Crush syndrome--delayed diagnosis due to a lack of apparent injury mechanism--a case report.

Changgeng yi xue za zhi / Changgeng ji nian yi yuan = Chang Gung medical journal / Chang Gung Memorial Hospital

PubMedID: 8069745

Chen JC, Bullard MJ, Liaw SJ. Crush syndrome--delayed diagnosis due to a lack of apparent injury mechanism--a case report. Changgeng Yi Xue Za Zhi. 1994;17(2):184-90.
A 38-year-old male presented to the emergent department complaining of bilateral leg numbness and weakness after waking from a sleep. Finding himself on the floor, he attributed this problem to falling out of bed. His subsequent course was complicated by progressive leg swelling, shock, profound hemoconcentration and renal failure. He received large volume of crystalloid and fasciotomy in the emergent department and then admitted. He ultimately recovered well. Crush syndrome without obvious compressive trauma or substance induced sleep is highly unusual. Early recognition is important because a delay of more than 6 hours in giving adequate volume support will lead to renal failure. Ischemic muscle times of greater than eight hours inevitably lead to residual disability. It remains imperative therefore, to recognize the presence of a compartment syndrome secondary to fluid sequestration early, either clinically or using compartment pressures. A fasciotomy within this eight hour window may still lead to complete recovery.