Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XVII: Crush Injury
United States Department of Defense
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The early splinting of major soft-tissue injuries and fractures is urgently important in crush injuries to minimize hypotension. To reduce tissue metabolism, the limb is kept cool by exposure to air. Unnecessary dressings and unnecessary movements of the limb are hazardous, as they cause the release of deleterious substances, particularly potassium in potentially lethal amounts, into the general circulation.
A tense and swollen limb should be decompressed immediately by liberal incision of the fascia. This measure is particularly urgent when the pressure of extravasated fluid impairs circulation. An early amputation is indicated when the limb is so severely crushed that it is obvious that function cannot be restored or when it is the only emergency procedure that permits extrication of the victim from under unmovable rubble. Debrided wounds and fasciotomy incisions should not be closed primarily.
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