1. Crush Syndrome Sustained in the 1995 Kobe, Japan, Earthquake; Treatment and Outcome
- Author
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Oda, Yutaka, Shindoh, Mitsuo, Yukioka, Hidekazu, Nishi, Shinichi, Fujumori, Mitsugu, and Asada, Akira
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Earthquakes -- Analysis ,Creatine -- Analysis ,Myoglobin -- Analysis ,Creatine kinase -- Analysis ,Cardiac patients -- Analysis ,Health - Abstract
Byline: Yutaka Oda, Mitsuo Shindoh, Hidekazu Yukioka, Shinichi Nishi, Mitsugu Fujumori, Akira Asada Abstract: Study objective: To assess the treatment and outcome of patients with crush syndrome sustained in an earthquake disaster. Methods: We conducted a retrospective analysis of eight patients with crush syndrome and subsequent acute kidney failure who were treated in the ICU of a university hospital. All eight patients had been extricated from buildings that collapsed in the 1995 Kobe, Japan, earthquake. Crush injury involved the upper extremities in one patient and the lower extremities in seven. Each patient received intravenous fluid infusion and diuretic drugs and underwent hemodialysis. Emergency fasciotomy was performed in some patients, 17 to 100 hours after extrication. Results: All patients were conscious and lucid on admission, and blood pressure and heart rate were normal. All the patients demonstrated kidney failure with increased concentrations of serum creatinine (1.9 to 9.6 mg/dL [169 to 852 [mu]mol/L]). Six patients were oliguric. Hyperkalemia (5.6 to 8.8 mEq/L) was present in six patients. We found close correlations between the serum potassium and creatine kinase concentrations, between the serum myoglobin and potassium concentrations, and between the serum myoglobin and creatine kinase concentrations. All the patients were weaned from hemodialysis. The serum creatinine concentration decreased to a normal level within 20 to 52 days of admission in all patients. No patients underwent amputation. Muscle weakness and sensory deficits persisted in all patients 6 months after the earthquake. Conclusion: Our findings support current therapeutic strategies for crush syndrome, despite the long delay to initiation of intensive therapy. All the patients recovered kidney function and were weaned from hemodialysis; none required amputation. [Oda Y, Shindoh M, Yukioka H, Nishi S, Fujimori M, Asada A: Crush syndrome sustained in the 1995 Kobe, Japan, earthquake: Treatment and outcome. Ann Emerg Med October 1997;30:507-512.] Article History: Received 28 September 1995; Revised 6 May 1996; Revised 3 December 1996; Revised 4 April 1997; Accepted 22 April 1997 Article Note: (footnote) [star] From the Department of Anesthesiology and Intensive Care Medicine,* the Division of Critical Care Medicine,a and the Intensive Care Unit,As. Osaka City University Medical School, Osaka, Japan., [star][star] Reprint no.47/1/84404 , a Address for reprints: Yutaka Oda, MD, Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, 1-5-7, Asahimachi, Abeno-ku, Osaka 545, Japan
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- 1997