From Politico.eu, September 10:
Government declared three days of national mourning after worst quake in more than a century.
Moroccan citizens on Sunday mourned the victims of a powerful earthquake that has killed more than 2,000 people and injured hundreds more.
Rescue teams struggled to reach thousands in hard-hit areas who were injured by the quake Friday night, the biggest to hit Morocco in 120 years, AFP reported. Survivors are being forced to sleep rough this weekend as relief efforts continue.
At least 2,012 people have died and more than 2,059 injured in the disaster, according to the interior ministry, with 1,404 in critical condition....
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Crush injuries of soft tissues release fat, plasma and other liquids, and toxins which head for the kidneys. From Wolters Kluwer's UpToDate:
Severe crush injury in adults
INTRODUCTION Severe crush injury results from direct physical trauma to the torso, extremities, or other parts of the body from an external crushing force. Severe compression results in direct tissue trauma and sequelae of ischemia-reperfusion injury. Once the compressive forces are released, muscle injury and swelling can occur, with possible muscle necrosis and neurologic dysfunction in the affected areas. Systemic manifestations resulting from crush injury, which is defined as crush syndrome, can result in organ dysfunction or death. It is imperative that rescuers and health care professionals recognize crush injury to avoid missing a narrow window of time in which to provide intensive fluid resuscitation, which may limit acute kidney injury.
Severe crush injury in adults is reviewed. Prevention of crush syndrome and other causes of rhabdomyolysis are reviewed separately. (See "Pathophysiology, classification, and causes of acute extremity compartment syndrome" and "Crush-related acute kidney injury" and "Rhabdomyolysis: Epidemiology and etiology".)
DEFINITIONS AND MECHANISM OF INJURY
Crush injury — Crush injury is the result of physical trauma from prolonged compression of the torso, limb(s), or other parts of the body. The resultant injury to the soft tissues, muscles, and nerves can be due to the primary direct effect of the trauma or ischemia related to compression. In addition to possible direct muscle or organ injury, after release of the compressive force, severe crush injury results in swelling in the affected areas, with possible muscle necrosis and neurologic dysfunction. This soft tissue injury can also be due to a secondary injury from subsequent compartment syndrome.
Nontraumatic presentations of crush injury include patients with prolonged immobilization while intoxicated or under anesthesia. In such cases, the weight of the body part alone without relief may produce a compartment syndrome and rhabdomyolysis. Other causes of impaired consciousness such as stroke or coma can also result in prolonged immobilization with crush injury. The affected muscle compartment may be the one lying on a hard surface or may be caused by one extremity crossing over another, increasing local pressure. Gluteal compartment syndrome has been described in postoperative, intoxicated, and comatose patients with prolonged immobilization and may lead to crush syndrome, especially as presentation or recognition is frequently delayed [1]. Other causes of nontraumatic crush syndrome have been described, including ischemic, metabolic, toxicologic, and oncologic causes of rhabdomyolysis.
●(See "Rhabdomyolysis: Epidemiology and etiology".)
●(See "Rhabdomyolysis: Clinical manifestations and diagnosis".)
Crush syndrome — Crush syndrome is defined as the systemic manifestations resulting from crush injury, which can result in organ dysfunction (predominantly acute kidney injury [AKI], but multisystem organ injury can also occur), or death [2-5]. The manifestations of crush syndrome are the systemic consequences of muscle injury, specifically rhabdomyolysis, which commonly result in AKI.
Crush syndrome can also manifest in other situations where there is compression of the tissues. As examples, crush syndrome can occur with prolonged immobilization, burns, and electrical injury. Crush syndrome is the second leading cause of death in earthquakes, following direct trauma.
Mechanism of injury — Typical causes of crush injury include being trapped under a vehicle or related to industrial, construction, or agricultural accidents [6,7]. In natural disasters such as major earthquakes, 3 to 20 percent of mass casualties may involve crush injuries due to building collapse and entrapment [8,9]. Mass crowd stampedes can cause crush injuries as well as traumatic asphyxia [10]. (See 'Traumatic asphyxia' below.)
The compressive force causes direct tissue damage while occluding venous outflow. With prolonged compression, the resultant cellular death, in particular myonecrosis, may lead to crush syndrome. Clinical deterioration including death can occur within 20 minutes of extrication, leading to the nickname of "smiling death". The victim, smiling after extrication and rescue, suddenly arrests from ventricular fibrillation from the efflux of potassium, phosphorus, and myoglobin from the areas of injury. Delayed complications and death that occur as a result of renal failure were well documented in patients extricated from collapsed buildings during historic earthquakes and during the 1941 London Blitz bombings [4,5].....
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