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POST # 1 MEGAN

A traumatic crush injury occurs when an external force directly impacts the body (Godat et al., 2019). Examples of incidents that cause these injuries are natural disasters, agricultural accidents, industrial accidents, construction accidents, and MVAs. In a traumatic crush injury, prolonged compression causes trauma and ischemia of the affected areas (Godat et al., 2019). Once the force is removed, blood flow is restored, but there is further injury during reperfusion. Swelling in the area can contribute to muscle necrosis and neurological dysfunction (Godat et al., 2019). As a result, patients with traumatic crush injuries are at risk for many complications. Crush syndrome is a life-threatening condition related to the systemic effects of traumatic crush injuries. Following these injuries, there is a massive fluid shift from the ECF to the damaged cells and the damaged cells release potassium, phosphorus, and myoglobin (Godat et al., 2019). This leads to hypovolemia, acid-base imbalance, and electrolyte imbalance, which can cause many problems. Some of these problems include hypovolemic shock, arrhythmia, cardiomyopathy, renal failure, and metabolic acidosis (American College of Emergency Physicians, n.d.). There is also a risk for compartment syndrome. Compartment syndrome is a medical emergency in which extensive swelling in an area causes local ischemia, and as a result, cellular anoxia (Godat et al., 2019). The swelling must be reduced immediately. This is often done by fasciotomy, a surgical incision that goes through the skin and fascia to quickly relieve pressure in the area (Godat et al., 2019).

Trauma to the skeletal muscle would have permanently disabling effects in the elderly. This is related to some of the musculoskeletal changes that individuals undergo with increased age. Older adults have reduced muscle mass, poor muscle quality, weakened muscle contractions, and less flexibility (Hubert et al., 2018; Taffet, 2019). After a certain age, muscle deteriorates, and subcutaneous and connective tissue infiltrate into old muscle (Taffet, 2019). Muscle fibers cannot be replaced so these changes are degenerative (Hubert et al., 2018). This takes a toll on mobility, and because the individual cannot move as much, there is more atrophy. The loss of subcutaneous tissue offers a poor layer of protection to the muscles. In addition to muscle changes, older adults experience bone changes. Osteoporosis is caused by decreased calcium intake or compromised calcium absorption in the years leading up to late adulthood. Inefficient calcium levels prevent healthy bone formation, leading to bones with decreased mass and density (Hubert et al., 2018). Formation of new bone declines with age (Taffet, 2019). This leaves individuals with bones that are porous, brittle, and likely to fracture (Hubert et al., 2018). Individuals often present with abnormal spine curvatures which compromise ventilation and mobility (Hubert et al., 2018). If an older adult sustains a traumatic crush injury, he or she is very likely to have prolonged, or incomplete, healing of the musculoskeletal structures.

As APRNs, it is important that we take action to prevent elderly patients from the effects of traumatic crush injuries. The best way to do this is to help them avoid these injuries in the first place. This can be done by gathering information about the patient’s home environment and ADLs. We can ask questions such as “Are you still working?”, “Do you still drive?”, and “Describe the setup of your house/apartment.” This will reveal hazards and allow us to provide safety education. To prevent elderly patients from traumatic crush injury complications, we can also educate them on maintaining adequate health. This way, if they do sustain an injury, they will make the best possible recovery. One healthy habit to recommend to the elderly is low-impact, moderate exercise (Hubert et al., 2018). Examples of this type of exercise are swimming and walking. It should be practiced a few days per week. For this age group, nutritional emphasis should be on proteins, minerals, and vitamins (Hubert et al., 2018). This will slow the musculoskeletal body changes that are related to aging.

American College of Emergency Physicians. (n.d.) Crush injury and crush syndrome.

https://www.acep.org/imports/clinical-and-practice-management/resources/ems-and-disaster-preparedness/disaster-preparedness-grant-projects/cdc---blast-injury/cdc-blast-injury-fact-sheets/crush-injury-and-crush-syndrome/

Godat, L. N. & Doucet, J. J. (2019). Severe crush injury in adults. UpToDate.

https://www-uptodate-com.regiscollege.idm.oclc.org/contents/severe-crush-injury-in-adults?search=traumatic%20crush%20injury&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Hubert, R. J. & VanMeter, K. C. (2018). Gould’s pathophysiology for the health professions.

(6th ed.). Elsevier.

Taffet, G. E. (2019). Normal aging. UpToDate.

https://www-uptodate-com.regiscollege.idm.oclc.org/contents/normal-aging?search=effects%20of%20aging&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H584138046