Prophylaxis of Acute Renal Failure in Traumatic Rhabdomyolysis

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Abstract
Better and Stein (March 22 issue)1 have outlined a logical approach to the care of patients with traumatic rhabdomyolysis and have made recommendations for the provision of emergency dialysis services in the event of a catastrophic earthquake. It is important to recognize, however, that this type of injury is not an inevitable consequence of all earthquakes. Crush syndrome was clearly a major problem after the Armenian earthquake in 19882 3 4 5 and to a lesser extent after the 1985 earthquake in Mexico City6 , 7 —two events that were characterized by the collapse of multistory reinforced-concrete or stone buildings. However, traumatic rhabdomyolysis followed by acute renal failure has not been documented in the wake of other recent large earthquakes in which most of the deaths and injuries resulted from the collapse of single-story adobe or brick structures.8 9 10 11 In the great earthquake in Tangshan, China (1976), crush syndrome accounted for only 2 to 5 percent of all injuries.12 This incidence is remarkably low, given the large number of patients whose extremities were trapped for many hours under the debris of crumbled walls and ceilings. Nor was crush syndrome seen after the large California earthquakes in 1971 and 1983,13 and (as Better and Stein have noted) only one case was reported after the 1989 earthquake in Loma Prieta.14 Prolonged entrapment simply has not been a problem in the collapse of one-story adobe and wood-frame structures.