Every person is practically not insured against various accidents. It can be anything from a traffic accident to an earthquake and a mine collapse. In any of these cases, SDS may develop. The syndrome has various causes, pathogenesis, mandatory treatment is required. Let's consider these questions further.
VTS concept
As a result of soft tissue compression, SDS may develop. The syndrome in women occurs with the same frequency as in the male population. It has other names, such as crush syndrome or compression injury. The cause of the syndrome may be:
- Squeezing body parts with heavy objects.
- Emergencies.
Such situations often occur after earthquakes, as a result of traffic accidents, explosions, collapses in mines. The force of compression may not always be large, but the duration of such a state plays a role here. As a rule, STS (prolonged compression syndrome) occurs if there is a prolonged impact on soft tissues, usually more than 2 hours. First aid is importantstage on which a person's life depends. That is why it is important to be able to distinguish the manifestations of such a state.
Varieties of VTS
In medical practice, there are several approaches to the classification of compression syndrome. Given the type of compression, the following syndromes are distinguished:
- Developing as a result of the collapse of the soil. Occurs as a result of being under a concrete slab or various heavy objects for a long time.
- Positional STS develops due to compression by parts of one's own body.
Localization can also be different, hence VTS is distinguished:
- Limbs.
- Heads.
- Belly.
- Breasts.
- Taza.
After emergencies, SDS often develops. The syndrome is often accompanied by other injuries, so they distinguish:
- Compression syndrome, accompanied by injuries of internal organs.
- With damage to the bone structures of the body.
- STS with damage to nerve endings and blood vessels.
Severity of the syndrome can vary. Based on this fact, they distinguish:
A mild form of the syndrome that develops when the limbs are squeezed for a short time. Cardiovascular disorders are usually not diagnosed
- If the pressure on the tissues is more than 5-6 hours, then the average form of SDS develops, in which there may be mild renal failure.
- Severe form is diagnosed when squeezing more than 7hours. Signs of kidney failure are expressed.
- If pressure is applied to soft tissues for more than 8 hours, then we can talk about the development of an extremely severe form of SDS. Acute heart failure can be diagnosed and is often fatal.
It often happens when SDS (prolonged compression syndrome) is accompanied by various complications:
- Myocardial infarction.
- Diseases of various organ systems are fraught with SDS. A syndrome in women that affects the lower part of the body, that is, the pelvic organs, is dangerous with severe complications and disruption of the normal functioning of the organs in this area.
- Purulent-septic pathologies.
- Ischemia of the injured limb.
Result of injury: STS
The cause syndrome has the following:
Pain shock
- Loss of plasma that escapes through the vessels into damaged tissues. As a result, the blood becomes thicker and thrombosis develops.
- As a result of tissue breakdown, intoxication of the body occurs. Myoglobin, creatine, potassium and phosphorus from injured tissues enter the bloodstream and cause hemodynamic disorders. Free myoglobin provokes the development of acute renal failure.
- All these causes must be eliminated as soon as possible in order to be able to save human life.
Periods of the clinical course of DFS
The course of the crash syndrome has several periods:
- The first is directly the compression of soft tissues withdevelopment of traumatic shock.
- In the second period, there are local changes in the injured area and the beginning of intoxication. It can last up to three days.
- The third period is characterized by the development of complications, which are manifested by the defeat of various organ systems.
- The fourth period is convalescence. Start it from the moment the kidney function is restored.
- Further, the victims are found to have factors that indicate immunological reactivity, bactericidal activity of the blood.
Symptomatic of tissue compression syndrome
If strong pressure on soft tissues is not immediately eliminated, then SDS gradually progresses. The syndrome symptoms exhibit the following:
- The skin on the squeezed limb becomes pale.
- Swelling appears, which only increases with time.
- The pulsation of the vessels is not palpable.
- The general condition of the victim is deteriorating.
- There is pain.
- A person has psycho-emotional stress.
Blood test shows an increase in fibrinogen, fibrinolytic activity decreases, the blood coagulation system also accelerates.
Protein is detected in the urine, erythrocytes and casts appear.
