title: Crush syndrome: a case report and review of the literature.
abstract: BACKGROUND
  Crush trauma to the extremities, even if not involving vital organs, can be life threatening. Crush syndrome, the systemic manifestation of the breakdown of muscle cells with release of contents into the circulation, leads to metabolic derangement and acute kidney injury. Although common in disaster scenarios, emergency physicians also see the syndrome in patients after motor-vehicle collisions and patients "found down" due to intoxication.
  
  
  OBJECTIVE
  The objectives of this review are to discuss the pathophysiology of crush syndrome, report on prehospital and emergency department treatment, and discuss the relationship between crush syndrome and compartment syndrome.
  
  
  CONCLUSIONS
  We present the case of a young man found down after an episode of intoxication, with compartment syndrome of his lower extremity and crush syndrome. Although he eventually required an amputation, aggressive fluid resuscitation prevented further kidney injury and metabolic derangement.
  
  
  CONCLUSIONS
  Early, aggressive resuscitation in the prehospital setting, before extrication if possible, is recommended to reduce the complications of crush syndrome. Providers must be aware of the risk of hyperkalemia shortly after extrication. Ongoing resuscitation with i.v. fluids is the mainstay of treatment. Compartment syndrome is a common complication, and prompt fasciotomies should be performed when compartment syndrome is present.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Alissa
authors.initials: A
authors.lastname: Genthon
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Wilcox
mesh_terms: D058186:Acute Kidney Injury / Q000517:prevention & control*; D000435:Alcoholic Intoxication / Q000150:complications; D000671:Amputation, Surgical; D003161:Compartment Syndromes / Q000150:complications; D003444:Crush Syndrome / Q000150:complications*; D005440:Fluid Therapy; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008659:Metabolic Diseases / Q000517:prevention & control*; D012151:Resuscitation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: crush syndrome; hyperkalemia; renal failure; resuscitation; rhabdomyolysis