Positional compression syndrome is an injury associated with prolonged squeezing of a limb by heavy weight. Such injuries occur quite often as a result of accidents, earthquakes, as well as collapses of buildings. The named syndrome is associated with complex injuries, the treatment of which is quite lengthy and time-consuming.
Causes of the Syndrome
In addition to emergencies, positional compression syndrome can be obtained as a result of a prolonged stay in an uncomfortable position, when the limbs are compressed by the weight of their own body. As a result of this, tissue necrosis may occur with the release of toxins. This can happen if a person is for a long time in an unconscious state or in a static position (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 treatment methods. If the diagnosis was made incorrectly or the person received incomplete treatment, and first aid was not provided, the prognosis is disappointing, since patients usually have irreversible trophic and neurological consequences.
Main types
Positional compression syndrome is classified immediately according to several criteria:
- type of compression;
- localization
- damage to other organs;
- the presence of complications;
- severity.
In terms of severity, this syndrome is divided into mild, moderate and severe:
- A mild degree is characterized by the fact that the damage area and its depth are small. The general manifestations of intoxication are insignificant; small kidney disorders are also observed, which quickly recover. Urine for some time has a reddish-brown hue. All indicators normalize after 5-7 days of intensive treatment in a hospital.
- The average degree is characterized by the presence of more extensive lesions. At the same time, intoxication is moderate. A blood test shows an increase in the level of residual nitrogen and urea. In case of untimely first aid, at this stage serious complications and the development of infection can occur.
- The third degree is characterized by significant damage to several zones, and severe intoxication can even lead to death.
What happens in the body with prolonged compression
When crushing a certain part of the body, there is a violation of the blood supply to tissues below this area. Often limbs suffer. Tissues are severely damaged, oxygen starvation is observed, a numb leg or arm loses its sensitivity and necrosis gradually begins with the release of many toxic substances.
Often, even at the time of injury, severe destruction of muscle tissue occurs, bone fractures, damage to the vascular system, resulting in bleeding. Also, a person feels severe pain, as a result of which even traumatic shock can occur.
Symptoms of the Syndrome
Symptoms of the syndrome of positional compression directly depend on the time of compression and the volume of affected tissues. For example, when squeezing the area of the forearm for 2-3 hours, acute renal failure will not be observed, although there may be a decrease in urine output. There are also no manifestations of intoxication. Such patients recover very quickly without any consequences.
At this stage, pallor, severe weakness, tachycardia are observed. The most dangerous in this case will be the extraction of the injured person from under the debris, since during normalization of blood circulation, intense production of potassium occurs, which can cause cardiac arrest. The initial period is characterized by such signs as:
- a numb leg or arm is not functioning;
- the skin is pale and cold;
- there are bubbles;
- pulse is practically absent.
In addition, bone fractures are often diagnosed.
Prolonged compression lasting up to 6 hours leads to the occurrence of moderate disorders. In this case, 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 toxic poisoning occurs, and the kidneys turn off completely. Without a powerful intensive care and hemodialysis, a person dies.
Diagnostics
You can determine if there is a problem right at the scene. If the victim has pain shock, then he may be in an unconscious state. 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 can help determine a decrease in protein concentration.
During the initial studies, there may be no changes in the urine, however, gradually it begins to acquire a somewhat brownish color, and an increase in density is also observed, and protein appears in it. With a microscopic examination, white blood cells, red blood cells and cylinders are determined.
First aid
First aid for compression syndrome depends largely on who provides it, as well as the availability of required measures, the availability of qualified medical personnel. Professional doctors and rescuers by their actions improve the prognosis for the patient.
First of all, the victim must be delivered to a safe place. Abrasions and wounds revealed during a surface examination must be treated and special aseptic dressings applied to them. If there is bleeding, you need to take measures to stop it, apply immobilizing tires or other improvised means to the fractures. If at this stage it is impossible to ensure the introduction of intravenous infusion, then the patient must be provided with plenty of water.
A tourniquet must be applied to the affected limb even before the person is released from the rubble in order to prevent the active release of potassium. An analgesic is then administered and the patient must be taken to the hospital for further treatment.
Which doctor to contact
If you suspect the presence of prolonged compression syndrome, you should immediately consult a traumatologist. Additionally, an examination by a nephrologist, cardiologist, dermatologist and neurologist may be necessary. Since pathology leads to various complications, the patient needs to conduct a comprehensive diagnosis.
Treatment
Treatment should be comprehensive, and its feature depends on the duration of the course of the disease. An injection of frozen plasma, as well as detoxification agents, is mandatory. During acute renal failure , daily hemodialysis is performed. Compliance with a special diet with limited drinking regimen and exclusion from the usual diet of fruits is also shown. Be sure to observe preventive measures for the occurrence of purulent complications and sepsis.
Patients may have 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.