Long-term compression syndrome of the extremities occurs with prolonged compression of soft tissues; it is caused by the absorption of toxic substances and decay products of crushed soft tissues into the blood. Complaints: pain in the injured part of the body, nausea, headache, thirst. Visible: abrasions and dents. The skin is pale and cold to the touch. The injured limb begins to swell quickly within minutes of being released.
Having discovered a person in the rubble, first of all you need to inspect this place and take measures to free the victim. A person can be removed from the rubble only after he has been completely freed. A sterile bandage is applied to wounds and abrasions and an anesthetic is given.
Fractures and cracks There are open and closed fractures. At open fracture fragments of bones, having broken through soft tissues and skin, protrude out. With closed fractures, the skin is not damaged, but bruising, swelling and pain appear at the fracture site. HOW TO PROVIDE FIRST AID? For an open fracture: Remove clothing from the fracture site (by cutting it) and make sure that the skin is not damaged. If the skin is damaged, you must first bandage the wound. Stop the bleeding by pressing your fingers against the large blood vessels above and below the wound, or apply a tourniquet. Wipe the skin around the wound with iodine or alcohol and apply a sterile bandage to protect the wound from contamination.
At closed fracture: Apply a cold compress. Place the injured limb in a temporary splint, bandaging it to the fracture site to prevent bone displacement. For all types of fractures and cracks, it is necessary to provide the victim with complete rest, excluding any movement. APPLYING A SPRINT If you don’t have special splints at hand, you can use planks, pieces of plywood, sticks, reeds, and tightly twisted straw instead.
SHOULDER FRACTURE First aid should be provided by two people: one supports the injured arm and slightly pulls the shoulder down; the other moves one tire with inside hands so that its upper end reaches armpit, and places the second splint on the outside of the arm (the upper end of this splint should protrude above the shoulder joint). Once the splints are properly applied, they are tied down. Folded clothing should be placed between the torso and arm. The hand is suspended on a scarf
Sprain Sprain refers to damage to ligaments, muscles, tendons and other tissues without violating their anatomical integrity. Typically, a sprain is a painful injury that causes significant tissue swelling in addition to pain in the joint. First aid for a sprain is as follows: you need to place the injured limb higher and apply a cold compress to the damaged area (for example, moistened cold water towel). After half an hour, the joint should be tightly bandaged and the victim should be sent to the doctor (of course, not under his own power).
Long-term compression syndrome (LCS) is a kind of severe injury caused by prolonged compression (compression) of soft tissues. It is characterized by complex pathogenesis, difficult treatment and high mortality rates.
In disaster medicine, one of the pressing issues is long-term compression syndrome (crash syndrome).
There are 3 main types of this syndrome. Their difference lies mainly in the conditions that led to the consequences of long-term compartment syndrome.
Long-term compression syndrome Develops after the victim is freed from the blockage, as soon as the blood begins to circulate again through the vessels of the injured arm or leg, and the breakdown products of the injured tissue enter the general bloodstream of the whole body. Self-poisoning occurs, and the victim can quickly die.
In the first type, prolonged compression of the limbs of the body occurs in people who find themselves under the rubble of a destroyed house, stuck in a car during a car accident, etc.
The second type of syndrome is the so-called positional compression. It develops when a person remains in one position for a long time, in which the vessels and nerves of the limbs are compressed under the weight of his own body. IN mild form this phenomenon can be observed when a person lies on one arm for a long time in a dream. But in an adequate state, the developing feeling of tingling and numbness forces you to change your position to a more comfortable one. People who are intoxicated or under the influence of drugs have a dulled sense of pain and may be in an uncomfortable position long time, which entails almost irreversible changes in the blood supply and innervation of the limbs.
Finally, the third type of prolonged compression syndrome develops with the so-called tourniquet syndrome. It often develops when a limb is wrapped in rope, wire, or fishing line. In infants, even a hair or thread wrapped around a finger can cause tourniquet syndrome.
Having discovered a person in the rubble, first of all you need to inspect this place and take measures to free the victim.
A person can be removed from the rubble only after he is completely freed
Signs of compartment syndrome
At the time of injury, intense pain in the compressed area of the body, speech and motor agitation are noted. After release, inadequate reactions to the environment, chills, increased heart rate, decreased blood pressure up to the point of collapse.
After a few hours, other signs of illness appear. Local manifestations are characterized by severe pallor of the skin with the presence of bluish spots and marks of depressions.
After 30-40 minutes, the damaged limb begins to swell and sharply increases in volume. As a result of swelling, blisters appear on the skin filled with serous or serous-hemorrhagic fluid. There may be hemorrhages between the blisters on the skin. Soft fabrics have a woody density. Compression of the nerve trunks occurs, and sensitivity in the damaged area and below is lost. Movement in the joints is impossible due to the severity of the injury.
