Pediatric Trauma: Module 5

Acute Crush Injuries


Crush injuries can be caused by several mechanisms in children.


Click on the tabs below to read more

  • Occurs when there is blunt compression of the chest wall. Signs include:
    • Cervical and facial petechial hemorrhages.
    • Cyanosis from inadequate blood flow.
    • Vascular engorgement.
  • Severe muscle injury can lead to acute kidney injury or compartment syndrome of an extremity.
    • Kidney injury occurs the large protein load due to rhabdomyolysis and leads to myoglobinuria.
    • Compartment syndrome of an extremity occurs from ↑ pressures within a confined fascial space, causing circulatory compromise, ischemia and ultimately tissue necrosis.
      • This condition is often diagnosed late in children due to their inability to effectively communicate their symptoms.
      • The 5 Ps of pain, pallor, pulselessness, paralysis and paresthesias are late signs and not reliable in children.
      • More reliable signs may be restlessness, agitation, anxiety and an increase in analegesic requirement in the context of extremity injuries and fractures


Small children can be driven over by a slow moving vehicle in reverse that does not see them. TV, furniture and appliance tip-overs are responsible for over 15,000 children ≤ 5 years old are treated in EDs annually in the US. In natural or human-generated disasters structural collapse can result in a child being pinned for a prolongued period. Because of a young child's small size, multiple systems may be involved in crush injuries.