Crush syndrome--delayed diagnosis due to a lack of apparent injury mechanism--a case report.
A 38-year-old male presented to the emergent department complaining of bilateral leg numbness and weakness after waking from a sleep. Finding himself on the floor, he attributed this problem to falling out of bed. His subsequent course was complicated by progressive leg swelling, shock, profound hemoconcentration and renal failure. He received large volume of crystalloid and fasciotomy in the emergent department and then admitted. He ultimately recovered well. Crush syndrome without obvious compressive trauma or substance induced sleep is highly unusual. Early recognition is important because a delay of more than 6 hours in giving adequate volume support will lead to renal failure. Ischemic muscle times of greater than eight hours inevitably lead to residual disability. It remains imperative therefore, to recognize the presence of a compartment syndrome secondary to fluid sequestration early, either clinically or using compartment pressures. A fasciotomy within this eight hour window may still lead to complete recovery.
Chen
J C
JC
Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Bullard
M J
MJ
Liaw
S J
SJ
D000328:Adult; D003161:Compartment Syndromes / Q000209:etiology; D003444:Crush Syndrome / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D013997:Time Factors