Emergency Management for Crush Injuries and Fractures

Overview of Crush Injuries

Crush injuries happen when an individual is caught between two opposing forces such as

Applying Ice for Injured knee

Applying Ice for Injured knee

getting run over by a fast moving car, getting compressed by heavy machinery/equipment, getting crushed in-between two vehicles and getting crushed under a collapsed ceiling or rubble of a fallen building. These types of injuries are very life-threatening since it compresses vital organs which preventing them from efficiently doing essential life supporting processes. Moreover, people with crushing injuries to the chest are at an even greater risk because injuries in the chest can severely interfere with breathing and circulation.

Assessment and Initial Findings

An individual with crushing injuries are monitored and observed for the following signs and symptoms:

  1. Hypovolemic shock resulting from leaking of blood and plasma into injured tissues immediately after compression has been released.
  2. Erythema and blistering of the skin.
  3. Paralysis of the crushed body part.
  4. Damaged body part (usually an extremity) appearing to be swollen, rigid and/or tender.
  5. Renal dysfunction (if with prolonged hypotension can cause gradual damage to the kidneys ).

Management  of crush injuries

In conjunction with properly maintaining the airway, breathing and circulation, the victim is normally monitored for acute renal insufficiency. Injuries at the back and flank area can cause severe kidney damage. If an extremity is injured, it is usually elevated to help relieve swelling and edema. To restore neurovascular function, the trauma physician may perform a palliative surgical intervention known as fasciotomy to help relieve pressure of the compressed nerve of the affected extremity. Medications for pain  and anxiety are then ordered and administered while the victim is on route to the operating room for further surgical management such as wound debridement  and/or open reduction of fractures.

Fractures

Immediate appropriate management of a fracture may greatly determine the individual’s prognosis/final outcome and may mean the difference between a fast recovery and permanent disability. When a victim is assessed for fractures, the affected body part is handled gently and as carefully as possible. Clothing is cut off in order to properly visualize the affected body part. Assessment is usually conducted focusing on pain, swelling, bone protrusion and  circulatory disturbance. Emergency personnel attending to the individual must always remain vigilant and must always suspect that a person coming in the ED may also have multiple fractures accompanied by the head, chest, spine or abdominal injuries.

Management  

Immediate attention is given to the victim’s general condition. As gruesome a fracture may appear, it will always come second in terms of urgency when airway, breathing and circulation is severely compromised. Immediately following the initial assessment, with all injuries identified, documented and treated, attention is now focused to the fracture noting for swelling, and noticeable deformity as well as checking for peripheral pulses.

Splinting is the simplest and most effective way to stabilize a fracture. Splinting immobilizes the joint, relieves pain and improves circulation. Ideally a splint should extend well beyond the joints adjacent to the fracture. If the fracture is open, a moist sterile dressing is applied.

After splinting, the vascular condition of the affected extremity must be assessed including color, temperature, pulse and blanching of the nail bed. In addition, the individual is evaluated for neurovascular compromise if pain pressure is evident. Moreover, compound fractures affecting long bones are normally treated surgically unlike closed fractures which can be  managed in a much more conservative manner.

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