Crush Syndrome vs Rhabdomyolysis: Key Differences

Clinical Presentation

Crush syndrome always involves systemic manifestations, including hypovolemia from massive third-spacing into damaged muscle compartments, and develops compartment syndrome due to increased intra-compartmental pressure from tissue edema, presenting with the "6 Ps": pain, paresthesia, paresis, pain with passive stretch, pink color, and pulselessness, with acute kidney injury from myoglobinuric nephropathy as the defining life-threatening complication, and life-threatening hyperkalemia occurring even before extrication from entrapment 1, 2
The American College of Emergency Physicians recommends recognizing crush injury early to prevent acute kidney injury, with a critical 6-hour window for intensive fluid resuscitation 4

The fundamental management difference is that crush syndrome requires immediate pre-hospital fluid resuscitation starting while the victim is still trapped, not after extrication, with 0.9% normal saline at 1000 ml/hour initially, and reducing infusion rate by at least 50% if extrication takes longer than 2 hours 4
The European Resuscitation Council recommends administering 3-6 liters of 0.9% normal saline in the first 24 hours with target urine output of 200-300 ml/hour until myoglobinuria clears 4

Never triage crush victims away from active treatment due to lack of dialysis availability, as intensive fluid management can restore renal function and avoid dialysis need entirely 4
Avoid limb elevation if compartment syndrome is suspected, as it worsens compartment ischemia by reducing perfusion pressure 4, 3