Presentation on the topic: Prolonged Compression Syndrome. Presentation Prolonged Compression Syndrome Prolonged Compression Syndrome Presentation

I degree - slight swelling of soft tissues, the skin is pale, on the border of the lesion it bulges over the healthy one. There are no signs of circulatory disorders. II degree - moderate indurative edema of soft tissues and their tension. The skin is pale, with areas of cyanosis. After 24-36 hours, bubbles with a transparent yellowish content are formed. Violation of venous circulation and lymph outflow leads to the progression of microcirculation disorders, microthrombosis, increased edema and compression of muscle tissue. III degree - severe swelling and tension of soft tissues. The skin is cyanotic or "marbled". After 12-24 hours, bubbles with hemorrhagic contents appear. Inductive edema and cyanosis rapidly increase, which indicates gross violations of microcirculation, vein thrombosis, leading to a necrotic process. IY degree - inductive edema is pronounced, the tissues are sharply tense. The skin is bluish-purple in color, cold. Epidermal blisters with hemorrhagic contents. Edema practically does not increase, which indicates profound disturbances in microcirculation and insufficiency of arterial blood flow.

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Stages of development of the syndrome

Bywaters was able to identify three consecutive
stages leading to the development of a crash syndrome:
limb compression and subsequent necrosis
fabrics;
the development of edema at the site of compression;
the development of acute renal failure and
ischemic toxicosis.

Syndrome pathogenesis

Bywaters syndrome results from
compression of the limb, damage to the main
vessels and great nerves. Similar trauma
occurs in about 30% of people affected
as a result of natural or man-made
disasters.
In the pathogenesis of this disease, the leading role
have three factors: regulatory, associated with
painful effect on the body, a significant
plasma loss and, finally, tissue toxemia.

Pain factor

The painful effect affects a person who is caught
under
blockage,
most
strongly.
It is noted
reflex peripheral vasospasm
organs and tissues, which leads to disruption
gas exchange and subsequent tissue hypoxia.
Vascular spasm and developing hypoxia
cause dystrophic changes in tissues
kidney, blood filtration drops significantly.

Plasma loss factor

Plasma loss develops soon after injury and
even after eliminating the cause of the squeezing.
Plasma loss
bind
with
increase
capillary permeability against the background of injury, which
leads to the release of blood plasma from the bloodstream.

Toxemia factor

V
location
damage
is developing
edema,
numerous hemorrhages, outflow of blood from
the compressed limb is disturbed, up to
complete blocking. As a result, it develops
ischemia
limbs,
v
tissues
strenuously
products of cellular metabolism accumulate and
etc. After the restoration of blood circulation, they
"In one gulp" begin to enter the vascular bed.
At this point, a number of symptoms appear,
characteristic of ischemic toxicosis.

The severity of the syndrome

Mild - compression of a small segment
limbs for no more than two hours. V
in this case, toxemia is mild, although
there is acute renal failure and
hemodynamic disorders. In most cases
with timely therapy, improvement
comes within a week.

The severity of the syndrome

Average
degree
arises
at
squeezing
whole limbs for four hours.
Similar
condition
characterized by
intoxication, myoglobinuria and oliguria.

The severity of the syndrome

Prolonged limb compression (4-7 hours)
leads to the manifestation of symptoms characteristic of
severe Bywaters syndrome. Are noted
essential
violations
hemodynamics,
symptoms of intoxication are expressed, quickly
acute renal failure develops.
Untimely
and
wrong
rendering
medical care in most cases leads
to death.

The severity of the syndrome

Extremely severe crash syndrome. Such
the diagnosis is made with compression of the lower extremities
for 8 or more hours. Developing
ischemic toxicosis will be detrimental to
patient shortly after decompression.
The mortality rate of such patients is extremely high even with
conducting timely treatment.

First aid for rescue operations

Carry out
anti-shock
activity:
introduce
analgesics,
drugs
for
normalization
blood pressure.
After releasing the injured limb into place
squeezing, a tourniquet is applied, which helps not
admit
"Salvo"
ejection
accumulated
toxic substances into the bloodstream.
After moving the victim and eliminating
compression, the limb is bandaged with an elastic
bandage, and only then remove the tourniquet. Also
cooling of the injured limb is recommended.

Syndrome treatment

For mild surgical treatment syndrome
do not carry out, often such patients are treated
outpatient.
With moderate severity of hemodynamic disturbances
expressed quite clearly, however, the surgical
treatment in this case is not always indicated. Held
therapy of acute renal failure.
In severe and extremely severe cases
the severity of the crash syndrome conservative treatment
ineffective and surgical treatment is necessary.
In parallel, acute renal therapy is carried out
failure.

Syndrome
Bywaters
was
highlighted
how
nosological unit not so long ago - only in
the middle of the 20th century. Upon salvation and subsequent
treatment
affected
with
heavy
compression
injuries
are important
coordinated actions of rescuers and doctors.
Quickly retrieving people from the rubble and starting
carrying out therapy even before removing the press
minimizes the severe effects of compression
limbs and helps to save the patient's life.

