JOCS

The aim of the Comprehensive Surgery is to publish original research articles of the highest scientific and clinical value at the international level in all surgical fields. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

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Index
Review
Crush syndrome: a review of current knowledge and treatment strategies
Crush syndrome is a severe systemic manifestation resulting from the breakdown of muscle cells leading to the release of toxic substances into the bloodstream. This condition can occur when a part of the body experiences a significant amount of pressure for an extended period. Crush syndrome presents with severe metabolic disruptions such as acute kidney injury, electrolyte disturbances, and cardiovascular collapse. It is essential to understand the pathophysiology and clinical features of crush syndrome for effective management and prevention of potentially devastating outcomes. The act of crushing and rupturing muscular cells generates a mechanical force that triggers the discharge of myoglobin. Subsequently, myoglobin undergoes a conversion into metmyoglobin and acid hematin, which are subsequently released into the systemic circulation. The muscular tissue harbors a variety of electrolytes and enzymes, which may attain toxic levels upon entry into the circulation in excessive quantities. The release of sodium, calcium, and fluids due to regional ischemia leads to increased muscle volume and tension, depletion of creatine kinase (CK) and ATP, and muscle vasodilation, further exacerbating hypotension. Crush syndrome can also lead to cardiovascular instability and renal failure due to vasomotor and nephrotoxic factors. Elevations in serum CK levels exceeding 1000 IU/l, along with accompanying clinical features, are widely recognized as indicative of crush syndrome. Diagnostic investigations commonly involve assessing serum levels of aldolase, myoglobin, and myoglobin degradation products. Progressive increases in serum levels of lactic acid, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) are observed, while levels of serum urea and creatinine exhibit a steep rise, particularly following prolonged compression, and serve as valuable predictors of renal failure. The treatment of crush syndrome requires a multidisciplinary approach that addresses the metabolic, cardiovascular, and renal complications associated with this condition. The mainstay of treatment includes early release of the affected limb or compartment, fluid resuscitation, correction of electrolyte abnormalities, and alkalinization of urine. Additionally, renal replacement therapy and hyperbaric oxygen therapy may be beneficial in managing acute kidney injury and tissue hypoxia, respectively. Crush syndrome, albeit infrequent, represents a potentially fatal medical condition that demands a thorough comprehension of its underlying pathophysiology, clinical manifestations, and treatment modalities. Early recognition and appropriate management of this condition can significantly r,educe morbidity and mortality associated with crush syndrome.


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Volume 1, Issue 1, 2023
Page : 7-10
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