SDS - prolonged compression syndrome: symptoms, treatment and prevention

Everyone is virtually immune from various accidents. It can be anything from a traffic accident to an earthquake and a collapse of a mine. In any of these cases, SDS may develop. The syndrome has various causes, pathogenesis, mandatory treatment is required. We will consider these questions further.

VTS concept

As a result of squeezing soft tissues, SDS can develop. The syndrome in women occurs with the same frequency as in the male population. It has other names, for example, crash syndrome or compression trauma. The cause of the syndrome may be:

• Compression of body parts with heavy objects.
• Emergency situations.

Such situations often occur after earthquakes, as a result of road traffic accidents, explosions, landslides in mines. The force of compression may not always be large, but here the duration of this state plays a role. As a rule, SDS (prolonged compression syndrome) occurs if there is a prolonged effect on the soft tissues, usually more than 2 hours. First aid is an important stage on which a person’s life depends. That is why it is important to be able to distinguish between the manifestations of this condition.

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 a landslide. Occurs as a result of prolonged exposure to a concrete slab or various heavy objects.
• Positional SDS develops due to compression by parts of one's own body.

Localization can also be different, hence the SDS is distinguished:

• Limbs.
• Heads.
• The abdomen.
• Breasts
• Pelvis.

After emergencies, SDS often develops. The syndrome is often accompanied by other injuries, therefore, there are:

• Compression syndrome, accompanied by injuries of internal organs.
• With damage to the bone structures of the body.
• VDS with damage to nerve endings and blood vessels.

The severity of the syndrome may be different. Based on this fact, they distinguish:

• A mild form of the syndrome, which develops when squeezing the limbs for a short time. Disorders from the cardiovascular system, as a rule, are not diagnosed.

• If the pressure on the tissue is more than 5-6 hours, then the average form of SDS develops, in which there may be mild renal failure.
• A severe form is diagnosed by squeezing for more than 7 hours. Signs of renal failure are pronounced.
• If the soft tissue is under pressure for more than 8 hours, then we can talk about the development of an extremely severe form of SDS. You can diagnose acute heart failure, which often leads to death.

It often happens when SDS (prolonged compression syndrome) is accompanied by various complications:

• Myocardial infarction.
• Diseases of various organ systems are fraught with SDS. The syndrome in women affecting the lower body, that is, the pelvic organs, is dangerous with severe complications and a disruption in the normal functioning of the organs of this sphere.
• Purulent-septic pathologies.
• Ischemia of a damaged limb.

Result of injury: VTS

Cause Syndrome has the following:

• Painful shock.

• Loss of plasma that passes through blood vessels into damaged tissue. 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 reasons must be eliminated as soon as possible in order to make possible the salvation of human life.

Periods of the clinical course of SDS

The course of the crash syndrome has several periods:

• The first is direct compression of the soft tissues with the development of traumatic shock.
• In the second period, local changes in the injured area and the beginning of intoxication are observed. 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. Its beginning from the moment of restoration of kidney functioning.
• Further, the victims reveal factors that speak of immunological reactivity, bactericidal activity of the blood.

Symptoms of tissue compression syndrome

If strong pressure on the soft tissues is not immediately eliminated, then SDS gradually progresses. The syndrome symptoms are as follows:

• The skin on the stiff limb becomes pale.
• Swelling appears, which only increases over time.
• Vascular pulsation is not palpable.
• The general condition of the victim is deteriorating.
• There is a pain syndrome.
• A person has psycho-emotional stress.

A blood test shows an increase in fibrinogen, decreases fibrinolytic activity, the blood coagulation system is also accelerated.

Protein is found in the urine, red blood cells and cylinders appear.

These are the manifestations of SDS. The syndrome is characterized by a relatively normal state of the affected if tissue compression is eliminated. But after a while, appear:

• Cyanosis and pallor of integument.
• Variegated skin color.
• Over the next day, swelling is increasing.

• Bubbles, infiltrates may appear, and in severe cases, necrosis of the limbs occurs.
• Cardiovascular failure develops.
• A blood test shows its thickening and neutrophilic shift.
• Tendency to thrombosis.

At this stage, it is important to conduct timely intensive infusion therapy using forced diuresis and detoxification.

Symptoms 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.

Symptoms at this time may appear as follows:

• The defeat of various organ systems.
• The development of renal failure.
• Swelling is getting bigger.
• On the skin, the appearance of blisters with a transparent or hemorrhagic content can be observed.
• Brightly begins to manifest anemia.
• Diuresis decreases.
• If you do a blood test, then the concentration of urea, potassium and creatinine increases.
• The classic picture of uremia with hypoproteinemia appears.
• An increase in body temperature of the victim is noted.
• General condition worsens.
• Inhibition and lethargy appear.
• May be vomiting.
• Staining of the sclera signals the involvement of the liver in the pathological process.

Even intensive care can not always save a person if diagnosed with SDS. Syndrome, if it reaches this period, then in 35% of cases leads to the death of victims.

In such cases, only extracorporeal detoxification can help.

