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Paramedic’s Corner: Crush syndrome can kill trapped victims after rescue
Paramedic’s Corner: Crush syndrome can kill trapped victims after rescue

Ambulance Director Gary Carmack
As the death toll in Haiti climbs to maybe 200,000 or more, many people wonder why so many die after being rescued. This article will attempt to explain the syndrome to the readers. The reason many of the people die hours, days, or even weeks after being rescued is called “crush syndrome.”

Crush syndrome is due to injuries related to having been crushed under collapsed structure. Crush syndrome is usually seen in times of warfare, but can also be from earthquakes, structure collapse, trench rescue, industrial accidents, motor vehicle crashes, or other prolonged inactivity such as a drug overdose or a stroke patient who has been lying on a leg or arm for an extended period of time.

The problem is that patients who have survived entrapment for days may die shortly after rescue if not treated appropriately and aggressively pre-release. These patients may also die days to weeks later if not treated on scene. However, patients survive if treated early and aggressively while still in the rubble.

The reason is because of complex metabolic issues. When muscles are compressed for several hours, the muscle cells begin to die and release their content called lactic acid into the bloodstream, plus some other electrolytes such as potassium and certain muscle enzymes. When the person is pulled out of the rubble without appropriate treatment, all of this is released into the bloodstream. This can kill the patient by causing shock, renal failure, and other metabolic calamities. One of these is hyperkalemia, which is elevated potassium. If potassium is rapidly released into the bloodstream the patient can have cardiac dysrhythmias and suddenly die. All of this is quite complex and I want the readers to know I am taking short cuts for brevity.

Appropriate management to prevent these deaths requires well-educated rescuers. A number of steps must be taken before releasing the compression force. The problem, as the readers might readily discern, when undisciplined and untrained rescuers see someone trapped, what is their first impulse? It would be for any of us, if untrained —get it off them, right? But that could be the patient’s death sentence.

Here is what must be done: Oxygen, high-flow oxygen must be administered, IVs of 0.9 percent saline must be infused, plus just prior to release a medication called sodium bicarbonate. The EKG must be monitored and a breathing treatment of albuterol is given. Albuterol is a medication that will help the potassium enter the cells rather than float around in the bloodstream causing toxicity. Then other medications, such as calcium, may be necessary. Insulin and dextrose may be needed to help stabilize the intracellular movement of the potassium. This is complex treatment and my intent is for the readers to know that when people are rescued ... they aren’t always rescued.

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