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A recent admission through the Christiaan Barnard Memorial Hospital ER included a woman who suffered extensive bruising, lacerations and a fractured left wrist following falling victim to domestic violence. (Please follow Our Time to STOP anti-violence campaign). The patient was attended to in the ER and subsequently sent to ICU for further investigations and monitoring. |
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The injury pattern relates to that of muscle tissue damage noted by significant areas of over lying bruising. Of the many possible concerns related to this type of injury, rhabdomyolysis stands out as a significant risk. Rhabdomyolysis may be defined as a syndrome caused by injury to skeletal muscle and involves the leakage of large quantities of potentially toxic intracellular contents into the plasma. This syndrome if not treated may result in acute renal failure. The images bellow depict the distribution of injuries:
Rhabdomyolysis in brief:
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The pathophysiological hallmark of this syndrome is an increase in intracellular free ionized calcium due to either cellular energy depletion, or direct plasma membrane rupture (as in the case of trauma). The increased intracellular calcium activates several proteases, intensifies skeletal muscle cell contractility, induces mitochondrial dysfunction, and increases the production of reactive oxygen species, ultimately resulting in skeletal muscle cell death. Direct blunt injury to muscle may lead to the same process.
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Clinically, the syndrome presents with: severe muscular pain; weakness and myoglobinuria. Myoglobinuric renal failure may result and can be either oliguric or nonoliguric in nature and damages the kidneys in several ways. The breakdown of myoglobin produces a pigment-induced nephropathy with subsequent sloughing of the tubular epithelium. This exfoliate, together with large myoglobin molecules (which are freely filtered in the glomerulus), results in the formation of brown casts that obstruct the renal tubules, causing an increase in intratubular pressure and the development of interstitial edema and subsequent acute renal failure.
Skeletal muscles can recover from episodes of rhabdomyolysis with surprisingly minimal permanent damage, and overall survival after rhabdomyolysis is approximately 77%.
-Harper J. Rhabdomyolysis and myoglobinuric renal failure. Crit Care Nurse. March 1990;10:32–36
Skeletal muscles can recover from episodes of rhabdomyolysis with surprisingly minimal permanent damage, and overall survival after rhabdomyolysis is approximately 77%.
-Harper J. Rhabdomyolysis and myoglobinuric renal failure. Crit Care Nurse. March 1990;10:32–36
Injuries resulting from domestic violence should be reported and require Police intervention. Please follow the link to acsess the South African Police Service website page on Domestic Violence for more information.
An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.
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