A crushing injury, also known as a crush injury, is a form of physical trauma where all or part of the body is subjected to crushing pressures. These injuries can be complicated to treat, and there are a number of risks to consider when evaluating patients and planning out a treatment plan. Such injuries are especially closely associated with earthquakes, where people can be buried under piles of heavy rubble, sometimes for days, and may develop significant medical problems as a result.
A cascading series of reactions can happen with a crushing injury. The tissue being crushed experiences ischemia, a lack of oxygen caused by an obstructed blood supply. Areas below the crush site can also become ischemic, as blood may not be able to move through the site of the injury. Crushing also creates shearing and tearing forces, shredding muscles, bone, and anything else in the way. This can make the treatment of wounds very complicated, and may necessitate extensive surgical repairs.
Heavy bruising is common in a crushing injury, and the patient can also develop a phenomenon known as compartment syndrome, where obstructed vessels inside a compartment of the body cause pressure to rise. This leads to cell death, as cells can only endure so much pressure before they rupture as the pressure seeks an outlet. The legs are an especially common site for compartment syndrome. It usually causes acute pain for the patient and may require a procedure like a fasciotomy for immediate relief.
Another concern with a crushing injury is a problem known as reperfusion injury. When people see a person trapped under something or between objects, the first reaction is often to lift or move the objects to relieve pressure and allow the person to escape. This can actually be quite dangerous, as the flood of blood to ischemic areas sometimes results in tissue damage and cell death. In some cases, the damage may be so severe that amputation is needed. Carefully evaluating a patient in situ before evacuating the patient for treatment is important to reduce the risks of a reperfusion injury.
Medically, treatment of a crushing injury can require the services of a surgeon, as well as specialists concerned with organ damage sometimes associated with such injuries. The care team has to work carefully to prevent further damage while treating the patient, staying especially alert to concerns like blood clots, reperfusion injuries, and compartment syndrome.