Further development of VTS

The fourth period is convalescence. 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.
• Perhaps the development of sepsis.
• If there are no complications, then swelling begins to subside.
• How quickly joint mobility recovers will depend on the severity of the damage.
• Since muscle tissue dies, they begin to be replaced by connective tissue, which does not have the ability to contract, so atrophy of the extremities develops.
• Anemia still persists.
• The victims lack appetite.
• There are persistent changes in homeostasis, and if intensive infusion-transfusion therapy is used, they can be eliminated after a month of intensive treatment.

During the last period, a decrease in the factors of natural resistance and bactericidal activity of the blood is revealed in the victims. The leukocyte index remains changed for a long time.

For a long time, victims experience emotional and mental instability. Depressive states, psychoses and hysteria are frequent.

How to recognize VTS?

The syndrome, the diagnosis of which should be carried out only by a competent specialist, requires special attention and treatment. The presence of pathology can be determined on the basis of the following indicators:

• The clinical picture and circumstances of the injury are taken into account.
• The results of the analysis of urine and blood do not go unnoticed.
• Instrumental diagnostics are carried out, which allows you to compare the dynamics of laboratory symptoms and kidney structure.

People undergoing heart diagnostics sometimes hear this diagnosis, but not everyone understands what the syndrome is. VDS 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 is carried out with the aim of:

• Detection of the level of myoglobin in blood plasma: usually with this condition, it increases significantly.
• Determination of myoglobin concentration in urine. If the indicators reach 1000 ng / ml, then we can talk about developing acute renal failure in diabetes.
• The syndrome can also be manifested by an increase in blood transaminases.
• Creatinine and urea rises.

According to urine analysis, doctors determine the degree of kidney damage. The study reveals:

• An increase in white blood cells if there is a complicated SDS.
• The concentration of salts increases.
• Urea content is increasing.
• Cylinders are present.

A correctly diagnosed diagnosis allows doctors to prescribe effective therapy in order to help the victim recover all the functions of the body as soon as possible.

How to provide first aid?

The condition of the victim, and maybe his life, if SDS develops, depends on emergency assistance. Syndrome, first aid should be provided as soon as possible, will not lead to serious complications, if you help the victim according to the following algorithm:

1. Give an anesthetic.
2. Then begin to release the affected area of ​​the body.

As such funds are suitable: "Analgin", "Promedol", "Morphine". All drugs are administered only intramuscularly.

Many people ask why with a SDS syndrome to apply a tourniquet? 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 the harness.
• All existing wounds must be treated with an antiseptic and covered with a sterile cloth.
• Try to cool the limb.
• To the victim to give a plentiful drink, tea, water, coffee or soda-saline solution is suitable.
• Warm the affected person.
• If there are blockages, then a person must be provided with oxygen as soon as possible.
• To prevent heart failure, administer Prednisone to the victim.

• Send the victim to the nearest hospital.

Compression Syndrome Therapy

There may be varying degrees of severity of VDS. The syndrome, the treatment of which should be carried out comprehensively, will not cause serious complications, given the pathogenesis of damage. Comprehensive impact - this means:

• To carry out activities in order to eliminate deviations of homeostasis.
• To have a therapeutic effect on the pathological lesion.
• Normalize the microflora of wounds.

Treatment measures should be carried out almost continuously, from the time of first aid to the complete recovery of the victim.

If the injuries are significant, then medical care consists of several stages:

• The first begins directly at the scene.
• The second is assistance in a medical facility, which can be quite far from the place of the tragedy, which is why “flying hospitals” and “hospitals on wheels” are often used. It is very important that there is appropriate equipment to assist with damage to the musculoskeletal system, internal organs.

• In the third stage, specialized assistance is provided. This usually happens at a surgical or trauma center. It has all the necessary equipment to assist with serious damage to the musculoskeletal system or internal organs. There are resuscitation services for removing a person from a shock condition, treating sepsis or kidney failure.

Drug therapy

The earlier this stage of therapy is started, the more likely the patient is to survive. Medical assistance at this stage is as follows:

• The injured are infused with 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 3-4 liters of blood or a blood substitute are administered to the victims as an anti-shock measure.
• To prevent the development of complications, diuresis is performed with the introduction of Furosemide or Mannitol.
• Reducing the body's intoxication is achieved by replacing blood and using 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 and filtration (hemodialysis, ultrafiltration).
• Feretic (plasmapheresis).

Amputation of limbs, which cannot be returned to normal, may be required.

Is it possible to warn SDS?

If serious injury was not avoided, in most cases SDS develops. A syndrome, the prevention of which is mandatory, will not lead to disastrous consequences if you immediately start active action. For this, it is necessary to introduce antibiotics of the penicillin series. The use of antibacterial agents may not save from suppuration, but to prevent gas gangrene in this way is quite possible.

Even before the victim is removed from the rubble, it is important to start infusion therapy to normalize the BCC. Often, Mannitol, a 4% solution of magnesium bicarbonate, is used for these purposes.

If all these actions are carried out directly at the scene of the incident, then it is entirely possible to prevent the development of serious complications of diabetes, such as gas gangrene and renal failure.

We examined in detail SDS (Syndrome of prolonged compression) of internal organs by the mass of one's own body or by heavy objects. This condition often occurs in emergency situations. 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 field 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 this syndrome means. Often it affects women burdened with power. Selfishness, lack of self-criticism, a biased attitude towards men, confidence in one's own infallibility and similar “symptoms” are characteristic of SDS syndrome in women.