Crush Injury
Crush injury is an injury that results in the crushing of certain body parts (such as bones, muscles, or even internal organs) due to being crushed or under great pressure from heavy objects. Injuries can be lacerations, closed and open fractures (parts of the bone protrude through the skin), traumatic amputations (parts of the body are cut off), and bruises (due to muscle damage). In severe cases, medical treatment needs to be done immediately, within minutes to hours. Because, if it is too late, it can cause complications and even death.
Symptoms of Crush Injury
The symptoms of this injury depend on which part of the body the injury is located. Generally, symptoms can include:
- Severe pain in the injured area.
- Bruises caused by muscle damage.
- Open wound.
- Numbness in the injured body part or the body part below the injury.
- Decreased consciousness, ranging from drowsiness to unconsciousness.
- Bleeding.
- Fractures can be open or closed.
Causes of Crush Injury
Crush Injury is caused by:
- Motor vehicle accidents, usually at high speed, such as motorbikes, cars, trains, and planes.
- Natural disasters, such as earthquakes, tsunamis, and landslides.
- Work accidents, for example, fingers or toes being caught in machines or heavy equipment while working or falling from a height by construction workers.
- Explosions, such as people being hit by a bomb or exploding gas.
- Body parts are crushed by heavy objects, especially the feet and toes.
Crush Injury Risk Factors
Groups of people at high risk of experiencing crush injuries include construction workers, workers who operate heavy machinery, and motor vehicle drivers.
Crush Injury Diagnosis
In every person who experiences trauma, the doctor must always check for life-threatening emergencies. After ensuring that the emergency has been resolved or ensuring that there are no life-threatening emergencies, the doctor will ask clearly about the history of the trauma experienced, then perform a physical examination of all parts of the body and the site of injury, and then determine supporting examinations for further diagnosis and treatment.
If there is an open wound or bleeding, blood laboratory tests should be done immediately. Urine tests can help in patients with suspected crush syndrome. Then, imaging tests, such as X-rays, CT scans, or MRIs are performed as needed at the location of the injured body. Usually as a guide for surgery.
Crush Injury Complications
Some complications that often occur due to crush injuries include:
- Crush Syndrome, a clinical condition caused by severe muscle damage that causes the muscles to release large amounts of myoglobin. The release of myoglobin into the blood causes shock, kidney failure, and blackish-yellow urine. This condition occurs due to crush injury to the muscles, most often the thighs and calves.
- Compartment Syndrome, occurs due to pressure in a space limited by fascia (muscle wrapping membrane) and high bones due to severe muscle swelling, so that it presses on the surrounding blood vessels and nerves and eventually does not get enough blood supply which causes damage and death of muscles and nerves. This syndrome is characterized by increasingly severe pain, swelling that gets bigger until the skin is tense, numbness in the area of swelling to the bottom. Usually, the areas that are often affected are the lower legs, lower arms, thighs, and gluteal area (buttocks).
- Hypovolemic Shock occurs due to injury resulting in severe bleeding and late treatment. A large blood loss can cause the blood volume in the blood circulation to decrease, the heart lacks oxygen supply and eventually the heart contractions will weaken resulting in very low blood pressure or even impalpable. This can be life-threatening. Cases like this usually occur due to crush injury which causes torn blood vessels or blood vessel rupture and traumatic amputation of the hands or feet.
- Acute Renal Failure occurs due to kidney poisoning by myoglobin due to severe muscle damage or severe bleeding. Usually, this occurs due to crush syndrome, late treatment of crush injury to the muscle or open wound with severe bleeding.
Crush Injury Treatment
The initial treatment for all trauma sufferers, including crush injury, is to determine whether or not there is a life-threatening emergency condition. Four initial steps are taken:
- First, the airway, the doctor will make sure the airway is smooth as seen from the sufferer being able to talk, not snoring. If snoring means there is a blockage in the airway that can threaten his life.
- Second, breathing, the doctor will ensure that the sufferer is breathing by looking at the chest wall and abdomen which are moving normally, do not look tight, or the movement of the chest wall is unbalanced due to several broken ribs.
- Third, blood circulation, the doctor will ensure that the pulse is normal, not weak, and if there is bleeding, stop the bleeding, then install an intravenous line or infusion.
- Fourth, neurological (nerve) evaluation, the doctor will conduct an examination covering the patient’s level of consciousness and certain nerve functions, such as the presence or absence of paralysis.
After ensuring that there is no emergency or critical condition has been handled, a complete physical examination will be performed, then specific treatment is carried out based on the location of the injury, for example, temporary splinting for closed fractures. Most cases of crush injury require surgery, such as pinning for multiple fractures, debridement (cleaning the wound and removing dead tissue) for large and dirty lacerations, and amputation in cases of traumatic amputation (body parts cut off due to trauma).
If compartment syndrome is found due to a crush injury, a fasciotomy is performed, which is a surgical procedure that involves cutting the membrane covering the muscle (fascia) so that tension or pressure on the nerves and blood vessels is reduced, so that the tissue below the injury site gets sufficient oxygen supply.
Before or after surgery, several types of drugs will be given, namely strong painkillers, to relieve pain due to injury and antibiotics, to prevent bacterial infections, especially in open wounds. All of these drugs are usually given intravenously or by injection.
Crush Injury Prevention
Preventive efforts to prevent someone from getting a crush injury include minimizing the risk of trauma, such as:
- Always pay attention to safety when driving and working
- Wear personal protective equipment when working and driving
- Avoid using alcohol before driving and operating machinery.
When to See a Doctor?
It is better to see a doctor immediately after experiencing trauma as mentioned above. Because, the injury may only look like a bruise, but there may be muscle, nerve, or bone damage. To do the examination, you can immediately make an appointment with a doctor.