These are the manifestations of SDS. The syndrome is characterized by a relatively normal state of the victims, if the compression of the tissues is eliminated. But after a while they appear:
- Cyanosis and pallor of the integument.
- Colored leather.
- Over the next day, swelling increases.
- Blisters, infiltrates may appear, and in severe cases, necrosis of the limbs may occur.
- He develops cardiovascular failure.
- A blood test shows its thickening and neutrophilic shift.
- Prone to thrombosis.
At this stage, it is important to conduct timely intensive infusion therapy using forced diuresis and detoxification.
Symptomatics of the third period
The third stage of the development of the syndrome (SDS) is characterized by the development of complications, it lasts from 2 to 15 days.
Signs at this time may appear as follows:
- Defeat various organ systems.
- Development of kidney failure.
- Puffiness is getting bigger.
- Blisters with transparent or hemorrhagic contents can be observed on the skin.
- Anemia is starting to show clearly.
- Diuresis decreases.
- If you do a blood test, the concentration of urea, potassium and creatinine increases.
- The classic pattern of uremia with hypoproteinemia appears.
- There is an increase in the body temperature of the victim.
- The general condition worsens.
- Slowness and lethargy appear.
- May be vomiting.
- Staining of the sclera indicates the involvement of the liver in the pathological process.
Even intensive care can not always save a person if SDS is diagnosed. The syndrome, if it reaches this period, then in 35% of cases leads to deathaffected.
In such cases, only extracorporeal detoxification can help.
Further development of VTS
The fourth period is a reconvalescence. It begins after the kidneys restore their work. At this stage, local changes prevail over general ones.
Symptoms may include:
- If there are open injuries, then infectious complications are observed.
- Sepsis possible.
- If there are no complications, then the puffiness begins to subside.
- How quickly the mobility of the joints is restored will depend on the severity of the damage.
- Since the muscle tissues die, they begin to be replaced by connective tissue, which does not have the ability to contract, therefore, atrophy of the limbs develops.
- Anemia still persists.
- The victims have no appetite.
- There are persistent changes in homeostasis, and if you apply intensive infusion-transfusion therapy, they can be eliminated after a month of intensive treatment.
During the last period, the victims show a decrease in natural resistance factors, bactericidal activity of the blood. The leukocyte index remains unchanged for a long time.
For a long time, the victims experience emotional and mental instability. Depressive states, psychoses and hysteria are frequent.
How to recognize STS?
Syndrome, the diagnosis of which should be carried out only by a competent specialist, requires special attention and treatment. It is possible to determine the presence of pathologybased on the following indicators:
- The clinical picture and the circumstances of the injury are taken into account.
- The results of urine and blood tests are not ignored.
- Instrumental diagnostics are being carried out, which allows you to compare the dynamics of laboratory symptoms and the structure of the kidneys.
People undergoing heart diagnostics sometimes hear this diagnosis, but not everyone understands what the syndrome is. SDS in the cardiogram of the heart may indicate the presence of a pathology that affects the chest. Being under the rubble can significantly affect the work of the heart muscle.
Laboratory diagnostics are carried out with the aim of:
- Detection of myoglobin levels in blood plasma: usually in this condition it is significantly increased.
- Determining the concentration of myoglobin in urine. If the indicators reach 1000 ng / ml, then we can talk about developing acute renal failure with DFS.
- The syndrome can also be manifested by an increase in blood transaminases.
- Increased creatinine and urea.
According to urine analysis, doctors determine the degree of kidney damage. The study reveals:
- Increase in leukocytes if complicated by DFS.
- The concentration of s alts is increasing.
- Urea increases.
- Cylinders present.
A correct diagnosis allows doctors to prescribe effective therapy to help the victim restore all body functions as quickly as possible.
How to give first aid?
Fromthe provision of emergency assistance depends on the condition of the victim, and maybe his life, if SDS develops. Syndrome, first aid should be provided as soon as possible, will not lead to serious complications if the victim is helped according to the following algorithm:
- Give pain medication.
