Long-term compression syndrome (crash syndrome). Crash syndrome, or body compression: first aid algorithm First aid for prolonged compression

Long-term compartment syndrome- symptoms and treatment

What is compartment syndrome? We will discuss the causes, diagnosis and treatment methods in the article by Dr. Nikolenko V.A., a traumatologist with 10 years of experience.

Definition of disease. Causes of the disease

Long-term compression syndrome(crash syndrome, CDS) is a life-threatening condition that occurs due to prolonged compression of any part of the body and its subsequent release, causing traumatic shock and often leading to death.

Two conditions contribute to the occurrence of this syndrome:

These factors lead to the fact that after the release of a compressed body part, the injury goes beyond the damage and local traumatic reaction.

In the compression zone, toxic products are formed (free myoglobin, creatinine, potassium, phosphorus), which are not “washed out” by the liquid that has accumulated due to a mechanical obstacle to the circulation of its current. In this regard, after eliminating the cause of the compression, a systemic reaction of the body occurs - the products of destroyed tissues enter the bloodstream. This is how the body is poisoned - toxemia.

A special form of crash syndrome is positional compression syndrome (PCS). In this situation, there is no external traumatic factor, but tissue compression occurs from an unnatural and prolonged body position. Most often, SPS is characteristic of a person in a state of severe intoxication: depression of consciousness and pain sensitivity, combined with a prolonged immobile position, lead to critical ischemia (decreased blood supply in a separate area of ​​the body). This does not mean at all that in order to achieve positional compression, a person must “rest” an arm or leg for hours. Tissue necrosis can be caused by maximum flexion of the joint for a sufficiently long time, which leads to compression of the vascular bundle and disruption of the blood supply to the tissue. Concomitant shifts in homeostasis (self-regulation of the body), characteristic of the biochemistry of intoxication, accompany the described positional syndrome.

Positional compression differs from true SDS in the rate of increase in toxemia and the rare incidence of irreversible organ damage.

Particular and least destructive is neurological symptom. It occurs quite rarely and is a separate component of crash syndrome. This symptom manifests itself in the form of damage or disruption to a particular nerve (neuropathy). In this case, there is no underlying chronic neurological disease or injury. This condition is reversible.

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of compartment syndrome

The symptoms of crash syndrome are extensive and varied. It consists of local (local) and general manifestations, any of which in itself is a serious injury.

During the initial examination of the patient, local symptoms may be interpreted incorrectly due to the non-obviousness of the damage: the affected tissues in the early stages look healthier than they actually are. Necrotic (dying) zones clearly appear only after a few days, and their delimitation can continue in the future.

The scale of local disturbances becomes apparent already at the stage of complications. This fact requires a special tactic from the surgeon - a secondary revision (examination) of the victim.

Local symptoms are primarily represented by injuries encountered in everyday life, but their massiveness is more significant. SDS is characterized by combined and combined injuries and polytraumas. These include open and closed fractures, extensive wounds, detachments of skin with tissue, crush injuries, traumatic amputations of limbs, torsion injuries (rotation of the bone around its axis).

With crash syndrome, large areas of destruction (destruction), organ-destructive and irreversible injuries occur. In addition to skeletal trauma and soft tissue injuries, SDS is often accompanied by neurotrauma (damage to the nervous system), thoracic (chest injuries) and abdominal (intra-abdominal) injuries. The victim’s condition can be aggravated by continued bleeding at the scene of the incident and infectious complications that arose earlier.

Local damage triggers a general process such as shock. Its appearance in DFS is due to multiple injuries, prolonged pain impulses and lack of blood supply to the compressed body segment.

Shock in crash syndrome is multicomponent: the mechanism of prolonged compression leads to the development of such types of stress in the body as hypovolemic (decrease in circulating blood volume), infectious-toxic and traumatic. Particularly dangerous in case of SDS are the toxic components of shock, which are characterized by suddenness: in large quantities, after the release of a compressed part of the body, they immediately enter the bloodstream. The combination of severe local damage and the toxic effect of one’s own tissues determines the course of the disease and can lead to a fatal outcome.

Pathogenesis of long-term compartment syndrome

The human body has compensatory capabilities- the body’s reaction to damage, in which the functions of the affected area of ​​the body are performed by another organ. Against the background of a person’s long stay in conditions hypovolemia(decrease in circulating blood volume), intense pain, forced position and accompanying injuries to internal organs, such body abilities are at the limit or completely dry up.

