Crush injury

Following massive crush injury, myoglobin released from damaged muscle fibers colors the urine dark red. Myoglobin can be detected in plasma following a myocardial infarction, but assay of serum enzymes (see Chapter 7) provides a more sensitive index of myocardial injury. 

Crush injuries Extensive surgery Head trauma Multiple trauma Miscellaneous... 

Crush injuries and those greater than 1 cm in depth are at risk for tetanus. A tetanus and diptheria toxoid booster (Td) should be administered to any patient who has not received... 

When the extent of the trauma to the vessel is increased, the degree of vascular constriction is increased. Accordingly, a sharply cut blood vessel bleeds far more profusely than a blood vessel damaged by a more crushing injury. The vasoconstriction may last for many minutes or hours, thus... 

Hirakawa, H., Okajima, S., Nagaoka, T., Takamatsu, T. and Oyamada, M. Loss and recovery of the blood-nerve barrier in the rat sciatic nerve after crush injury are associated with expression of intercellular junctional proteins. Exp. Cell Res. 284 196-210,2003. 

Crush injury and myoglobinuria Patients recovering from renal allografts Gout... 

In two experimental models of ischaemia, it has been shown that HU-211 significantly increases cell survival. It was seen that after forebrain ischaemia produced by 20 min of carotid occlusion, the number of viable neurons in the hippocampal CA1 region of HU-211-treated rats was significantly higher than in controls. The same effect was seen in gerbils after 10 min of bilateral carotid occlusion on treatment with HU-211 [197, 198]. A related effect has been noted after rat optic nerve crush injury. Administration of HU-211 improved recovery of the nerve, with the visual evoked response amplitude increasing significantly [199],... 

Immediate Care Shock, airway problems, chest injury, crush injury, amputation, open fracture Class I (emergent) Red Critical life threatening—compromised airway, shock, hemorrhage... 

Burns (flash, partial, and full thickness). Crush injuries. 

Deaths and injuries from earthquakes vary according to the type of housing available, time of day of occurrence, and population density. Common injuries include cuts, broken bones, crush injuries, and dehydration from being trapped in rubble. Stress reactions are also common. Morbidity and mortality can occur during the actual quake, the delayed collapse of unsound structures, or cleanup activity. Disruption of the earth may release pathogens that when inhaled can lead to increased reports of infectious disease (see Case Study 17.3). 

Foodborne botulism accounts for approximately 1,000 cases per year worldwide, of which approximately 30 occur in the United States. Home processed foods account for 94% of U.S. cases. Infantile botulism, a form of the disease in which C. botulinum spores are ingested by infants due to food contamination, occurs in approximately 60 children per year in the United States, more than half of which are in California. Wound botulism, typically involving intravenous drug users who either inject drugs intravenously or in the subcutaneous tissue (a practice known as skin-popping ), is reported one to three times per year in the United States. It can also occur in other types of contaminated wounds such as a severe crush injury or other areas of contaminated avascular tissue. Botulism due to intestinal colonization by C. botulinum is extremely rare only seven cases have been reported in the literature (CDC, 1998). 

Opdc nerve crush injury models have been studied in mice and rats by Schw artz and others (Schw artz, 2004). Experiments... 

Since the work of Sibley and Fleisher (S22) made it plain that elevation of serum aldolase activity occurred quite characteristically in other diseases besides myopathy, such as in hemolytic anemia and in acute hepatitis, it would be most useful to know that in muscular dystrophy the increased serum aldolase was indeed derived from the diseased muscle. Direct demonstration of this origin has been provided (D14) by showing that in 5 of 10 patients with muscular dystrophy the femoral venous return had a higher serum aldolase activity than the femoral arterial supply to the diseased muscles of the lower limb. Further strong support is given by the discovery that serum contains two aldolases (S8) with different substrate requirements (H5) whereby colorimetric methods have been devised for the separate assay of each (S5). These are 1,6-diphosphofructoaldolase ( muscle aldolase) and 1-phosphofruc-toaldolase ( liver aldolase). The ratio in mammalian tissues of muscle to liver aldolase activity is 40 in skeletal and cardiac muscle, 12-25 in spleen, lung, and red cells, and only unity in liver and kidney (S6, S7). The serum activities of both are equally elevated in hepatitis, but in muscular dystrophy and in muscle crush injury only that of muscle aldolase is raised (S4, S6) indeed, the ratio of serum activity of muscle to liver aldolase has been reported as about unity in healthy individuals and in patients with virus hepatitis, but as about 26 in a series of 14... 

Li JY, Pfister KK, Brady ST, Dahlstrom A (2000) Cytoplasmic dynein conversion at a crush injury in rat peripheral axons. J Neurosci Res 61 151-161. 

Rhabdomyolysis is the breakdown of muscle fibers, the result of skeletal muscle injury, which leads to the release of potentially toxic intracellular contents into the plasma. The causes are diverse muscle trauma from vigorous exercise, electrolyte imbalance, extensive thermal burns, crush injuries, infections, various toxins and drugs, and a host of other factors. 

Wound botulism, a relatively rare form of the disease, results from the production of toxin by organisms that multiply in a contaminated wound. Wounds associated with botulism may not appear obviously infected (38). Before 1980, wound botulism was most likely associated with complicated wounds, such as extensive crush injuries, compound fractures and other wounds associated with avascular areas. Since 1980, most cases have occurred in illicit drug users, including intravenous drug users with contaminated needle puncture sites or drug users with nasal and sinus wounds secondary to chronic cocaine sniffing (38). In 2001, there were 23 reported cases of wound botulism in the United States, with one death (39). 

Skeletal muscles also contribute enzymes to blood. Again, the cause may be poor perfusion, hypotliermia, or direct trauma to the muscles (crush injuries). Infection, inflammation (polymyositis), degenerative changes (dystrophies), drugs, and alcohol (alcoholic myopathy) wid cause enzyme leakage from myocytes. Enzyme release from muscles and other tissues also occurs as a result of anesthesia. 

In acute rhabdomyolysis due to crush injuries, with severe muscle destruction, serum CK activities exceeding 200 times the upper reference Umit may be found. Serum CK can also be increased by other direct trauma to muscle, including intramuscular injections and surgical interventions. Finally, a number of drugs at pharmacological doses can increase serum CK activities. 

Wound botuhsm is relatively rare, accounting for only 5% of all outbreaks. The majority of these are caused by serotype A, and the remainder by serotype B (Shapiro et al., 1998). The neurological symptoms of wound botulism differ httle from those of foodbome botulism except for the general absence of G1 symptoms. Historically, this form of botulism was so uncommon that it was not even recognized until the last half of the twentieth century. From its discovery in 1943 until 1990, only 47 incidences of wound botulism were documented (Weber et al., 1993). An examination of these cases indicated that wounds susceptible to C. botulinum are generally deep with avascular areas but need not appear obviously infected or necrotic. Additional risk factors include compound fractures and extensive crush injuries (Mershon and Dowell, 1973). Contamination of wounds with... 

Rhabdomyolysis—The breakdown of muscle tissue and release of myoglobin and intracellular electrolytes into the circulation due to a variety of causes such as crush injuries, drug-induced immobilization, and status epilepticus. It often leads to acute renal failure. 

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