Isotonic fluids are used to replace the loss of extracellular fluid and help extra diuresis potassium and avoid acute renal failure. Likewise, Mannitol, Sodium bicarbonate, and Calcium gluconate can be used as well.
What about Australian Resuscitation Guidelines for crush injury management?
As per Australian Resuscitation Guidelines, you must follow the given steps.
- Ensure the scene is safe, and there is no risk of injury to the rescuer. You can use DRSABCD (Danger, Response, Send, Airway, Breathing, CPR, Defibrillation) for safety.
- Call an ambulance.
- Remove all the crushing forces as soon as possible.
- Ensure to evacuate all victims exposed to crush injury safely.
[Initially, the blood pressure and pulse of people removed from the collapse site are often normal. But a shock can occur as soon as blood from the ruptured vessels starts to fill the wounded area. And when more blood leaves the circulatory system, the blood pressure drops, while the presence of too much blood causes the affected area to become painful, swollen, and stiffened. So, you must make sure to get all the people who might have faced the accident-causing crush injury.]
- Keep the victim warm, and immediately treat any bleeding (ARC Guideline 9.1.1)
- Continuously monitor the victim’s condition. Follow Australian Resuscitation Council if the victim becomes unresponsive and is not breathing normally.
- Avoid using a tourniquet if you want to provide first aid management for crush injury victims.
Note that even if any victim is alert and not distressed, there is a risk of deterioration; thus, the specialised personnel must work for the reassessment of the victim’s condition.
How can crush injuries be prevented?
- Provide your workers with training on how to operate machinery safely and the risks involved with operating it improperly.
- Ensure that everyone using equipment knows how to use it safely. Workers should use a safe method of work that could prevent crush injury.
- Check and maintain your equipment regularly.
- Ensure that clothing is not flapping and cannot become entangled in a machine’s moving parts. Also, hair should be tied back.
- Follow traffic rules to prevent road accidents. Make sure your vehicles are serviced regularly.
- Always wear the safety gear given by the company.
Which first aid training course to study to help crushed injured victims?
If you are interested in learning more about crush injuries or helping the victims with our first aid treatment, then you must have certified training in First aid. For this, you can pursue HLTAID011, Provide first aid and
HLTAID011 Provide first aid
Here, the students will learn the skills and knowledge required to provide a first aid response to a casualty in line with first aid guidelines determined by the Australian Resuscitation Council (ARC) and other national clinical bodies.
HLTFA403C – Manage first aid in the workplace
HLTFA403C focuses on establishing and maintaining facilities to provide appropriate first aid in the workplace. Skills and knowledge garnered after completing HLTFA403C can address specific industry, enterprise or workplace requirements and specific risks and hazards and associated injuries.
HLTAID012 Provide First Aid in an education and care setting
HLTAID012 Provide First Aid in an education and care setting course is targeted to provide a first aid response to infants and children. Early childhood workers and educators working with school-age children during school hours or outside school and vacation programs can pursue this course.
Why choose Bright College for First Aid training courses in Australia?
Bright College is a leading college for first-aid courses in Australia. We offer
- HLTAID009 Provide cardiopulmonary resuscitation
- HLTAID011 Provide First Aid
- HLTAID012 Provide First Aid in an education and care setting
We have special offers for deserving students. So, contact us to enrol in first-aid courses at Bright College.