The Crush Syndrome (and Lessons Learned from the Marmara Earthquake)

ARF induced by traumatic rhabdomyolysis and crush syndrome is a well-known complication occurring in the wake of natural or manmade disasters. As a matter of fact, it is the second most frequent cause of death, following the direct traumatic impact. Early recognition of the crush syndrome and rapid initiation of fluid replacement is essential as this can dramatically reduce the incidence of ARF. After the Marmara earthquake of 1999, the Turkish Society of Nephrology, in collaboration with the Renal Disaster Relief Task Force of the International Society of Nephrology, prepared special questionnaires to obtain patient data and follow-up information to analyze the extent of the nephrological problems. This book is based on the 639 cases consequently documented, constituting an unprecedented collection of first-hand experience on crush syndrome-related ARF following earthquakes. In addition to the data / analysis gained from the Marmara earthquake, each chapter also summarizes classical information on crush syndrome. In every major natural catastrophe, a rapid, appropriate and effective international response is essential to minimize losses and be able to adequately treat victims. This can be achieved only by rational planning and the establishment of an infrastructure composed of trained personnel, equipment, supplies and transportation that can be mobilized at a few hours’ notice is essential. This book has been written with the intent to make use of the experiences made after the Marmara earthquake to save more lives in similar future disasters.

Table of Contents:
Forewords; Preface; Acknowledgements; 1 The Basic Concepts; Introduction; Terminology; Structures and functions of the muscles; Analysis of the Marmara earthquake; Basic lessons learned from (or reminded by) the Marmara earthquake; 2 Epidemiology; Incidence; Age; Gender; The cities where casualties lived; Timing of hospital admissions; Time period under the rubble; Lessons learned from the epidemiological features of the Marmara earthquake crush syndrome casualties; 3 Etiology and Pathogenesis; Etiology and pathogenesis of rhabdomyolysis; Pathogenesis of crush syndrome and acute renal failure (ARF) on the basis of rhabdomyolysis; Lessons learned from the pathogenetic features of the Marmara earthquake crush syndrome casualties; 4 Clinical Features; Clinical features at the disaster field; Clinical features at admission to hospitals; Clinical course and the complications; Causes of death; Lessons learned from the clinical features of the Marmara earthquake crush syndrome casualties; 5 Laboratory Findings; Urinalysis; Blood count; Blood biochemistry; Lessons learned from laboratory findings of the Marmara earthquake crush syndrome casualties; 6 Diagnosis; Clinical features; Urinalysis; Biochemical findings; Other diagnostic tools; An assessment of diagnostic tools; Lessons learned from the diagnostic features of the Marmara earthquake crush syndrome casualties; 7 Prognosis; Overall prognosis in disaster victims; Prognosis of the casualties with crush syndrome; Lessons learned from the prognostic features of the Marmara earthquake crush syndrome casualties; 8 Prophylaxis; Prophylaxis of ARF; Prophylaxis of infections; Lessons learned from the prophylactic interventions in the Marmara earthquake crush syndrome casualties; 9 Therapeutic Interventions; Surgical interventions; Medical interventions; Other interventions; Lessons learned from the therapeutic interventions in the Marmara earthquake crush syndrome casualties; 10 Logistics; Overall logistic issues following earthquakes; Logistic issues in renal disasters; Lessons learned from the logistic interventions in the Marmara earthquake crush syndrome casualties; 11 Appendix; First-line treatment in crush syndrome casualties; Second-line treatment in crush syndrome casualties; Renal disaster coordination algorithm for the potential Istanbul earthquake; Autorizations, duties and responsibilities of the general disaster relief coordinator; Autorizations, duties and responsibilities of the local disaster relief coordinator.