Syndrome of positional compression - an injury associated with prolonged squeezing of a limb with a heavy weight. Such injuries are quite common as a result of accidents, earthquakes, and collapses of buildings. This syndrome is associated with the most complex injuries, the treatment of which is quite long and laborious.
Causes of the syndrome
In addition to emergency situations, positional compression syndrome can be obtained as a result of a long stay in an uncomfortable position, when the limbs are squeezed by the weight of one's own body. As a result, tissue necrosis may occur with the release of toxins. This can happen if a person is unconscious or in a static position for a long time (more than 12 hours).
The result of the treatment will largely depend on how long the person has been in the described position, on the correctness of the diagnosis and the prescribed methods of treatment. If the diagnosis was made incorrectly or the person received incomplete treatment, and first aid was not provided, then the prognosis is disappointing, since patients, as a rule, have irreversible trophic andneurological consequences.
Main species
Positional compression syndrome is classified according to several criteria at once:
- in terms of compression;
- localizations;
- damage to other organs;
- presence of complications;
- severity.
The severity of this syndrome is classified as mild, moderate and severe:
- Mild degree is characterized by the fact that the area of damage and its depth are small. General manifestations of intoxication are minor, and minor kidney disorders are also observed, which are quickly restored. Urine for some time has a reddish-brown tint. All indicators return to normal after 5-7 days of intensive treatment in the hospital.
- The average degree is characterized by the presence of more extensive damage. Intoxication is moderately pronounced. A blood test shows an increase in the level of residual nitrogen and urea. If first aid is not provided in time, serious complications and infection may occur at this stage.
- The third degree is characterized by significant damage to several areas, and severe intoxication can even lead to death.
What happens in the body with prolonged compression
When squeezing a certain part of the body, there is a violation of the blood supply to the tissues below this area. The limbs are often affected. Tissues are severely damaged, oxygen starvation is observed, a stiff leg or arm loses its sensitivityand gradually begins necrosis with the release of many toxic substances.
Often, even at the time of injury, there is a strong destruction of muscle tissue, bone fractures, damage to the vascular system, resulting in bleeding. Also, a person feels severe pain, as a result of which even traumatic shock may occur.
Syndrome symptoms
Symptoms of positional compression syndrome are directly dependent on the time of compression and the volume of affected tissues. For example, when squeezing the forearm area for 2-3 hours, acute renal failure will not be observed, although there may be a decrease in urine production. There are also no signs of intoxication. Such patients recover very quickly without any consequences.
At this stage, there is pallor, severe weakness, tachycardia. The most dangerous in this case will be the extraction of the injured person from under the rubble, since when blood circulation is normalized, there is an intensive production of potassium, which can provoke a cardiac arrest. The initial period is characterized by such signs as:
- stiff leg or arm not functioning;
- skin is pale and cold;
- have bubbles;
- pulse is practically absent.
In addition, bone fractures are often diagnosed.
Prolonged compression, lasting up to 6 hours, leads to moderate disturbances. In suchcase, there are vivid manifestations of intoxication and impaired renal function throughout the week. The prognosis of the disease largely depends on the period of first aid and the timeliness and quality of subsequent therapy.
With more than 6 hours of compression, severe poisoning with toxic substances occurs, and the kidneys are turned off completely. Without powerful intensive care and hemodialysis, a person dies.
Diagnostics
You can determine the presence of a problem immediately at the scene. If the victim has pain shock, then he may be unconscious. Objective data make it possible to make a diagnosis with a fairly high probability.
When conducting laboratory tests, you can get all the required information regarding blood clotting, electrolyte disturbances, increased levels of glucose, urea, bilirubin. A biochemical blood test will help determine the decrease in protein concentration.
Urine may be normal during initial testing, but gradually it begins to take on a slightly brownish color, and there is an increase in density, and protein appears in it. Microscopic examination reveals leukocytes, erythrocytes and casts.
First Aid
First aid for compression syndrome depends largely on who provides it, as well as the availability of the required measures, the availability of qualified medical personnel. Professional doctors and rescuerstheir actions improve the prognosis for the patient.
First of all, the victim must be taken to a safe place. Abrasions and wounds identified during a superficial examination must be treated and special aseptic dressings applied to them. If there is bleeding, measures must be taken to stop it, immobilizing splints or other improvised means should be applied to the fractures. If at this stage it is impossible to provide the introduction of intravenous infusion, then the patient must be provided with plenty of fluids.
A tourniquet must be applied to the injured limb before the person is released from the rubble to prevent the active release of potassium. Then an anesthetic is administered and the patient must be taken to the hospital for further treatment.
Which doctor to contact
If you suspect the presence of a syndrome of prolonged compression, you should immediately seek advice from a traumatologist. Additionally, an examination by a nephrologist, cardiologist, dermatologist and neuropathologist may be necessary. Since pathology leads to various complications, the patient needs to undergo a comprehensive diagnosis.
Providing treatment
Treatment should be complex, and its peculiarity depends on the duration of the course of the disease. An infusion of frozen plasma, as well as detoxification agents, is mandatory. In the period of acute renal failure, daily hemodialysis is performed. It also shows compliance with a special diet with limited drinking regimen and exclusion from the usualfruit diet. Be sure to follow the measures to prevent the occurrence of purulent complications and sepsis.
Patients may experience complications from many internal organs and systems, the development of irreversible limb ischemia, purulent-septic complications, thromboembolism. But the main complication is acute renal failure. It is she who often leads to the death of the patient.
