ABSTRACT
Rescuing patients after structural collapse can be alien to emergency nurses but their ability to adapt should stand them well to provide good patient care in these unusual circumstances. Generally, they are held back until patients are released from the collapsed structures or specific requests for analgesia, anaesthesia or aggressive fluid resuscitation are made.
Subject(s)
Emergency Nursing/methods , Rescue Work/methods , Crush Syndrome/complications , Crush Syndrome/nursing , Emergency Medical Services/organization & administration , Emergency Treatment/nursing , Humans , Hyperkalemia/etiology , Hyperkalemia/nursing , Pain/etiology , Pain/nursing , Rescue Work/organization & administration , Rhabdomyolysis/etiology , Rhabdomyolysis/nursingABSTRACT
Patients with broken bones or crush injuries are at risk for life-threatening complications--acute compartment syndrome, rhabdomyolysis, and fat embolism syndrome. Do you know how to recognize these complications quickly and respond?
Subject(s)
Crush Syndrome/complications , Crush Syndrome/nursing , Fractures, Bone/complications , Fractures, Bone/nursing , Multiple Trauma/complications , Multiple Trauma/nursing , Compartment Syndromes/etiology , Compartment Syndromes/prevention & control , Embolism, Fat/etiology , Embolism, Fat/prevention & control , Humans , Nursing Assessment/methods , Orthopedic Nursing/methods , Rhabdomyolysis/etiology , Rhabdomyolysis/prevention & control , Risk FactorsABSTRACT
Crush injuries result from prolonged entrapment or immobilization. The resultant complications can be devastating and fatal. There is significant tissue injury and muscle necrosis that may lead to one or more complications including compartment syndrome, rhabdomyolysis, renal failure, and coagulopathies. Using a case study format, this article discusses the chain of events surrounding crush injuries and the nursing management issues important for minimizing further complications for critically ill patients.
Subject(s)
Critical Care/methods , Crush Syndrome/nursing , Multiple Trauma/nursing , Accidents, Traffic , Crush Syndrome/etiology , Crush Syndrome/physiopathology , Female , Humans , Middle Aged , Multiple Trauma/etiology , Multiple Trauma/physiopathology , Nursing Assessment/methods , Orthopedic Nursing/methodsABSTRACT
In Part I of this paper, "Intensive care of the Crush victim" (1) Gayle Burr presented the mechanism of crush injury and the pathophysiology underlying the clinical manifestations of the crush syndrome, its assessment and management. Part II outlines the case study of John who was trapped for 10-12 hours following a motor vehicle accident. A chronological overview of the events in this case will be described. The medical management and nursing implications of each of his presenting complications will be discussed.
Subject(s)
Accidents, Traffic , Critical Care/methods , Crush Syndrome/nursing , Adult , Crush Syndrome/physiopathology , Crush Syndrome/therapy , Hemofiltration , Humans , Male , Patient Care PlanningABSTRACT
The victims of disasters, accidents and many forms of trauma are often trapped or wedged under and within rubble which can lead to crush injury. Prolonged immobility can also cause crush injury if the weight of a person's body compresses muscle and soft tissue for an extended period of time. Extensive muscular tissue pathology can result from the crush injury itself and once the pressure, or compressive force, is removed a predictable sequence of events can cause widespread haemodynamic and metabolic disturbances--the crush syndrome. Part one includes the mechanism of crush injury and the pathophysiology underlying the clinical manifestations of the crush syndrome. The aims of assessment and management are discussed as well as a brief review of the literature related to management of the local crush site and the potential problem of compartment syndrome. Part two involves a case study of a person who was trapped for 10-12 hours following a motor vehicle accident. This patient was transported to 2 country centres and then transferred to a major teaching hospital in Sydney. Discussions will centre on the classic nature of the case, and the findings and management strategies will be correlated with the literature. The implications for nursing practice are explored and include the need for astute assessment and monitoring based on a thorough understanding of the sequelae of crush. Interventions are aimed at minimising discomfort and reducing complications both at the local crush site and generalised systemic level. Close monitoring and interpretation of the patient's response to interventions is essential for the continuation of definitive care.
Subject(s)
Critical Care/methods , Crush Syndrome/physiopathology , Crush Syndrome/nursing , Crush Syndrome/therapy , Hemodynamics , Humans , Nursing Assessment , Water-Electrolyte BalanceABSTRACT
Crush syndrome is characterized by a predictable sequence of events that include hypovolemia, compartment syndrome, rhabdomyolysis and acute tubular necrosis (ATN). Cardiac dysrhythmias are common. Pathophysiology, current management, and a plan of nursing care for patients with crush syndrome are presented.
Subject(s)
Crush Syndrome/physiopathology , Shock, Traumatic/physiopathology , Crush Syndrome/nursing , Crush Syndrome/therapy , Education, Nursing, Continuing , Humans , Patient Care PlanningSubject(s)
Crush Syndrome/nursing , Shock, Traumatic/nursing , Acute Kidney Injury/nursing , Acute Kidney Injury/prevention & control , Adult , Crush Syndrome/physiopathology , Disseminated Intravascular Coagulation/nursing , Disseminated Intravascular Coagulation/prevention & control , Female , Humans , Respiratory Distress Syndrome/nursing , Respiratory Distress Syndrome/prevention & control , Spouse AbuseABSTRACT
Permanent disability following musculoskeletal injury can often be prevented with prompt recognition and appropriate temporary or definitive management. This article has highlighted some specific injuries and guidelines for emergency treatment.