Violation of the volume of red blood cells in the blood and the flow of plasma into the interstitial space causes ischemia, slowing blood flow and increasing capillary permeability. Sweating of plasma into the tissue and interstitial space also leads to the accumulation of myoglobin (a protein that creates oxygen reserves in the muscles). A drop in blood pressure maintains hypoperfusion (insufficient blood supply), plasma loss, and increased tissue edema.

During the entire time of compression, tissue breakdown products entering the bloodstream affect the kidneys. After the victim is released, there is a sharp increase in the release of toxic substances and a massive “washing out” of tissue detritus (destroyed cells) into the bloodstream. Freed from the compression block, the blood flow resumes, inevitably filling the circulating blood volume with the resulting autotoxins. This leads to the appearance acute renal failure, resulting in immediate autoimmune reactions: temperature crises, generalized disorders of humoral regulation (metabolic processes).

Kidney failure develops due to the blocking of the kidney tubules by the myoglobin of destroyed muscles and the cessation of the vital process of reabsorption (reabsorption of water). This is greatly aggravated by ionic disturbances. Tissue breakdown products additionally entering the blood have an uncontrollable effect on the diameter of the lumen of blood vessels. As a result, the vessels narrow, including in the filtration glomeruli of the kidneys, which leads to thrombosis and complete cessation of filtration.

In connection with acute renal failure, the resulting decompensation is aggravated by increasing ion imbalance (hyperkalemia). This leads to gross violations of the body’s self-regulation and “acidification” of internal environments - acidosis.

The phenomenon of mutual aggravation (hypovolemia + pain impulses + toxemia) is now unfolding in full. Symptoms become maximally pronounced, cascading and increasing, and the likelihood of their elimination by the body’s forces becomes impossible.

The described disorders are accompanied by a collapse of hemodynamics (blood movement through the vessels) due to blood loss and reflex hypotension (lowering blood pressure). This leads to a stepwise increase in severity and the formation of a vicious circle. It is possible to interrupt pathological processes in case of long-term compression syndrome only with medical intervention - timely, coordinated and competent.

Classification and stages of development of long-term compartment syndrome

The classification of crash syndrome is based on the severity of the clinical manifestation, which depends on the area and duration of compression.

VTS forms:

Due to the knowledge of the pathogenesis of crash syndrome and the knowledge of the prognosis of each form of SDS, this classification is generally accepted and remains unchanged for a long time. And although it is quite simplified and does not take into account the details of local damage, this systematization proves its importance in the distribution of patient flows in disaster conditions, thereby increasing the efficiency of medical care.

• according to the predominant clinical component of shock;
• according to the picture of toxinemia;
• according to the ratio of local damage, injuries to internal organs and the severity of the toxic-shockogenic component.

However, these scales are of little use for quickly assessing the condition of patients, as they slow down the provision of assistance through laboratory and instrumental studies.

Before diagnosing and analyzing the clinical picture, it is important to assess which stage a particular DDS belongs to:

• Early period- lasts less than three days from the moment the patient is removed from under the compressive objects. This stage is characterized by the development of complications characteristic of shock, with the addition of acute renal failure.
• Interim period- lasts 3-12 days. The clinical picture of acute renal failure develops completely, reaching the terminal stage. The general clinical picture is expressed by obvious demarcation zones and the volume of damage.
• Late period- lasts from 12 days to 1-2 months. It is a period of reparation (recovery): no violations of vital functions have occurred, the body mobilizes compensatory capabilities. The duration of the period up to two months is arbitrary - the duration depends on which structures are damaged and how seriously they are damaged, as well as how adequate the treatment is provided.

Complications of compartment syndrome

The severity of crash syndrome and the likelihood of its outcome depend on the complications that arise. The main complications of DFS include:

The chronology of complications plays a leading role in long-term compartment syndrome, explaining many clinical patterns.

Due to the severity of the damage, favorable conditions arise for the development of “intensive separation” problems:

• distress syndrome (respiratory failure);
• fatty, air and thromboembolism (blockage);
• disseminated intravascular coagulation syndrome;
• nosocomial pneumonia.

These complications do not always occur with SDS, but their manifestation often causes the death of a large percentage of victims.

Also, with DDS, local complications of wounds occur:

• wound infection with the addition of anaerobic flora;
• destruction (destruction) of the anatomical structure: severe and poorly drained extensively scalped wounds, multiple “pockets”, detachments, ischemic foci.

