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Earthquake, rescued victims, crush injury and their follow up

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Thirty complicated crush injury patients were accepted to our ICU after the Big Marmara (Turkey) earthquake in August 1999. Results of 18 patients were reviewed and are presented below.

The mean ages of 10 male and 8 female patients were 31.1± 12.6 (range: 15-55) years. Time from earthquake to salvage and first medical aid were 12.5± 9.4 (range: 4-40) and 17.5± 10.9 (range: 6–41) h, respectively.

Victims were accepted into our unit 5± 8.4 (range: 1-35) days after the disaster. Their initial problems were acute renal failure (13), respiratory failure (5), disseminated intravascular coagulopathy (DIC) (4), bleeding (3), long bone fractures (2), pelvic fracture (2), lung contusion (1), haemodynamic instability (1), sepsis (1), in addition to crush injuries in the lower extremities (14) and upper extremities (6). Decompressive fasciatomies had been performed for all patients with crush injuries before acceptance to our ICU. Patients were treated for acute renal failure (14); DIC (13); sepsis (13) [originating from wounds (11), urinary system (9) and respiratory system (7)], respiratory failure (10), hepatic dysfunction (7) and cardiac dysfunction (3) during their stay in the ICU. Mean dialysis requirements for patients with renal failure were 5.1± 3.6 (range: 3-13) for a period of 10.1± 6.8 (range: 6-23) days. Venovenous hemofiltration was performed twice for two patients and once for four patients because of volume overload. Fresh frozen plasma, 9.5± 10.4 (range: 0-37) units; platelet suspension, 5.2± 7.1 (range: 0-21) units; cryoprecipitate, 3± 6.6 (range: 0-26) units; and erythrocyte suspension, 18.6± 10.6 (range: 6-39) units were transfused because of preDIC/DIC and massive bleeding especially after excision of debris. Antithrombin III replacement was performed in 8 patients. Ten patients with respiratory failure were mechanically ventilated for 9± 14.8 (range: 3-55) days. Amputations were required in six patients.

Eventually two patients with MOF died and 16 patients were discharged to other clinics with some sequels like neuropathies (10) and cardiomyopathy (1). One patient was discharged for hyperbaric oxygen therapy because of deep soft tissue infection unresponsive to medical therapy.

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Ünal, N., Oral, M., Yilmaz, A. et al. Earthquake, rescued victims, crush injury and their follow up. Crit Care 4 (Suppl 1), P195 (2000).

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