What is a Crush Injury?
A crush injury occurs when an intense amount of pressure is put on the body or a specific part of the body, such as the head, foot, leg, hand or arm. It can happen as a result of a car accident, natural disaster, work-place injury, or another incident involving significant impact.
It is an acute traumatic ischemia characterized by an insufficient amount of blood supply, and therefore, oxygen, to organs and tissues throughout the body. It is a serious condition and survivors of such ordeals can suffer detrimental side effects. One is crush syndrome.
Symptoms of a Crush Injury
When you’ve suffered from a crush injury, typical symptoms include bruising and swelling, bone fractures, numbness in the affected area, concussions or head trauma, and open wounds. If these symptoms are not immediately addressed, you run the risk of having long-term effects. They can include infection from untreated open wounds, nerve and tissue damage, as well as the development of compartment syndrome—a dangerous condition resulting from excessive pressure building up in muscle tissue.
What is Crush Syndrome?
The U.S. Centers for Disease Control and Prevention (CDC) describes crush syndrome as a “localized crush injury with systemic manifestations. These systemic effects are caused by a traumatic rhabdomyolysis (muscle breakdown) and the release of potentially toxic muscle cell components and electrolytes,” including potassium, phosphorous, creatinine and myoglobin, “into the circulatory system.”
In other words:
Crush syndrome is a serious complication of crush injury, in which the compression of muscles sends damaging toxins into the body’s bloodstream. Typically, shock or kidney failure follows.
Aside from shock and/or renal failure, crush syndrome may also cause metabolic issues, as the CDC points out. These include:
• Hyponatremia - low amount of sodium or high amount of water in the blood
• Hypocalcemia - low amount of calcium in the blood
• Hyperkalemia - high amount of potassium in the blood
• Acidosis - high amount of acid in the body
Such problems put those affected at risk of even more health complications, including hypertension, irregular heartbeat, and/or cardiac arrest.
Research indicates many crush injury survivors develop crush syndrome.
In fact, an August 2018 report addressing “crush-related acute knee injury” states that "Crush syndrome develops in 30 to 50 percent of cases of traumatic rhabdomyolysis and is frequently seen after catastrophic earthquakes”—one of the aforementioned common causes of crush injuries. “According to some estimates, the incidence of crush syndrome ranges between 2 and 5 percent of all injured victims of catastrophic earthquakes,” it continues.
Another report published in 2010 and shared by the U.S. National Library of Science assessed the number of soldiers who developed crush syndrome as a result of combat-related crush injuries. Most don’t survive these, and half of those who do suffer from crush syndrome, it found, reiterating the prevalence of the condition.
"...seeking medical attention immediately after a crush injury is extremely important to ensure the proper treatment."
A 2017 study also shared by the U.S. National Library of Science examined the presence of crush syndrome specifically in those who survived the 2003 Bam earthquake in Iran. Titled “Trends of Serum Electrolyte Changes in Crush syndrome patients of Bam Earthquake; a Cross sectional Study,” it reveals that among the 118 patients evaluated, 52.5% showed signs of hyponatremia, 100% showed signs of hypocalcemia and 90.5% showed signs of hyperphosphatemia on the first day of being admitted for medical attention.
“Evaluation of 10-day trend shows a slow decreasing pattern of these imbalances as after 10 days, 43.9% still remain hyponatremic, 92.3% hypocalcemic, and 66.7% hypophosphatemic,” states the study.
However, although crush syndrome is commonly associated with natural disasters and combat-related injuries, the condition can affect people in other ways.
Car accidents and work-related injuries also have the potential to cause crush injury, and thus, crush syndrome. In fact, work-related hospitalized injuries in British Columbia between 1991-2009 were assessed in an article published by peer-reviewed medical journal BMJ. Crushing injuries, as well as fractures, dislocations, burns and other trauma, were considered acute injuries in which the patient spent at least one night in the hospital, as a result. Construction workers tend to be more at risk than those in other industries.
Treating Crush Injury & Crush Syndrome with HBOT
Rest and elevation are always recommended to those who suffer a crush injury. But if you're looking for a non-invasive, crush injury treatment that could help you heal as quickly as possible, you may want to consider hyperbaric oxygen therapy (HBOT). In fact, this could be useful not just for people who are recovering from a crush injury, but for people who experienced other traumatic events in which blood supply to tissues has been compromised. When there is less blood reaching the tissues, there is less oxygen available, which can lead to tissue death or even an amputation. HBOT immediately reverses low oxygen levels, regenerating and revitalizing tissue.
Hyperbaric oxygen therapy could help to reduce or even eliminate these symptoms experienced by a crush injury. Furthermore, hyperbaric oxygen therapy is FDA approved for the treatment of crush injuries, meaning that the treatment is covered by insurance.
How HBOT Works
Oxygen is an essential part of life, as it allows our bodies to produce energy and function properly. Without it, we wouldn’t be able to survive. Hyperbaric oxygen therapy, commonly referred to as HBOT, is a holistic therapy that utilizes the power of oxygen to help promote a person’s recovery from an array of injuries and illnesses, including crush injuries.
HBOT is performed in a controlled environment with a trained medical professional overseeing the entire session from start to finish. The patient stays inside a hyperbaric chamber and breathes pure oxygen at increased pressure. Raising the amount of oxygen in the bloodstream promotes recuperation and improves a wide range of conditions.
Some benefits of receiving HBOT to treat a crush injury could include:
- Reducing inflammation
- Healing damaged tissue
- Preventing the need to amputate digits and limbs
- Strengthening the body’s ability to fight infection
- Reducing the size of a wound
- Creating new blood vessels
- Increasing the release of stem cells
- Avoiding the need to undergo painful surgeries (i.e., fasciotomies)
Like any other treatment, you must first meet with a medical professional in order to determine if it's right for you. Once you receive a proper evaluation, your doctor can determine what treatment plan would be most advantageous for your condition.
Seeking medical attention immediately
Seeking medical attention after a crush injury is extremely important. Remember, it is essential to reverse tissue ischemia as soon as possible to avoid permanent damage. However, the re-perfusion (restoration of blood flow) may result in a severe local and systemic inflammatory response that may create more destruction than the original injury. All of the physiological processes that characterize re-perfusion, including white blood cell adhesion, platelet adhesion, and leaky blood vessels, are reversible with Hyperbaric Oxygen.
Hyperbaric oxygen therapy (HBOT) is an FDA-approved treatment for crush injury and other acute traumatic ischemias. It can reduce any swelling or excess fluid in the affected area, fight infections by strengthening the immune system via pure oxygen, and thus, increase blood vessel growth and blood flow, as well as promote healing in the damaged or ischemic body tissue.
Hyperbaric Medical Solutions is dedicated to providing our patients a personally developed and comprehensive care plan that incorporates HBOT to help each one heal and feel better sooner.
Written by Alan Katz, MD, FUHM, FACEP, FAAEM
Dr. Alan Katz, National Medical Director of Hyperbaric Medical Solutions (HMS), is double board certified in Emergency Medicine and Hyperbaric Medicine. He directs clinical operations, as well as education and research initiatives for HMS, particularly in exploring the use of hyperbaric oxygen therapy....Read More