Slide 1

INJURY. DIAGNOSTICS. TREATMENT. LONG-TERM PRESSURE SYNDROME. Department of General Surgery SOGMA Lecture:

Slide 2

Trauma is the impact on the body of external factors (mechanical, thermal, electrical, radiation, etc.) that cause disruption of anatomical structures, physiological functions in organs and tissues and are accompanied by a general and local reaction of the body.

Slide 3

Injury is the prevalence of injuries in certain populations under similar conditions. Distinguish: Industrial - industrial - agricultural Transport - automobile - railway Military Sports Household Each of these types of injuries is caused by certain factors and has its own characteristic features. So, in industrial and military wounds, wounds prevail, and in sports - bruises and sprains.

Slide 4

CLOSED OPEN NONPENSIVE PENETRATING SINGLE MULTIPLE COMBINED COMBINED ACUTE CHRONIC INJURY

Slide 5

CLOSED INJURIES Contusions (contusio) are closed mechanical damage to tissues and organs without visible damage to the skin. They are accompanied by rupture of capillaries and hemorrhage into soft tissues. Clinical signs are pain, bruising, swelling, dysfunction, and possible hematoma formation. If the joint is bruised, hemarthrosis may occur, i.e. accumulation of blood in the joint. Principles of treatment: cold, pressure bandage, ointments that relieve swelling - troxevasin, indovazin, heparin ointment. With hemarthrosis, joint puncture with blood evacuation, immobilization, and physiotherapy are performed.

Slide 6

CLOSED INJURIES Sprain (distorsio) is a closed injury to the ligamentous apparatus of the joint without disrupting its anatomical integrity. In this case, there is a rupture of individual fibers of the articular bag and punctate hemorrhages. Clinically, stretching is manifested by an increase in the volume of the joint due to edema of the paraarticular tissues, pain, limitation of the range of motion in the joint. Principles of treatment: cold, surface anesthesia with chloroethyl or lidocaine, fixing bandage, plaster immobilization, application of ointments - finalgon, indomethacin, dolpig, fastum gel, physiotherapy.

Slide 7

CLOSED INJURIES Tissue ruptures (rupturae) - occur when the physiological limit of elasticity and strength of tissues, ligaments, tendons, muscles is exceeded. Clinically, ruptures are manifested by pain and loss of function, pathological mobility in case of rupture of ligaments, symptoms of blockade in case of damage to the menisci of the joint. Treatment of ruptures is only operative - restoration of anatomical continuity with local tissues or plastic surgery.

Slide 8

CLOSED INJURIES Concussion (commotio) is a mechanical effect on tissues, leading to a violation of their functional state without macroscopically visible anatomical disorders.

Slide 9

DISTRACTIONS Clinic - pain, lack of active and passive movements, edema, bruising or hematoma, hemarthrosis, forced position of the limbs, deformity in the joint area. The diagnosis is confirmed by X-ray

Slide 10

Dislocation (luksacio) is a persistent pathological displacement of the articular surfaces relative to each other, excluding active and passive movements. CLASSIFICATION Congenital Acquired Incomplete Complete Pathological Habitual Complicated Dislocations

Slide 11

DISCUSSION Treatment: Prehospital stage - transport immobilization with Kramer's, Dieterichs' tires, pneumatic tires, Dezo's fixing bandage, improvised means. The introduction of analgesics (and narcotic). In the hospital: after the diagnosis has been clarified, local anesthesia is performed with novocaine, lidocaine, ultracaine, the introduction of narcotic drugs and reduction, which is based on stretching and relaxing the muscles and repetition of movements characteristic of this joint. They use the method of Kocher and Dzhenilidze. After reduction, a control image is taken and fixation with a plaster splint for 1 - 2 weeks.

Slide 12

Slide 13

LONG-TERM PRESSURE SYNDROME The synonyms used to refer to this term are crash syndrome, traumatic endotoxicosis, tissue compression syndrome, myorenal syndrome. SDS is the development of intravital tissue necrosis, due to prolonged compression of a segment of the body, causing endotoxicosis and the development of acute renal failure.

Slide 14

PATHOGENESIS TISSUE ISCHEMIA MECHANICAL DESTRUCTION TRAUMATIC TOXEMIA METABOLIC ACIDOSIS MYOGLOBINURIA AND MYOGLOBINEMIA RENAL TUBULE BLOCKADE ACUTE RENAL INSUFFICIENCY

Slide 15

CLASSIFICATION By type of compression: crushing compression (direct, positional) By localization: isolated (one anatomical region) multiple combined (with fractures, damage to blood vessels and nerves, TBI). By severity: I Art. - light (compression up to 4 hours) II Art. - medium (up to 6 hours) III Art. - heavy (up to 8 hours) IY Art. - extremely severe (compression of both limbs for 8 hours or more).

