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September 20, 1941


JAMA. 1941;117(12):1019-1020. doi:10.1001/jama.1941.02820380041013

Cases recently reported in the British Medical Journal1 indicate what appears to be a new syndrome: fatal renal failure after crushing of the limbs by fallen débris. Here is a typical history: The patient has been buried for several hours with pressure on a limb or limbs. On admission to the hospital his condition may be good, the pulse and blood pressure normal. There is swelling of the limb, some local anesthesia and whealing. The edema spreads along the limb or limbs, movements of the limbs become limited or absent, and there may be various sensory disturbances, such as anesthesia, hyperesthesia or paresthesia. The hemoglobin is raised; a few hours later the blood pressure falls and shock ensues. This may be successfully combated by transfusions of serum, plasma or blood. The urine, however, diminishes and contains albumin and many dark brown and black granular casts. The patient is alternately