May 31, 2022
Contributor: Nick Hatch, MD
- “Smiling Death” describes the prehospital
phenomenon of a person who is happy to be extricated from an
extended period of crush injury, but dies suddenly soon after the
- Smiling Death is caused by Crush Syndrome.
Crush Syndrome begins when large areas of tissue are damaged by
compression and subsequent impeded blood flow. Resultant cell death
is followed by release of myoglobin and efflux of electrolytes
including potassium. Upon removal of the crushing force, high
levels of potassium enter circulation and cause cardiac arrhythmias
leading to sudden death.
- Prevention measures include aggressive
hydration using normal saline before extrication. An acceptable
starting rate is 1L per hour, but providers should take patient
status into consideration and titrate
- Standard techniques for controlling
hyperkalemia by intracellular shifting may be less effective. Early
dialysis may be useful.
Gonzalez D. Crush
syndrome. Crit Care
Better OS. Rescue and salvage of
casualties suffering from the crush syndrome after mass
Summarized by Kirsten
Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks,
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