Introduction: Many of those who survive following an earthquake die in the next phase due to preventable and treatable medical conditions such as hyperkalemia. The present study aimed to evaluate the trend of potassium changes in CRUSH SYNDROME patients of Bam earthquake. Methods: In this retrospective cross-sectional study, using the database of Bam earthquake victims, which were developed by Iranian Society of Nephrology following Bam earthquake, Iran, 2003, the 20-day trend of potassium changes in > 15 years old CRUSH SYNDROME patients was evaluated. Results:135 CRUSH SYNDROME patients with the mean age of 29.9 § 9.91 years were evaluated (56.3% male). Mean potassium concentration during the first 3 days of admission was 5.6 § 1.3 mEq/L. On the day of admission, 43.1% (95% CI: 34.0 - 52.2) had normal potassium concentration, 3.4% (95% CI: 0.1 - 6.8) had hypokalemia, and 53.4% (44.3 - 62.6) had hyperkalemia. During 20-day follow-up, 62.3% (95% CI: 66.7-71.9) of the patients had normal potassium. While, 11.5% (95% CI: 9.7-13.3) had hypokalemia and 19.2% (95% CI: 17.0-21.5) had hyperkalemia. As the days of hospitalization increased, prevalence of hyperkalemia decreased while hypokalemia increased. On the 17th day 21.2% (95% CI: 2.2-39.9) had hypokalemia and 10.5% (95% CI: 0.1 -24.7) had hyperkalemia. Conclusion: Findings of the present study showed that following urine alkalinization and fluid resuscitation, the prevalence of hyperkalemia reduced, but hypokalemia developed. It seems that the correction of serum potassium level should be accompanied by precise monitoring of intake and output of the patient and prescription of reasonable amount of intravenous fluid.

Introduction: Electrolyte imbalances are very common among CRUSHed earthquake victims but there is not enough data regarding their trend of changes. The present study was designed to evaluate the trend of changes in sodium, calcium, and phosphorus ions among CRUSH SYNDROME patients. Methods: In this retrospective cross-sectional study, using the database of Bam earthquake victims, which was developed by Iranian Society of Nephrology following Bam earthquake, Iran, 2003, the 10-day trend of sodium, calcium, and phosphorus ions changes in > 15 years old CRUSH SYNDROME patients was evaluated. Results: 118 patients with the mean age of 25.6 ± 6.9 yearswere studied (57.3 male). On the first day of admission, 52.5% (95% CI: 42.7 - 62.3) of the patients had hyponatremia, which reached 43.9% (95% CI: 28.5 - 59.3) on day 10. 100.0% of patients were hypocalcemic on admission and serum calcium level did not change dramatically during the 10 days of hospitalization. The prevalence of hyperphosphatemia on the first day was 90.5% (95% CI: 81.5 - 99.5) and on the 10th day of hospitalization 66.7% (95% CI: 48.5 - 84.8) of the patients were still affected. Conclusion: The results of the present study shows the 52.5%prevalence of hyponatremia, 100% hypocalcemia, and 90.5% hyperphosphatemia among CRUSH SYNDROME patients of Bam earthquake victims on the first day of admission. Evaluation of 10-day trend shows a slow decreasing pattern of these imbalances as after 10 days, 43.9% still remain hyponatremic, 92.3% hypocalcemic, and 66.7% hypophosphatemic.

In the natural disasters such as earthquake, based on severity of trauma, time under the rubble and quality/quantity of hydratation we will confront with a spectrum of traumatic rhabdomyolysis. In present study we evaluate victims of Bam earthquake to show different stage of muscle trauma, from minor trauma with almost normal level of muscle enzyme to those with moderate trauma leading to CRUSH injury and finally to advanced CRUSH SYNDROME. Questionnaire consisted of clinical, biochemical and demographic items was designed and completed by our research team retrospectively. We divided the patients to CRUSH and non-CRUSH and also CRUSH injury and CRUSH SYNDROME, and then compared aforementioned items between them. Clinical and laboratory data of 2962 hospitalized victims, with an average age of 28.4(SD14.2) years (range 1-90) were collected (40% female). 611 patients were affected with CRUSH injury (20%). These were entrapped 2.2 hours longer than the others (P<0.001). Mean IV intake in first 5 days was 3.6(SD2.6) liters for these patients in compare with 2.5(SD1.4) liters for others (P<0.001). 200 cases showed complete feature of CRUSH SYNDROME. Electrolyte imbalance and systemic complications were drastically increased in the worst patients with CRUSH SYNDROME. In approach to CRUSHed patients of natural disasters by attention to the wide spectrum of muscle damage and systemic problems, the stepwise management protocol based on severity of traumatic rhabdomyolysis is inevitable and warranted.

CRUSH injury may follow prolonged continuous pressure on muscle tissue. It can lead to CRUSH SYNDROME. Ischemia reperfusion is the main mechanism of muscle injury in CRUSH SYNDROME. Acute renal failure and Compartment SYNDROME are the most important side effects of CRUSH SYNDROME. This case report introduced 24 years old woman who was affected by CRUSH SYNDROME after her leg CRUSH. After that, Patient leg's compartment became ischemic, and compartment SYNDROME was developed. Delayed fasciotomy and subsequent reperfusion SYNDROME caused acute renal failure and severe limb edema caused muscles necrosis. Subsequently, acute necrotizing fasciitis developed. Finally, the patient was rescued from death by CRUSHed limb amputation. As a result, in such cases the key point is managing and predicting clinical conditions before they present themselves. Amputation at an early stage may prevent CRUSH SYNDROME. Developing standard treatment protocol and providing training courses for clinicians and health care providers can prevent similar problems.

Introduction & Objective: Compartment SYNDROME has been defined as "a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space". Intense pain, swelling, and elevated compartment pressures characterize the early presentation in the affected muscle group. If untreated myonecrosis, myoglobinuria, and renal failure may result. To avoid a delay in diagnosis requires vigilance intracompartmental pressure measurement. Diagnosis of limb compartment SYNDROME is based on clinical vigilance and repeated examination. Many techniques exist for tissue pressure measurement but they are indicated only in doubtful cases, the unconscious or obtunded patient and children. However, monitoring of pressure has no harmful effect and may allow early fasciotomy. In acute situations, fasciotomy can be done prophylactically or as early therapeutic decompression, the latter being performed as soon as the first symptoms of compartment SYNDROME are present.This review encompasses limb compartment SYNDROME, including diagnosis and treatment.Material & Methods: In this preview article it was tried to answer these questions by literature review since 2000 till now.Results: Faciotomy doesn’t increase renal complication and we perform fasciotomy in proper time to preserve limb function.Conclusions: It is recommended to perform fasciotomy for compartment SYNDROME according to clinical sign and symptom compartment pressure monitoring timely and properly.