Traumatic Rhabdomyolyisis / Crush Syndrome

Crush syndrome and traumatic rhabdomyolysis result from prolonged muscle compression, leading to severe ischemia and systemic toxicity upon reperfusion. The release of intracellular components like potassium and myoglobin poses life-threatening risks, most notably acute kidney injury caused by myoglobin-induced tubular obstruction and systemic electrolyte imbalances. Effective management requires aggressive early fluid resuscitation—ideally initiated during extrication—to maintain high urine output and prevent renal failure. Alkalinization of urine helps dissolve myoglobin casts, while mannitol serves as an osmotic diuretic and free radical scavenger. Clinicians must avoid succinylcholine in these patients due to the high risk of hyperkalemia-induced cardiac arrhythmias. Furthermore, while compartment syndrome is a frequent complication, delayed fasciotomy in mass casualty settings may increase morbidity, necessitating careful clinical judgment regarding the timing of surgical intervention.