The local status of wounds in long-term compartment syndrome always raises concerns and has an unfavorable prognosis, even with the condition of complete and timely surgical treatment. Healing of wounds, open fractures, and damage to internal organs occurs with significant difficulties due to the accompanying shock. The phenomenon of mutual burden is clearly expressed.

Diagnosis of long-term compartment syndrome

The diagnosis of SDS is complex, that is, it can be established by adding and combining the components of the injury, taking into account its mechanism. Diagnosis of crash syndrome is preventive - it is of a cautionary nature. The doctor, taking into account the circumstances and conditions of the injury, determines SDS as the expected diagnosis.

Despite the severity and variety of clinical manifestations, DFS can present a challenge for many experienced specialists. This is due to the rare occurrence of the syndrome in peacetime.

Diagnosis becomes very difficult if the injury history is unknown. In this case, the only correct tactical decision for the surgeon is a cautious approach. It manifests itself in the assumption of SDS in the absence of contact with the patient, with polytrauma of unknown duration, severe segmental injuries with a compressive nature of the injury. Infected wounds, signs of compression of the extremities, and a discrepancy between the local manifestations of injury and the general condition of the patient may also indicate the likelihood of crash syndrome.

To detail the diagnosis, generally accepted research schemes are used: clarification of complaints, anamnesis, mechanism of injury, focusing on the duration of compression and activities preceding release from compression.

When collecting a life history, attention is paid to previous kidney diseases: glomerulonephritis, pyelonephritis, chronic renal failure, as well as nephrectomy (removal of a kidney or part thereof).

When assessing the objective status, a close examination of the patient is indicated to assess the severity of the damage. Clear consciousness, insignificance of complaints, the active position of the patient should not mislead the doctor, since it is possible that the examination is carried out during the “light” period, when the body is subcompensated and symptoms do not appear.

Objective parameters are assessed: arterial and central venous pressure, heart rate, respiratory rate, saturation, diuresis (urine volume). Laboratory screening is carried out.

The parameters of biochemical tests and “renal” markers are indicative: concentration of creatinine, blood urea, creatinine clearance. Early informative indicators will be blood ionic shifts.

Inspection of wounds and damage resulting from tissue compression is performed primarily. It is a therapeutic and diagnostic procedure that allows us to clarify the depth and extent of tissue destruction.

In order to exclude specialized injuries, narrow specialists are involved: urologists, neurosurgeons, abdominal surgeons, gynecologists.

For diagnosis, radiography, computed tomography and magnetic resonance imaging (optional) are also used. Patients are subject to continuous monitoring even if their condition was stable at the time of admission.

Treatment of compartment syndrome

The fundamental points in the treatment of crash syndrome are related to the release and evacuation of the victim. The correctness of the doctor’s actions at the scene of the incident largely determines the success of inpatient treatment.

Preliminary and most effective assistance depends on the stage of SDS. And although the general treatment of crash syndrome is complex, the priority method of treatment also depends on the stage of this condition.

Immediately after detection, the victim is given analgesics, including narcotic, antihistamines, sedatives and vascular drugs proximally, that is, closer to the area of ​​compression of the limb, and a tourniquet is also applied. Without removing the tourniquet, the damaged segment is bandaged with an elastic bandage, immobilized and cooled. After this initial amount of medical care has been completed, the tourniquet can be removed.

Then the wounds are cleaned and aseptic dressings are applied. Permanent venous access (peripheral) is established, and solutions are infused. Against the background of ongoing analgesia (relief of pain symptoms), the patient is transported to the hospital under the control of hemodynamic parameters (blood movement through the vessels). Treatment is effective in an intensive care unit. Puncture and catheterization of the central vein, continuation of infusion-transfusion therapy (introduction of necessary biochemical fluids) with transfusion of fresh frozen plasma, crystalloid and high molecular weight solutions are indicated. Plasmapheresis, hemodialysis (purification of blood outside the body), oxygen therapy, hyperbaric oxygenation (treatment with high pressure oxygen) are performed.

Based on the indications, symptomatic treatment is also carried out. Continuous monitoring of diuresis, heart rate, pulse, and central venous pressure is carried out. Control the ionic composition of the blood.

The effectiveness of general measures directly depends on local surgical treatment. There are no universal schemes for treating wounds and managing the victim. Active prevention of compartment syndrome (swelling and compression of muscles in fascial sheaths) is carried out, including early implementation of subcutaneous fasciotomy.

