Wednesday, September 26, 2007

Housewatch, episode 4.1

I've decided to start explaining (or trying to) episodes of House, M.D. I like the show, medicine and Hugh Laurie.

Now, last night's episode was a case of mistaken identity. Not very medical.

Perhaps the most interesting medical hypothesis was crush syndrome, which I had never heard of. Basically, you get crushed by a building or other heavy object and unsurprisingly, it's not very good for you. It's common after earthquakes, but was first described during the Blitz, in London, (Bywaters EGL, Beall D. Crush injuries with impairment of renal function. BMJ 1941; 1: 427-32.) when buildings were falling left and right.

During crush syndrome, the large muscles of the body get compressed. Cutting off the blood supply causes cells to weaken, since they don't have the energy to maintain themselves, and they release potassium, phosphate, enzymes and the muscle protein myoglobin into the bloodstream. Ultimately, it's bad for the kidneys. But the brain and muscles can suffer too, often leading to amputation of a limb.

The patient also had acute respiratory distress syndrome. It's a little less interesting. When you have lots of other problems, it's not very surprising that the lungs get a little stressed and can fail when they fill with fluid.

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