Care Instructions for Mild Crush Injury
For mild crush injuries, thoroughly irrigate the wound with a large volume of warm or room temperature potable water with or without soap until there is no foreign matter in the wound, then cover with an antibiotic ointment or cream and a clean occlusive dressing to promote healing and reduce infection risk. 1
Initial Assessment and Management
- Assess for signs of compartment syndrome using the "6 Ps": pain, paresthesia, paresis, pain with stretch, pink color, and pulselessness 2
- Remove any tight-fitting dressings and avoid limb elevation if compartment syndrome is suspected 2
- Apply cold therapy (crushed or cubed ice with water) to reduce pain, swelling, and edema, limiting application to 20-minute intervals 2
- Place a barrier, such as a thin towel, between the cold container and the skin to prevent tissue ischemia 1
Wound Care
- Thoroughly irrigate superficial wounds and abrasions with a large volume of warm or room temperature potable water until there is no foreign matter in the wound 1
- Cover the wound with an antibiotic ointment or cream and a clean occlusive dressing to improve healing and reduce infection risk 1
- Leave blisters intact and loosely cover them with a sterile dressing to improve healing and reduce pain 1
Fluid Management
- For mild crush injuries without systemic symptoms, oral hydration is usually sufficient 1
- For more significant crush injuries, intravenous fluid resuscitation may be necessary, with an initial rate of 1000 ml/h of 0.9% saline to be tapered by at least 50% after 2 hours 1, 2
- Avoid potassium-containing balanced salt fluids such as Lactated Ringer's solution, as potassium levels may increase markedly even with intact renal function 1, 2
- Avoid starch-based fluids as they are associated with increased rates of acute kidney injury and bleeding 1, 2
Monitoring
- Monitor for signs of crush syndrome, which can develop even with seemingly mild injuries 3
- Watch for dark urine (indicating myoglobinuria), decreased urine output, and signs of kidney dysfunction 1
- Be alert for signs of infection: increasing pain, redness, warmth, swelling, or purulent drainage 1
When to Seek Medical Attention
- Burns with blistering or broken skin 1
- Difficulty breathing 1
- Injuries to the face, neck, hands, or genitals 1
- Injuries covering a large surface area 1
- Signs of compartment syndrome: severe pain, especially with passive stretching of the muscles, paresthesia, pallor, or pulselessness 2
- Dark urine or decreased urine output 1
- Signs of infection: increasing pain, redness, warmth, swelling, or purulent drainage 1
Special Considerations
- Conservative local treatment of crush injury generally has better outcomes than operative treatment 4
- Fasciotomy should be avoided unless there is clear evidence of compartment syndrome 4
- Topical haemostatic agents can be used in combination with other measures for venous or moderate arterial bleeding associated with parenchymal injuries 1
- Hyperbaric oxygen therapy may enhance wound healing in patients with crush injuries, but evidence is limited 1
Prevention of Complications
- Early and adequate fluid resuscitation is key to preventing crush syndrome and acute kidney injury in more severe crush injuries 1, 2
- Monitoring electrolytes, acid-base status, and kidney function can help detect early signs of complications 1
- Failure to recognize crush injury early can miss the narrow time window when intensive fluid resuscitation may prevent acute kidney injury 2