Assessing tissue viability during primary surgical treatment can be difficult: the lack of delineation between healthy and damaged areas, borderline and mosaic perfusion disorders (blood release through body tissues) keep surgeons from taking radical actions.

In case of doubt, amputation of the limb with dissection of most of the fascial sheaths, additional access for adequate examination, drainage, application of delayed sutures or packing of the wound is indicated.

The clinical picture of local damage is poor in the initial period of DFS. Therefore, there is a need for a secondary examination of the wound or revision of the limb after 24-28 hours. Such tactics make it possible to sanitize (clean) the emerging foci of necrosis against the background of secondary capillary thrombosis, assess the viability of the tissues and the segment as a whole, and adjust the surgical plan.

Forecast. Prevention

The prognosis of DFS depends on the duration of compression and the area of ​​compressed tissue. The number of deaths and the percentage of disability predictably decreases depending on the quality of medical care, the experience of the surgical team, the equipment of the hospital and the capabilities of the intensive care unit.

Knowledge of the pathogenesis and stages of crash syndrome allows the doctor to select a priority treatment method according to the situation. In a significant number of cases, with the exception of severe forms of the syndrome, this leads to functionally favorable outcomes.

Landslides, earthquakes, traffic accidents, explosions - these events can cause the development of crash syndrome. This syndrome develops as a result of prolonged compression of the trunk and limbs. There is a violation of blood circulation, oxygen starvation of tissues. A person experiences a decrease in blood pressure, vascular spasms, and lethargy. After release, crash syndrome is determined by a weak pulse, bluish skin, and poor sensitivity.

First aid for long-term compartment syndrome involves ensuring free access of oxygen and calming the victim. You can give him water and painkillers. A person is not suddenly released from pressure factors. A tourniquet is first used in the affected area so that the release is gradual. The syndrome can be mild, moderate, severe or very severe depending on the time of compression.

Prolonged compression of the limbs and torso leads to impaired blood circulation in these areas. Blood does not flow, oxygen starvation of tissues develops, cells die. Necrotic areas release decay products - essentially poison. Dehydration aggravates the condition. The problem becomes more acute the more time passes before help arrives. When blood flow is resumed, cardiac, pulmonary, and renal failure rapidly develops. Even without damage to internal organs, fractures or other associated injuries, a favorable outcome with a large area of ​​soft tissue damage tends to zero.

Signs of the syndrome

The clinical picture can be divided into two stages - before the person is freed from the rubble, the compressive object is removed, and after these factors are eliminated.

In the first phase, traumatic shock develops. Loss of blood from wounds or plasma due to swelling and muscle crushing leads to a decrease in the total amount of circulating blood, lowering blood pressure. Severe, prolonged pain and panic increase stress. The body begins to fight. To increase pressure, the endocrine glands secrete cortisol, adrenaline, and other vasoconstrictors.

On the one hand, this helps to increase blood pressure, but there is a downside - spasm of blood vessels that are already clogged with blood clots. Blood circulation changes, with priority given to the brain, heart, and lungs. All peripheral organs and tissues suffer, including the kidneys, up to anuria. The body cannot cope with the damage, an increase in the amount of endorphins further reduces blood pressure, and indifference and lethargy develop.

After eliminating the compressive factors, symptoms of a disease called crash syndrome, traumatic rhabdomyolysis, and Bywaters syndrome develop. Locally in the affected area, a bluish appearance of the skin is observed, the pulse is difficult to palpate, and in severe cases is completely absent. Then bubbles with liquid appear, sensitivity is weakened. In general, the body shows signs of severe poisoning.

First aid

The procedure for providing first aid to victims of long-term compartment syndrome has two phases.

Phase 1 involves performing certain actions. Before the arrival of rescuers who must free the victim, it is necessary, if possible, to check the victim’s respiratory tract and make sure there is oxygen access. Reassure, morally support the person, say that help is close. You should check for visible damage and touch the stomach. A hard belly indicates injury to internal organs. If the stomach is soft, then there are no violations. In this case, you can and should give the victim plenty of fluids. You can give him water, if you have special rehydration products in your first aid kit, it’s better to feed him with them.

If you have soda, salt and water, mix them (1 tsp per liter of water). This solution is effective against dehydration. The crushed limb must be cooled to slow down the process of cell destruction. To do this, you can use cold water bottles, ice or snow in the cold season. Painkillers and drugs to support the functioning of the cardiovascular system are allowed. Every person can provide emergency first aid.

