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Crush injuries

AGE  Not significant factorsGENDER  More common in males
LIFESTYLE  Risk factors depend on the causeGENETICS  Not significant factors

Crush injuries are injuries to any part of the body caused by compression, most frequently as a result of a road traffic accident.

Crush injuries
© DK
Skin bruising may be the only visible sign of a crush injury. This bruise is due to a seat belt pressing across the chest.

Crush injuries are most often caused by road traffic accidents, which account for nearly 3,500 deaths in the UK each year. Accidents that occur in the construction industry and explosions can also cause crush injuries to any part of the body. This type of injury may range in severity from simple bruising to life-threatening damage to internal organs and tissues. Men are at greater risk of sustaining crush injuries because they are more likely to work in the construction industry and engage in high-risk activities.

What are the types?

Most damage sustained by crushing is internal, and often the only obvious external evidence is bruising. Fractures are common, especially to the limbs, and, if the chest is crushed, one or more ribs are likely to be broken and may puncture the lungs. Multiple rib fractures may result in a flail chest, in which breathing may become sufficiently impaired to cause respiratory failure and shock. Crush injuries may lead to a pneumothorax, in which air is trapped between the two-layered membrane covering the lungs. Damage to the heart can also occur.

If the abdomen has been crushed, the intestines, liver, spleen, or kidneys may be damaged. The contents of a ruptured intestine may leak out into the abdominal cavity and cause an infection (see Peritonitis). If the spleen or the liver is ruptured, massive internal bleeding may occur.

In addition to specific injuries, more general complications may develop. For example, if a large proportion of the body's tissues is compressed, chemicals released from the damaged tissue may impair kidney function (see Kidney failure), which may be fatal.

What might be done?

Call an ambulance immediately. Anyone with a suspected crush injury should be freed as soon as possible. Find a trained first-aider to administer emergency first aid. Once the person reaches hospital, treatment depends on the injuries sustained. General measures include emergency resuscitation and giving oxygen and intravenous fluids. Painkillers are given as needed. If bleeding is excessive, a blood transfusion may be necessary.

After emergency measures have been carried out, internal damage is assessed using imaging techniques, such as chest X-rays, CT scanning, and MRI. Treatment is then directed at specific injuries. For example, fractures are treated by resetting the broken bones in their correct position and immobilizing the affected part if needed (see Fracture treatments). If limbs have been crushed, surgery may be done to repair blood vessels and nerves (see Microsurgery). Amputation may be necessary if limb damage is irreparable. A person with severe or multiple rib fractures may need mechanical ventilation to aid breathing (see Intensive care unit).

If internal bleeding into the abdominal cavity is suspected, a procedure called peritoneal lavage may be carried out, in which a small tube is inserted into the abdominal cavity, and sterile fluid is introduced into the abdomen. This fluid is then withdrawn, and, if it contains blood, surgery is performed to look for and repair the source of bleeding (see Endoscopic surgery).

Antibiotics are prescribed to treat peritonitis and other infections. Additional complications, such as kidney failure, are treated as they arise.

The outlook depends on the type of crush injury, the length of time that the person was crushed, and the speed with which treatment was initiated.

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