Crush syndrome

IV Diseases where high potassium levels may be encountered hyperkalemia renal failure and conditions in which potassium retention is present oliguria or azotemia anuria crush syndrome severe hemolytic reactions adrenocortical insufficiency (untreated Addison disease) adynamica episodica hereditaria acute dehydration heat cramps hyperkalemia from any cause early postoperative oliguria except during Gl drainage. 

Blachar Y, Fong JS, de Chadarevian JP, Drummond KN (1981) Muscle extract infusion in rabbits. A new experimental model of the crush syndrome. Circ Res 49 114-124... 

Donmez, O., Meral, A., Yavuz, M., Durmaz, O. (2001). Crush syndrome of children in the Marmara Earthquake, Turkey. Pediatrics International, 43, 678-682. 

B4. Barranco, C., Sul comportamento della transaminasi glutammico-ossalacetica del siero di sangue nella crush syndrome. Arch. Sci. Med. 107, 383 (1959). 

Hyperkalemia is an infrequent problem associated with the massive transfusion of old blood. Potassium intoxication threatens only patients with raised potassium concentrations before transfusion, for example in the crush syndrome, renal insufficiency, and extensive bums. 

Odeh M. The role of reperfusion-induced injury in the pathogenesis of the crush syndrome. N Engl J Med 1991 324 1417-1422. 

Oda, Y. 1997. Crush syndrome sustained in the 1995 Kobe, Japan earthquake treatment and outcome. Ann. Emerg. Med., 30, 507-512. 

Intussusception Crush syndrome Epinephrine administration Ergot poisoning General Cardiac arrest... 

This occurs when large areas of muscle tissue are damaged b> crushing accidents. There is severe shock with acute renal failure and uraemia. Myoglobin is found in the urine in crush syndrome. 

Overflow proteinuria. This occurs as a result of an accumulation of particular proteins in the blood, e.g. Bence-Jones protein in myeloma or myoglobin in crush syndrome (qv). 

Crush injuries from collapsing buildings are common in terrorist bombings. Clinically, they do not differ from crush due to other causes, except in the nature of the associated injuries. Conventional treatment protocols should be followed. Crush injury to tissues, usually of the limbs, may require fasciotomy and debridement. Crush syndrome is managed with copious intravenous fluids and renal replacement therapy if required. Huid balance should be carefully monitored and fluid therapy may need reduction in the presence of active uncontrolled haemorrhage. Electrolyte imbalance must be monitored and corrected. 

Association of Pain, neuropathic pain is defined as pain initiated or caused by a primary lesion, dysfunction in the nervous system". Neuropathy can be divided broadly into peripheral and central neuropathic pain, depending on whether the primary lesion or dysfunction is situated in the peripheral or central nervous system. In the periphery, neuropathic pain can result from disease or inflammatory states that affect peripheral nerves (e.g. diabetes mellitus, herpes zoster, HIV) or alternatively due to neuroma formation (amputation, nerve transection), nerve compression (e.g. tumours, entrapment) or other injuries (e.g. nerve crush, trauma). Central pain syndromes, on the other hand, result from alterations in different regions of the brain or the spinal cord. Examples include tumour or trauma affecting particular CNS structures (e.g. brainstem and thalamus) or spinal cord injury. Both the symptoms and origins of neuropathic pain are extremely diverse. Due to this variability, neuropathic pain syndromes are often difficult to treat. Some of the clinical symptoms associated with this condition include spontaneous pain, tactile allodynia (touch-evoked pain), hyperalgesia (enhanced responses to a painful stimulus) and sensory deficits. 

The major clinical applications of cyproheptadine are in the treatment of the smooth muscle manifestations of carcinoid tumor and in cold-induced urticaria. The usual dosage in adults is 12-16 mg/d in three or four divided doses. It is of some value in serotonin syndrome, but because it is available only in tablet form, cyproheptadine must be crushed and administered by stomach tube in unconscious patients. 

Heroin can be snorted, smoked, and given intravenously. Complications of heroin use include overdoses, anaphylactic reactions to impurities, nephrotic syndrome, septicemia, endocarditis, and acqnired immunodeficiency. Oxycodone, a controUed-release dosage form, is sometimes crushed by abusers to get the full 12-hour effect almost immediately. Snorting or injecting the crushed tablet can lead to overdose and death. 

Indications for renal replacement therapy in the acute setting and for other disease processes are different from those for ESRD. A common mode of ESRD therapy in the outpatient setting is intermittent hemodialysis (IHD) where a patient receives intense treatment over the course of a few hours several times a week. Acute renal failure in the inpatient setting is often treated with continuous renal replacement therapy (CRRT), which is applied for the entire duration of the patient s clinical need and relies upon hemofiltration to a higher degree than IHD (Meyer, 2000). Other nonrenal indications for CRRT are based on the theoretical removal of inflammatory mediators or toxins and elimination of excess fluid (Schetz, 1999). These illnesses include sepsis and systemic inflammatory response syndrome, acute respiratory distress syndrome, congestive heart failure with volume overload, tumor lysis syndrome, crush injury, and genetic metabolic disturbances (Schetz, 1999). 

An intramuscular injection with a licensed pharmaceutical preparation that contains hydrocortisone sodium succinate would constitute a major treatment option. However, the child s parents do not want to give an injection to their child. Klaartje drinks very reluctantly as all babies with the Trader Willi syndrome. The parents don t consider administration with the feeding of the contents of a capsule or of crushed tablets as a reliable option. Therefore, the doctor has suggested a rectal preparation. 

Abuse liability is the potential for a drug to produce positive effects that will reinforce a pattern of misuse, abuse, or diversion. To date, there is no evidence that the naltrexone component of combined morphine/ naltrexone will prevent or deter abuse. Novel abuse liability trials have been developed to assess the effects of combined morphine/naltrexone when tampered with. The pharmacodynamic effect of naltrexone in the setting of crushed morphine/naltrexone capsules was examined in two clinical trials an oral and an intravenous abuse liability trial [8]. These were conducted in nondependent recreational opioid abusers, as dependent, daily or habitual users would probably experience a withdrawal syndrome when exposed to the naltrexone component with crushed morphine/ naltrexone capsules. 

Hypotension. Diarrhea. Dizziness. Liver failure. Lupus erythematosus-like syndrome. Nausea and vomiting. Heart block. Agranulocytosis. Procainamide increases risk of death in patients with non-life-threatening arrhythmias. Use with caution in patients with liver or kidney dysfunction. Tell patient not to crush or break extended-release tablets. 

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