Slide 16

I degree - slight swelling of soft tissues, the skin is pale, on the border of the lesion it bulges over the healthy one. There are no signs of circulatory disorders. II degree - moderate inductive edema of soft tissues and their tension. The skin is pale, with areas of cyanosis. After 24-36 hours, bubbles form with a transparent yellowish content. Violation of venous circulation and lymph outflow leads to the progression of microcirculation disorders, microthrombosis, increased edema and compression of muscle tissue. III degree - severe swelling and tension of soft tissues. The skin is cyanotic or "marbled". After 12-24 hours, bubbles with hemorrhagic contents appear. Inductive edema and cyanosis rapidly increase, which indicates gross violations of microcirculation, vein thrombosis, leading to a necrotic process. IY degree - inductive edema is pronounced, the tissues are sharply tense. The skin is bluish-purple in color, cold. Epidermal blisters with hemorrhagic contents. Edema practically does not increase, which indicates profound disturbances in microcirculation and insufficiency of arterial blood flow.

Slide 17

CLINIC I period - early (shock period) up to 48 hours after release from compression. The clinic is dominated by manifestations of traumatic shock: severe pain syndrome, psycho-emotional stress, hemodynamic instability, hemoconcentration, creatininemia, proteinuria and cylindruria. II period - the period of acute renal failure. Lasts 3 to 12 days. In the clinic, swelling of the extremities freed from compression is growing, blisters and hemorrhages are found on the damaged skin. Hemoconcentration is replaced by hemodilution, anemia increases, urine output decreases sharply, up to anuria. Hyperkalemia and hypercreatininemia reach the highest L-values - 35%. III period - recovery (3-4 weeks) Renal function, the content of protein, creatinine and blood electrolytes are normalized. Infectious complications come to the fore. The risk of developing sepsis is high. TREATMENT One of the first prehospital measures should be the application of a rubber tourniquet on the compressed limb, its immobilization and the administration of narcotic analgesics (promedol, omnopon, morphilong) to relieve pain and emotional stress. Slide 21

TREATMENT PERIOD II The composition and volume of infusions are adjusted depending on the daily diuresis, the degree of intoxication, acid-silk balance and the nature of the surgical intervention. Infusion-transfusion therapy is carried out in a volume of at least 2 liters per day: plasma, albumin, amino acids, sodium bicarbonate, glucose-novocaine mixture, glucose solution. Plasmapheresis is indicated for all victims who had compression for more than 4 hours, with signs of intoxication and local changes in the injured limb. HBO - 1-2 times a day in order to reduce tissue hypoxia. Forced diuresis - up to 80-100 mg of lasix against the background of the introduction of 3-4 liters of intravenous solutions. Antibiotic therapy Disaggregant therapy: heparin, courantil, trental The choice of surgical tactics - depending on the condition and degree of ischemia of the injured limb.

3 periods of the course of the syndrome of prolonged compression: 1. Early from the moment of release of the victim up to 24 - 48 hours. Ø General condition of the victim: - lethargy, indifference to the environment, but it may be preceded by speech and motor excitement; - thirst and vomiting (rare); - the limb becomes pale, cyanosis of the fingers appears, swelling rapidly increases, the skin acquires a woody density; - the pulsation of peripheral vessels is not detected; - with the deepening of local changes: pain syndrome develops, psychoemotional stress, blood pressure drops sharply. Ø The condition of the victim can rapidly deteriorate with the development of acute cardiovascular failure. Ø The victim may die from a sharp drop in blood pressure. If he survives, then the second period begins.

2nd period - intermediate (3 -7 days) Characterized by: the development of acute renal failure, as a result of blockage of the renal tubules by the decay products of dead muscles. Ø The body temperature rises, the victim's condition deteriorates sharply, lethargy and lethargy increase, vomiting and thirst, yellowness of the sclera and skin appear. Ø Pains appear in the lumbar region. Ø The swelling of the extremity that has been compressed increases, bubbles with transparent or hemorrhagic contents appear, areas of necrosis of the extremity appear. Ø If the patient does not die of renal failure, the 3rd period begins. 3 period - late or recovery period (3-4 weeks). Ø Renal function is normalized and complications from the affected limb - various suppurations - come to the fore. Ø In uncomplicated cases, limb edema and pain disappear by the end of the month.

Pathogenesis of SDS Through the bloodstream, oxygen is delivered to the tissues and the waste products (acid, carbon dioxide) are removed from them. The first occurs through the arteries, the second through the veins. If the blood supply is disturbed, oxygen is not delivered to the tissues and the toxic substance of metabolism accumulates in them. As a result, cells die first, then tissues, and then the whole organ. The longer ischemia lasts, the more tissue dies.

First aid for SDS The provision of PMP is carried out in two stages - before and after release from compression: Stage I: Cover the pressed limb with packets of ice, snow, cold water. Anesthetize (3-4 tablets of analgin, 2 capsules of tramal). Cardiovascular drugs (cordiamine, corvalol, nitroglycerin). Abundant warm soda - salt drink (1 teaspoon of baking soda + 1 teaspoon of salt to dissolve in 1 liter of water). Application of a tourniquet above the place of compression.

Stage II: Immediately after release, tightly bandage the injured limb (to create an additional restraining case). Slow release of the tourniquet. Mandatory immobilization of the limb. Repeated coldness to the limb. Take the patient to a warm, calm place, give him a hot drink, wrap him up well. Gentle and urgent hospitalization of the victim and only in the supine position.

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