The beginning of measures to release the compressive object marks the transition to the second phase of assistance for SDS. It seems logical that the sooner you free the victim, the faster relief will come. This is not an entirely correct assumption. Quick release in this case is tantamount to murder, since it is after the compression is removed that intoxication processes begin, affecting the heart, lungs, and kidneys. To prevent this, it is necessary to apply a tourniquet above the affected area. According to the rules, a note must be attached to the tourniquet indicating the time of its application.

The main task is to gradually free the limb from the compressive object and apply a bandage. When providing assistance, applying a bandage for crash syndrome, we replace one compression with another. Therefore, it is better to use an elastic bandage, since a gauze bandage will not create the necessary pressure. If there is no damage to the arteries after ligation, the tourniquet should be removed. Next, the limb is immobilized, that is, fixed with a splint. The administration of potent analgesics and local cooling are indicated. The patient is ready for transportation to a medical facility, which is recommended to be done as quickly as possible.

A complex of correctly, fully and timely first aid for this syndrome, coordinated actions of rescuers and doctors professionally conducting the stages of primary care, increases the likelihood of a successful outcome by 40%. The basic principle of first aid: compressive objects are replaced with compressive bandages.

Degrees and stages of the syndrome

The degree of severity is determined by two criteria:

1. the weight of the press exerting pressure;
2. exposure period.

The following stages of the syndrome are distinguished:

• mild (compression time – up to 4 hours, with a small affected surface);
• medium (compression of one limb for 4-6 hours);
• severe (duration of compression - 6-8 hours, localized to one limb, disturbances in the functioning of the kidneys and heart);
• very severe (massive body damage, compression for 8 hours or more, traumatic shock, organ failure).

During the course of the disease the following stages are observed:

• The first three days are considered the early stage. It is accompanied by symptoms such as pain, the development of traumatic shock, swelling of damaged tissues, the appearance of blisters with serous contents, and impaired sensitivity.
• Intermediate conditionally begins on the 4th day and can last until the 20th. The decisive period during which swelling increases, failure of internal organs and acidosis are possible. The patient's condition is serious and unstable.
• The recovery stage begins with normalization of kidney function. There is a long-term illness, a large, slowly healing wound surface, necrosis can lead to the development of sepsis.

Earthquakes, hurricanes, floods in mountainous areas, and major transport accidents cause the collapse of structures or trees. A person who has fallen under a rubble and is crushed by a weight experiences the so-called crash syndrome.

Crash syndrome is toxic poisoning by waste products of one’s own body in an injured part of the body that is under pressure from a heavy object. If a person has fallen under a rubble and is crushed, it is necessary to free him as soon as possible in order to preserve his health and life. The sooner first aid is provided for long-term compartment syndrome , the greater the chance a person has of avoiding serious complications or death.

The main causes of crash syndrome are massive loss of plasma due to its release through damaged vessels, as a result of which edema and thrombosis of small vessels develop; disruption of metabolic processes in damaged tissues, intoxication of the body with decay products; strong pain.

In case of crash syndrome, you need to try to free the victim from the rubble as quickly as possible and take him to a medical facility.

The main clinical picture of SDS, long-term compression syndrome caused by a blockage, is usually similar to mechanical injuries of the body: fractures, bleeding, hematomas, edema.

What to pay attention to

When providing assistance, a non-specialist must pay attention to the following signs and conditions of the victim:

• fever and chills (may indicate a urinary tract infection);
• decreased blood pressure, decreased heart rate (with cardiovascular failure);
• loss of consciousness, shock.

With such symptoms, you need to try to free the victim from the rubble as quickly as possible, provide first aid, and take him to a medical facility to begin intensive therapy. With strong, prolonged compression, by the end of the first week there is an increase in symptoms of intoxication:

• lethargy and lethargy develops;
• nausea, vomiting;
• motor restlessness increases;
• depression, psychosis, fear;
• delirium may begin.

Head injuries require special care when extricating from the rubble.

Degrees of crash syndrome

Easy degree	Average degree	Severe degree	Severe degree
Compression of small areas, short in time, no more than 4 hours. No impairment of the kidneys or cardiovascular system.	Compression of the soft tissues of both extremities for no more than 6 hours. Mild kidney damage. Symptoms of damage to the cardiovascular system are not expressed.	Compression for more than 6-7 hours. Symptoms of kidney failure, Disruption of the circulatory system.	Occurs during major accidents or in places where it is difficult for the ambulance team to reach. Compression for more than 8 hours. Often leads to severe complications: heart attack, sepsis, death

The severity of the lesion also depends on:

• from localization: compression of the head, thoracic region, abdomen, pelvic organs, limbs;
• associated pathologies: injuries to internal organs, fractures, chronic pathologies, damage to nerves and large blood vessels.