- Then begin to release the affected area of the body.
As such means suitable: "Analgin", "Promedol", "Morphine". All drugs are administered intramuscularly only.
Many people ask why a tourniquet should be applied with SDS syndrome? This is done in the presence of severe arterial bleeding or extensive damage to the limbs so that the victim does not die from blood loss.
- Inspect the damaged area.
- Remove tourniquet.
- All existing wounds must be treated with an antiseptic and covered with a sterile napkin.
- Try to cool the limb.
- Give the victim plenty of fluids, tea, water, coffee or soda-s alt solution will do.
- Warm the victim.
- If there are blockages, then the person must be provided with oxygen as soon as possible.
- To prevent heart failure, administer Prednisolone to the victim.
Send the victim to the nearest hospital
Compression Syndrome Therapy
May have varying degrees of severity of SDS. The syndrome, the treatment of which should be carried out in a complex manner, will not cause serious complications, given the pathogenesisdamage. Comprehensively influence - this means:
- To carry out activities to eliminate deviations of homeostasis.
- To have a therapeutic effect on the pathological focus of damage.
- Normalize wound microflora.
Treatment measures should be carried out almost continuously, starting from the moment of first aid and until the victim is fully recovered.
If the injuries are significant, then medical care consists of several stages:
- The first one starts right at the scene.
- The second is assistance in a medical facility, which can be quite far from the scene of the tragedy, so “flying hospitals”, “hospitals on wheels” are often used. It is very important that there is appropriate equipment to help with damage to the musculoskeletal system, internal organs.
At the third stage, specialized assistance is provided. This usually happens in a surgical or trauma center. It has all the necessary equipment to provide assistance in case of serious damage to the musculoskeletal system or internal organs. Resuscitation services are available to bring a person out of a state of shock, treat sepsis or kidney failure
Drug therapy
The sooner this stage of therapy is started, the more likely the patient is to survive. Medical assistance at this stage is as follows:
- Victims are given an infusion of a mixture of sodium chloride and 5%sodium bicarbonate in a ratio of 4:1.
- If a severe form of the syndrome is observed, then the victims are given 3-4 liters of blood or a blood substitute as an anti-shock measure.
- To prevent the development of complications, diuresis is carried out with the introduction of "Furosemide" or "Mannitol".
- Reduction of intoxication of the body is achieved by replacing the blood and the use of gamma-hydroxybutyric acid at an early stage. It has an inhibitory effect on the central nervous system and has a hypertensive effect.
If all conservative methods of therapy do not give the desired result, then surgical treatment is required, which is based on the use of the following detoxification methods:
- Sorption methods.
- Dialysis-filtration (hemodialysis, ultrafiltration).
- Peretic (plasmapheresis).
May require amputation of limbs that cannot be returned to normal life.
Can SDS be prevented?
If serious injuries cannot be avoided, then in most cases SDS develops. The syndrome, the prevention of which is mandatory, will not lead to disastrous consequences if you immediately start taking action. To do this, it is necessary to introduce antibiotics of the penicillin series. The use of antibacterial agents may not save you from suppuration, but it is quite possible to prevent gas gangrene in this way.
Even before removing the victim from the rubble, it is important to start infusion therapy to normalize the BCC. Often for these purposes use "Mannitol", a 4% solution of bicarbonatemagnesium.
If you take all these actions directly at the scene, then it is quite possible to prevent the development of serious complications of DFS, such as gas gangrene and kidney failure.
We examined in detail SDS (prolonged compression syndrome) of the internal organs with the weight of one's own body or heavy objects. This condition often occurs during emergencies. It should be noted that timely assistance can save a person's life. But in the literature and on the pages of modern magazines you can find a completely different interpretation. It is also called - SDS syndrome - a female disease of the century. This concept is from a completely different area and should not be confused with such a serious pathology. This is a topic for a completely different article, but it should be briefly noted what such a syndrome means. Often it strikes women burdened with power. Selfishness, lack of self-criticism, prejudice against men, confidence in one's own infallibility, and similar "symptoms" are characteristic of DFS in women.
