Crush syndrome

ABSTRACT Objective: To describe the clinical features of crush syndrome, the inter‐relationship between rhabdomyolysis, compartment syndrome and crush syndrome, and to make recommendations on the pre‐hospital and emergency department management of the condition. Clinical features: Three case reports are described of patients presenting with crush syndrome following drug induced coma, including one patient in cardiac arrest. Raised compartment pressures were confirmed by manometry, and extensive rhabdomyolysis by myoglobinuria and raised creatine kinase. Intervention and outcome: Vigorous medical management was undertaken including infusion of large volumes of intravenous fluid, and therapy with bicarbonate; mannitol, frusemide and dopamine. Surgical fasciotomy was not performed and a good outcome resulted in each case. Conclusion: Drug induced coma is now the commonest cause of the crush syndrome. Effective medical management may obviate the need for surgical fasciotomy in cases with raised compartment pressures.