First aid: algorithm - instructions

First aid depends on the condition of the victim, the complexity of the injuries, and the duration of crushing of the limbs or the entire body under the rubble. Basic actions of a rescuer in case of crash syndrome:

Action	Description
	Remove the victim from under the rubble.
	Clear your mouth and respiratory tract of foreign objects.
	Move to the safest place, cover with a warm blanket.
	The sequence of assistance depends on the degree of injuries and their location (extremities, head) of the victim. Examine the head for damage to the skull bones and compression of the brain.
	Lay the victim on the ground and place a cushion around the neck to reduce head movement. The roller can be rolled out of clothing.
	If necessary, carry out resuscitation measures.
	When restoring heart function and breathing, treat wounds and abrasions on the head.
	When treating wounds on the head, you cannot remove stuck foreign objects or fragments of skull bones from them, so as not to damage the brain. It is enough to apply a clean bandage and take the victim to the hospital or call an ambulance as quickly as possible
	Inspect wounds and cover abrasions with sterile napkins, bandages (for example, from a driver’s first aid kit), clean napkins, handkerchiefs, or a piece of cloth.
	If the victim begins to experience severe swelling of the tissues, it is necessary to unbutton, cut, and tear the clothes in this place to prevent further compression of the body.
	If possible, apply cold to the affected area of ​​the body to reduce swelling.
	If there is bleeding, apply a hemostatic tourniquet or a homemade twist.
	Be sure to write a note about the time the tourniquet is applied. If you don’t have paper or pencil, you can write on your clothes with blood. Further medical care in the hospital will depend on this information.
	Doctors recommend applying a tourniquet to injured limbs above the point of compression, even if there is no bleeding, even before the person is freed from the rubble, especially if a significant amount of time has passed since the injury.
	Important information: Applying a tourniquet will prevent a sudden flow of potassium from the blood plasma to the myocardium (heart muscle), which can prevent collapse, a fatal arrhythmia. If the victim develops gangrene or the limb is almost completely lost, the tourniquet is left in place for a long time, or is removed only in a medical facility.
	Immobilize (immobilize the damaged limb) with any available material or tie it to a healthy limb.
	Provide the victim with plenty of fluids to quickly remove toxins from the body.
	Give a painkiller (Analgin, Baralgin, Ketanov).
	If the heart and breathing stop, emergency resuscitation measures must be carried out: artificial respiration and chest compressions - do 15 chest compressions for every two breaths

The video for this article is an illustration of doctors who briefly tell and show how to behave with the victim, how to properly provide emergency first aid.

What happens next

Further assistance is provided by professional rescuers, ambulance or air ambulance paramedics, and hospital doctors. The main assistance provided by a hospital doctor:

• infusion therapy, hemodialysis;
• plasmaphoresis, hemosorption;
• psychological correction.

In some cases, surgical treatment is performed involving the removal of necrotic tissue areas or amputation of the affected limbs.

Immediate provision of first aid for long-term compression syndrome is a guarantee of restoration of health, the ability to avoid amputation, and save life. Particularly quickly, first of all, it is necessary to provide assistance to children who have suffered from prolonged compression, because they endure pain more severely, become hypothermic faster, and are more injured.

As a result of exposure of a person's soft tissues to heavy objects for several hours, long-term compression syndrome begins to develop. In medical practice, this condition has several definitions: crash syndrome, traumatic toxicosis, positional syndrome or compression syndrome.

Long-term compression syndrome, for which first aid is of paramount importance, appears in people who have been in the area of ​​earthquakes, rubble, collapses, and car accidents.

Positional compression is also distinguished, which develops due to a person’s prolonged stay under the influence of a compressive factor or the gravity of his own body in a state of sleep or unconsciousness. Most often, this condition occurs as a result of taking alcohol or drugs, when a person cannot control the level of danger.

A characteristic feature of SDS is the development of pathological changes after the removal of severity from the patient’s body. At this moment, active restoration of the stopped blood flow begins, in which tissue breakdown products have already accumulated.

Clinic and its manifestations

In case of long-term compression syndrome, the main criterion for the development of pathology is massive damage to muscle tissue, which occurs for the following reasons:

• Damage and subsequent cell death due to the traumatic factor itself;
• Lack of blood flow through the compressed muscle;
• Cell hypoxia resulting from hemorrhagic shock.

