Pre-hospital and in-hospital integrated treatment for severe crush injuries of extremities:experience in 49 cases
WANG Jian-bai
GAO Jin-mou
HU Ping
YANG Jun
LIN Xi
HUANG Guang-bin
HE Ping
AI Tao
XIANG Jiang-xia
DU Ding-yuan
Abstract：Objective To evaluate the therapeutic methods and effect of pre-hospital and in-hospital inte-grated treatment for severe crush injuries of extremities . Methods The clinical data of 49 patients with severe crush injuries of extremities from May 2008 to Jul.2015 in Chongqing Emergency Medical Center was retrospectively studied.There were 44 males and 5 females,with age ranging from 19 to 82 years (average,43.7 years).There were 5 cases of earthquake injury ,20 cases of traffic accident injury ,17 cases of mining accident injury ,and 7 cases injured by other causes .Injured sites of crushes were as follows: shoulder and upper limbs in 8 cases ( 16.3%) , pelvic and lower limbs in 41 cases(83.7%).Thirty-two cases(65.3%) were associated with fractures and disloca-tion of pelvis and joints,and 44 cases were associated with multiple injuries (89.8%).Results Pre-hospital time was 35min-49h.Venous pathway was established and infusion was applied in 19 cases during on-the-scene rescue and tourniquet was applied in 31 cases (63.3%).Decompressive fasciotomy was performed in 1 case and amputa-tion was performed in 1 case during on-the-scene rescue .Electrocardiogram monitoring was performed in all cases after decompression.In-hospital therapeutic measures included vacuum sealing drainage (VSD) in 14 cases after debridement and 17 cases with decompressive fasciotomy . The effective rate of VSD was 96.8%( 30/31 ) and no case was amputated in this group .The incidence rate of crush syndrome (CS) was 57.1%(28/49),of which 11 cases (22.4%) were combined with hyperkalemia ,and 8 cases with renal failure.Eight cases were treated with ventilator assisted therapy and 8 cases were treated with continuous renal replacement therapy ( CRRT ) . At the end,31 cases(63.3%) were cured,13 cases(26.5%) were improved,and 5 cases(10.2%) were uncured,which included 3 cases ( 6.1%) of amputation and 1 death case ( 2.0%) died from failed cardiopulmonary resuscitation due to hyperkalemia .Conclusion Tourniquet and electrocardiogram monitoring should be emphasized in pre-hos-pital treatment of severe crush injuries of extremities .Application of VSD in in-hospital treatment can reduce the in-cidence rate of amputation of severe crush injuries of extremities .
Keywords：extremity injurycrush injuriesintegrated treatmentamputation
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 393-396 )