Intensive care of the crush victim. Part 1.

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.