Note!

At the moment of compression of the muscle, there is no crash syndrome. Their manifestations begin after the injured person is released from under heavy objects.

Constricted or crushed vessels and muscles, in which their decay products have accumulated, open up. All toxic substances rush through the bloodstream. Having reached the kidneys, a special muscle protein (myoglobin) blocks the tubules of the organ, preventing urine from being produced.

A few hours are enough for tubular necrosis to occur, and irreversible processes in the kidneys begin, the result of which will be.

First honey assistance will depend on the length of time the body remains under the rubble.

There are 3 stages of pathology development:

• Early (characteristic symptoms appear in the first three days);
• Intermediate (manifestations last one and a half months);
• Late (time period until complete recovery).

Each of these periods has characteristic symptoms and features of their manifestation.

After properly provided emergency care for long-term compression syndrome in the late period, the body begins to independently reject dead tissue and restore the functioning of all vital organs.

In particularly severe cases, surgical removal of necrotic tissue is required.

The specifics of care for long-term compartment syndrome will depend on several other factors:

• Type: crushing or squeezing;
• Location: chest, pelvis, abdominal area, limbs;
• Combination of injury with complications: violations of the integrity of internal organs, large vessels and nerves;
• The severity and area of ​​damage;
• Combination with other injuries: poisoning, etc.

When providing primary care, it is mandatory to determine the severity of injuries.

Doctors distinguish 4 degrees:

1. Easy. The compression lasts no more than 3-4 hours. It has the most favorable prognosis, since renal dysfunction is insignificant.
2. Average. The duration of exposure to gravity is 5-6 hours. Fatalities are about 30%;
3. Heavy. Development of necrosis due to 7-8 hours of being under rubble. There are always serious complications. Mortality accounts for up to half of all cases.
4. Very severe degree is characterized by compression of large areas of the body for more than 9 hours. A fatal outcome is inevitable within a day after liberation from the rubble.

Specifics of urgent measures

First aid for long-term compartment syndrome has a number of characteristic features.

Note!

Its main feature is a categorical prohibition on releasing a person from under a heavy object without first applying a tourniquet or a pressure bandage.

Apply above the damaged area and only after that remove the weights. If this rule is violated, the released toxins will immediately begin to spread through the systemic bloodstream, causing irreversible damage to the kidneys and liver. Then there will be no need to provide medical care: the victim will die.

If the limbs are compressed, first aid consists of completely immobilizing them.

The general algorithm for providing first aid comes down to the following actions:

• Secure the injured part with a tourniquet or bandage above the injury site;
• Give to prevent painful shock (if possible, administer it intramuscularly);
• Release the victim from the effects of heavy loads;
• Cool the affected part of the body;
• Open wounds will require disinfection;
• Remove the tourniquet;
• Apply a pressure bandage using the same principle;
• Immobilize the limb;
• If there are no signs of abdominal injury, the patient is given warm, generous fluids;
• To prevent cardiovascular disorders, prednisolone can be given to the victim.

Note!

Long-term use of a tourniquet is allowed only in case of arterial bleeding or obvious signs of incipient gangrene.

Immediately after the actions taken, you need to write a note indicating the exact time of application of the device.

Further first aid for prolonged compression is provided in a health care facility, where the victim is taken on a stretcher.

Long-term compartment syndrome (LCS)- one of the most severe types of injuries that occur during various accidents and natural disasters as a result of rubble, destruction of buildings, and landslides. It is known that after the atomic explosion over Nagasaki, about 20% of the victims had more or less pronounced clinical signs of prolonged compression or crush syndrome. The development of a syndrome similar to compartment syndrome is observed after removal of a tourniquet applied for a long time. This condition is called crash syndrome or long-term compression syndrome.

When reading a large amount of educational literature, I noticed that a tourniquet or twist (analogous to a tourniquet) is mentioned everywhere. I still do not recommend using a tourniquet. This is what our paramedic Elena Bednarskaya, who has extensive experience, writes; and understanding all the difficulties of working with a tourniquet, for a person who is unprepared, or, even worse, who thinks that he is definitely prepared, but in fact, he just read the information on the Internet.

Note “Life Safety. Territory of Rus'".

