This event, defined as Crush syndrome or death of liberation; can cause the survivors of the earthquake debris to die in a very short time.
About 20% of deaths after major earthquakes occur immediately after rescue. Death that develops immediately after the patient is taken out of the debris or rescued after earthquakes is called salvation death (crush syndrome).
This painting, also called rescue death; was first attracted by Santangelo and his friends after the northern Italy earthquake 30 years ago. Later similar pictures were encountered in the 1988 armenia and the 1999 Marmara earthquake.
Causes of Crush Syndrome
- An interesting (and sad) point that can be observed early in the immediate period after earthquakes in which a large number of cases of rhabdomyolysis have occurred: The patient is fine as long as he is under the rubble, but immediately after rescue (excavation from the debris) compartment syndrome, hypovolemic shock and hemoconcentration develops. Even the patient may die (death of salvation). The main reason for the goodness under the wreckage is the buffering effect of the rubble on the muscles and preventing the toxic substances (protons, potassium, cytokines) from entering the circulation. With the removal of pressure, both plasma fluid rapidly infiltrates into the damaged muscles, leading to hypovolemia and shock; as well as reperfusion injury develops. For this reason, it is important to start the treatment of disaster victims when they are under the rubble.
- Interestingly, survivors are somewhat protected from the systemic and haemodynamic effects of rhabdomyolysis while under the rubble. However, after the rescue, when the limbs are decompressed (unexpectedly by the rescue teams); the shock picture occurs and patients can be lost quickly (death of salvation), (santangelo, 1982; noji, 1992). Therefore, it is very important to start treatment while patients are still under the rubble.
The application of a tourniquet before the survivor is removed in order to prevent the death of salvation is a subject of much debate; North American school supports this practice; European school opposes tourniquet application, foreseeing that it could increase the risk of amputation.
- A critical picture that draws attention during the earthquakes in italy and armenia is the rapid deterioration of some patients who looked good while under the rubble or immediately after recovery; This picture, which is named as salvation death, is probably caused by severe metabolic acidosis during trauma and hyperkalaemia aggravated by this acidosis.
The importance of starting treatment while the patient is under debris
According to the assumptions, debris or household items pressing on the limb while the patient was still under the rubble blocked circulation in the muscle and prevented systemic complications of rhabdomyolysis; However, after the patient is rescued; the transfer of metabolites in the muscle to the bloodstream can lead to death (Santangelo, 1982; better, 1990; noji, 1992).
According to these explanations, rescue teams should be aware; that disaster victims can get worse in a very short time after they are removed from under the wreckage; if possible, treatment should be started under the rubble and should monitor these patients very closely in the first hours. Once the patient is rescued, infusions of sodium bicarbonate, calcium chloride or calcium gluconate, insulin, and glucose may be required immediately to control the effects of hyperkalaemia (noji, 1992).