Crush syndrome

Crush syndrome (also traumatic rhabdomyolysis or Bywaters' syndrome) is a serious medical condition characterized by major shock and renal failure after a crushing injury of skeletal muscle. Cases occur commonly in catastrophes such as earthquakes, such that victims have been trapped under fallen masonry.

Pathophysiology

The syndrome was discovered by British physician Eric Bywaters in patients during the 1941 London Blitz.Bywaters EG, Beall D. Crush injuries with impairment of renal function. Br Med J 1941;1:427-32 It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products – notably myoglobin, potassium and phosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions).

The specific action on the kidneys is not understood completely, but may be due partly to nephrotoxic metabolites of myoglobin.

• Seigo Minami, a Japanese physician, first reported the crush syndrome during 1923. Morton's medical bibliography -An annotated check-list of texts illustrating History of medicine (Garrison-Morton). Aldershot: Solar......
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