Due to the fact that evil spirits attack and bomb only residential buildings, people may end up under the rubble. If a person is under a rubble, then long-term compression syndrome is inevitable. This syndrome is considered one of the most severe types of injuries; it can also be complicated by fractures, bleeding, TBI (traumatic brain injury), and other “joys”. Signs of long-term compression syndrome: the damaged limb swells greatly, has an atypical shine for a healthy one, is bluish, cold to the touch, the skin may be covered with blisters, and with prolonged compression, the skin turns black. What to do if you find a person in the rubble? Firstly, the minimum number of people who can provide PMP (first aid) is two. Why two?! The algorithm for providing primary care for long-term compression syndrome involves working in pairs. The algorithm itself is as follows:

First aid is provided at the scene of the incident. Elimination of pain and reduction of psycho-emotional stress in victims at the source of the disaster should be carried out at the first opportunity, even before releasing them from the compressive factor. For the purpose of pain relief, a 2% -1.0 solution of promedol, 50% - 2.0 analgin, and sedatives are administered. If there are no signs of damage to the abdominal organs, give 40 - 70% alcohol to drink. If possible, freeing the victim begins with the head and torso. At the same time, they are fighting asphyxia (giving a comfortable position, cleaning the upper respiratory tract, artificial ventilation). Measures are taken to stop external bleeding.

1. do not suddenly lift the object, causing compression, we lift part of it and quickly bandage the limb with an elastic bandage, namely elastic, if not at all, only then with gauze, but this is much worse, i.e. The task is to release the limb in parts and at the moment of release, quickly bandage it. Why is this so? When squeezed, a huge amount of toxins accumulate in damaged tissues, blood supply is disrupted, etc. They abruptly removed the object: all these toxins flow into the muscles, shock develops just before our eyes, so proper and quick dressing can save the victim.

2. apply cold to the injured limb, Just bottles of cold water will do;

3. place soft material under the limb(clothes, blanket, etc.);

4. during transportation, we monitor the condition of the victim;

5. if the stomach is “soft”, i.e. there is no damage to internal organs, we give the victim plenty of warm drink with the addition of baking soda - this will save his kidneys. How is a soft belly different from a “hard” one? You just need to feel the stomach; if there are injuries to internal organs, then the stomach will be very hard.

Experience shows that some people’s lives can be saved even after compression of body parts for several days, while others die after a few hours.

After releasing the victim from the rubble, it is necessary to determine the degree of disruption of the blood supply to the tissues, on which the correctness of further actions to provide medical care depends. This is easy to do if you know the signs of the four degrees of ischemia.

First degree- compensated ischemia, which, despite prolonged compression, did not lead to disruption of blood circulation and metabolism in the compressed limb. With such ischemia, active movements are preserved, i.e. the victim can independently move his fingers and other parts of the compressed limb. There is tactile (touch) and pain sensitivity. We use elastic bandages.

Second degree- uncompensated ischemia. With such ischemia, tactile and pain sensitivity is not determined, there are no active movements, but passive ones are free, i.e. You can bend and straighten your fingers and other parts of the injured limb with light efforts from the helping hand. There is no rigor mortis of the muscles of the compressed limb. We use elastic bandages.

Third degree- ischemia is irreversible. Tactile and pain sensitivity are also absent. The main symptom appears - loss of passive movements, rigor mortis of the muscles of the compressed limb is noted. With such ischemia, the tourniquet cannot be removed.

Fourth degree- necrosis (death) of muscles and other tissues, which ends in gangrene. In this case, the tourniquet should not be removed either.

After the issue with the tourniquet is resolved, it is necessary to apply aseptic dressings to the existing wounds and immobilize the limb using standard splints or improvised material. If possible, cover the injured limb with ice packs or cold water heating pads, warm the victim and give him an alkaline drink. After first aid is provided, all measures must be taken to quickly evacuate the victim to a medical facility. It is better to transport him lying on a stretcher, preferably accompanied by a medical professional.

REMEMBER! If within 15-20 minutes it was not possible to free the crushed limbs, then you should stop any attempts at liberation and wait for the arrival of rescue services.

REMEMBER! Before the arrival of rescuers and ambulances, you should cover your limbs with ice or snow packs, apply tight bandages (if you have access to them) and provide plenty of warm fluids.

UNDER NO EVENT CAN YOU!

Release pinched limbs

after 15-20 minutes after their compression

without the participation of rescue services.

UNACCEPTABLE!

Release the compressed limb before applying protective tourniquets

and administering large amounts of fluid to victims.

Warm crushed limbs.

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GUNSHOT WOUNDS

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