CRUSH INJURY

any of the effects of compression of the body, as caused by collapsing buildings, mine disasters, earthquakes, and cave-ins. Victims with severe injuries to the chest and abdomen usually die before help can be obtained. Injuries to the extremities may not appear immediately serious; however, latent symptoms frequently arise. When the skin and bones become compressed sufficiently, liquid fat may seep out of the fat cells and bone marrow. The fat droplets collect into globules, forming embolisms that block the capillaries and blood vessels leading to the lungs, brain, skin, and kidneys. Persons freed from the site of collapse usually have a normal pulse and blood pressure at first. As soon as the injured part of the body begins to swell with blood from the ruptured vessels, shock occurs. The blood pressure usually begins to fall as more blood is lost from the main circulatory system. The damaged part becomes tender, swollen, and hardened by the presence of excessive blood. Kidney failure a day or two after the accident can cause death or delay recovery. The effects of fat emboli usually do not become evident for several days after the initial injury. Breathing may become laboured and shallow if the lungs are affected. If blood vessels to the brain are blocked by emboli, there may be restlessness, anxiety, convulsions, or unconsciousness. Often if emboli occur there are traces of fat excreted in the urine, and the skin shows fine brownish hemorrhages.