Do not pull the victim out immediately; instead, gradually free the part of the body that is buried to avoid shock, keep the victim conscious, and protect them from contaminated water.
This article is professionally consulted by Dr. Le Nhat Duy, University Medical Center Ho Chi Minh City – Facility 3.
Rhabdomyolysis syndrome (crush syndrome) occurs when muscle cells are severely damaged and release toxins into the bloodstream, especially after the body is compressed for a long time due to disasters such as floods or landslides.
This is a serious medical emergency, often seen in victims who have been trapped for an extended period or have sustained severe injuries.
Mechanism of Rhabdomyolysis Syndrome
Muscle Damage: When the body or a part of a limb is compressed by a heavy object, the muscles suffer from a lack of oxygen and blood supply. This leads to necrosis and damage to muscle cells.
Release of Myoglobin and Toxins: When muscle cells die, they release myoglobin, potassium, phosphate, and creatine kinase (CK) enzymes into the bloodstream. Myoglobin is a protein that can obstruct the renal tubules, leading to acute kidney failure.
– Biochemical consequences:
- Myoglobin: causes kidney obstruction, leading to acute kidney failure.
- Potassium: can cause arrhythmias or cardiac arrest if levels in the blood are too high.
- Phosphate: may cause electrolyte imbalances and metabolic acidosis.
- Lactate: increases acidity in the blood, resulting in metabolic acidosis.
Symptoms of Rhabdomyolysis Syndrome
Symptoms of rhabdomyolysis typically present after a few hours or days following entrapment and include:
- Muscle pain and swelling: particularly in the area that was compressed.
- Dark urine: urine appearing dark red or brown due to the presence of myoglobin.
- Fatigue and muscle weakness: the body feels weak, and movement is difficult.
- Decreased urine output: which may lead to acute kidney failure.
- Systemic symptoms: fever, nausea, vomiting, headaches, and confusion.
Ambulance transporting a patient suffering from “crush syndrome” to Phu Tho General Hospital. (Photo: Provided by the hospital)
First Aid Principles
First aid for victims at risk of rhabdomyolysis should focus on preventing kidney failure and protecting cardiovascular health. Specific steps include:
– Field Stage:
- Do not pull the victim out immediately if they have been trapped for a long time to avoid a sudden release of toxins into the bloodstream.
- Provide fluid replacement immediately: if possible, administer intravenous fluids with saline to prevent dehydration and help the kidneys flush out myoglobin.
- Stabilize the victim:
- Ensure the airway is clear and breathing is stable.
- Check circulatory status; if needed, perform chest compressions.
- Gradually relieve pressure: if possible, slowly free the buried part of the body. Avoid sudden release of all pressure to prevent shock or a sudden spike in potassium levels.
Keep the victim conscious: minimize loss of consciousness by talking and comforting them.
Protect the victim from environmental factors such as cold, heat, or exposure to contaminated floodwaters.
– Hospital Emergency Stage:
- Administer intravenous fluids: use saline or alkalizing solutions such as bicarbonate to help the kidneys eliminate myoglobin and correct metabolic acidosis.
- Monitor serum potassium levels: potassium levels can rise suddenly, leading to arrhythmias or cardiac arrest. Calcium gluconate or insulin combined with glucose can be used to lower potassium levels.
- Dialysis: if the kidneys are unable to function effectively due to acute kidney failure, dialysis may be necessary to remove harmful substances.
- Pain management and treatment of other complications: provide pain relief, address other injuries, and monitor vital signs.
Preventing Rhabdomyolysis Syndrome in Disasters
To minimize the risk of rhabdomyolysis in disaster situations, preventive measures are necessary:
- Community Education: raise awareness about the risks of landslides, floods, and basic safety steps.
- Establish Early Warning Systems: to allow residents to evacuate from dangerous areas in time.
- Strengthen Disaster Response Capacity: ensure rescue teams are trained in first aid and how to handle trapped victims.
- Prepare Medical Equipment: ensure first aid supplies, intravenous fluids, and emergency support equipment are always ready.
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