title: Management of crush syndrome casualties after disasters.
abstract: After direct impact of the trauma, crush syndrome is the second most frequent cause of death after mass disasters. However, since crush syndrome is quite rare in daily practice, mistakes are frequent in the treatment of these cases. This paper summarizes the etiopathogenesis of traumatic rhabdomyolysis and of crush syndrome-based acute kidney injury. The clinical and laboratory features, prophylaxis, and treatment of crush cases are described as well. The importance of early and energetic fluid resuscitation is underlined for prophylaxis of acute kidney injury. Since there is chaos, and an overwhelming number of victims, logistic drawbacks create a specific problem in the treatment of crush victims after mass disasters. Potential solutions for logistic hurdles and disaster preparedness scenarios have also been provided in this review article.
authors.affiliation: Local co-ordinator for the Renal Disaster Relief Task Force of the International Society of Nephrology (ISN); Department of Internal Medicine/Nephrology, Istanbul School of Medicine, Istanbul, Turkey, and.
authors.forename: Mehmet Sukru
authors.initials: MS
authors.lastname: Sever
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
keywords: Crush syndrome; kidney; rhabdomyolysis; trauma
references.citation: N Engl J Med. 2004 May 27;350(22):2247-56
references.pmid: 15163774
references.citation: N Engl J Med. 1989 May 11;320(19):1291-2
references.pmid: 2710215
references.citation: Kidney Int. 1996 Feb;49(2):314-26
references.pmid: 8821813
references.citation: J Am Soc Nephrol. 2004 Jul;15(7):1862-7
references.pmid: 15213274
references.citation: Acta Clin Belg. 2007;62 Suppl 2:375-9
references.pmid: 18284003
references.citation: Kidney Int. 2001 Feb;59(2):783-91
references.pmid: 11168962
references.citation: Nephrol Dial Transplant. 2002 Nov;17(11):1942-9
references.pmid: 12401851
references.citation: Kidney Int. 2002 Dec;62(6):2264-71
references.pmid: 12427155
references.citation: N Engl J Med. 1991 Mar 21;324(12):815-21
references.pmid: 1997854
references.citation: Ren Fail. 1997 Sep;19(5):633-45
references.pmid: 9380882
references.citation: Arch Intern Med. 1984 Feb;144(2):277-80
references.pmid: 6696564
references.citation: J Am Soc Nephrol. 1998 Feb;9(2):322-32
references.pmid: 9527411
references.citation: Int J Epidemiol. 1993 Dec;22(6):1070-6
references.pmid: 8144288
references.citation: J Am Soc Nephrol. 2000 Aug;11(8):1553-1561
references.pmid: 10906171
references.citation: J Am Coll Surg. 1998 Jun;186(6):693-716
references.pmid: 9632160
references.citation: J Trauma. 1987 Oct;27(10):1130-5
references.pmid: 3312621
references.citation: N Engl J Med. 2006 Mar 9;354(10):1052-63
references.pmid: 16525142
references.citation: J Trauma. 1997 Sep;43(3):427-32
references.pmid: 9314303
references.citation: Science. 2000 Apr 28;288(5466):661-5
references.pmid: 10784447
references.citation: J Bone Joint Surg Am. 1976 Jan;58(1):112-5
references.pmid: 1249096
references.citation: Int J Epidemiol. 1985 Mar;14(1):113-7
references.pmid: 3988425
references.citation: Ren Fail. 1997 Sep;19(5):665-71
references.pmid: 9380885
references.citation: J Trauma. 1997 Apr;42(4):641-6
references.pmid: 9137251
references.citation: Injury. 1990 Jan;21(1):5-8; discussion 15-6
references.pmid: 2347634
references.citation: Mil Med. 1999 May;164(5):366-9
references.pmid: 10332179
references.citation: J Trauma. 2002 Jan;52(1):33-9
references.pmid: 11791049
references.citation: Clin Nephrol. 2003 May;59(5):326-33
references.pmid: 12779093
references.citation: N Engl J Med. 1979 May 24;300(21):1169-72
references.pmid: 431646
references.citation: Kidney Int. 1997 Oct;52(4):886-94
references.pmid: 9328926
references.citation: N Engl J Med. 1990 Mar 22;322(12):825-9
references.pmid: 2407958
references.citation: Disasters. 1996 Sep;20(3):231-47
references.pmid: 8854459
references.citation: Kidney Int. 2003 Mar;63(3):1155-7
references.pmid: 12631101
references.citation: Nephron. 1990;55(2):97-103
references.pmid: 2194135
references.citation: Kidney Int. 1993 Sep;44(3):479-83
references.pmid: 8231019
references.citation: J Trauma. 1997 Mar;42(3):470-5; discussion 475-6
references.pmid: 9095115
references.citation: Lancet. 1990 Jun 9;335(8702):1388-90
references.pmid: 1971672
references.citation: Kidney Int. 2001 Sep;60(3):1114-23
references.pmid: 11532107
references.citation: Am J Med Sci. 1995 Apr;309(4):219-22
references.pmid: 7900744
references.citation: Nephrol Dial Transplant. 2009 Jun;24(6):1730-5
references.pmid: 19258385
references.citation: J Trauma. 2004 Jun;56(6):1191-6
references.pmid: 15211124
references.citation: Am J Med. 2002 Aug 15;113(3):260
references.pmid: 12208396