The pulse in the vessels of the affected limb, as a rule, is not detected.
Complaints:
pain in the damaged part of the body;
nausea;
headache;
thirst.
Reliable signs of compartment syndrome
significant deterioration in condition immediately after release;
appearance of pink or red urine.
Before limbs are freed:
plenty of warm drinks and pain relief;
cold below the compression site (if possible)
Providing assistance at the scene of an incident
Help at the scene of the incident is provided in two stages.
The first stage can last several hours and depends on how quickly the limbs can be freed from under the debris that has crushed them. Do not be discouraged by the lack of opportunity to immediately release the victim. Only special equipment can lift a multi-ton slab or concrete pillar. But if, from the first minutes of the accident, the injured limbs are covered with bags of ice or snow, tight bandages are applied (if there is access to them) and the person is provided with plenty of warm drinks, then there is every reason to expect a favorable outcome. The application of protective tourniquets is not necessary here. Providing assistance at this stage may take several hours. Professional rescue teams working in earthquake and disaster zones necessarily include specially trained people, the meaning of whose actions is one thing - to get to the hand of a person crushed by the ruins as soon as possible and establish intravenous administration plasma replacement fluid. And their comrades, following behind with special equipment, very carefully, without fuss, remove the victim from under the ruins. This tactic saved many thousands of lives.
Long term syndrome
squeezing is
disease,
arising in
as a result of long
squeezing soft
fabrics.
3 periods of the course of long-term compression syndrome:
1. Early from the moment the victim is released until24 - 48 hours.
General state victim:
- lethargy, indifference to the environment, but he can
preceded by speech and motor excitement;
- thirst and vomiting (rare);
- the limb becomes pale, cyanosis of the fingers appears,
swelling quickly increases, the skin becomes woody
density;
- pulsation of peripheral vessels is not detected;
- with deepening local changes: pain develops
syndrome, psycho-emotional stress, blood pressure drops sharply.
The victim's condition may rapidly deteriorate with
development of acute cardiovascular failure.
The victim may die from sharp fall HELL. If
he survives, then the second period begins. 2nd period - intermediate (3-7 days)
Characterized by: development of acute renal failure, because of
blockage of the renal tubules by decay products of dead muscles.
The body temperature rises, the victim’s condition deteriorates sharply,
lethargy and lethargy increase, vomiting and thirst appear,
yellowness of the sclera and skin.
Pain appears in the lumbar region.
The swelling of the limb subjected to compression increases, and
blisters with clear or hemorrhagic contents, areas appear
limb necrosis.
If the patient does not die from renal failure, the 3rd
period.
Period 3 - late or recovery period (3-4 weeks).
Kidney function is normalized and complications with
sides of the affected limb - various suppurations.
In uncomplicated cases, swelling of the limb and pain in it by the end of the month
pass.
Pathogenesis of SDS
Along the bloodstreamtissues and removal from them
waste products
(acids, carbon dioxide).
The first happens by
arteries, the second - through the veins. At
disruption of blood supply
oxygen is delivered to
tissues and accumulates in them
toxic substance exchange.
As a result, it happens
first cell death, then
tissues, and then the whole organ.
The longer the ischemia lasts, the
more tissue dies.
First aid for SDS
The provision of primary care is carried out in two stages - before and afterrelease from compression:
Stage I:
Cover the crushed limb with ice packs,
snow, cold water.
Pain relief (3 - 4 analgin tablets, 2 capsules
tramal).
Cardiovascular drugs (cordiamin, corvalol,
nitroglycerine).
Plenty of warm soda-salt drink (1 teaspoon
soda + 1 teaspoon of salt diluted in 1 liter of water).
Apply a tourniquet above the compression site.
Stage II:
Immediately after release, perform a tightbandaging the injured limb (for
creating additional deterrent
case).
Slow removal of the tourniquet.
Mandatory immobilization of the limb.
Repeated coldness to the limb.
Take the patient to a warm, quiet place, give
He needs a hot drink and is well wrapped up.
Careful and urgent hospitalization of the victim
and only in a supine position.
Description of the presentation by individual slides:
1 slide
Slide description:
2 slide
Slide description:
Long-term compartment syndrome (LCS) is a pathological complex that develops in response to prolonged compression tissue characterized by heavy clinical course and high mortality, as well as shock-like pictures with the development of acute renal failure (ARF). In case of DFS, three pathological factors influence the human body: - painful irritation and psycho-emotional factor, which is the trigger of shock; - traumatic toxemia caused by the absorption of decay products of crushed tissue. This is the reason for the development of acute renal failure. - plasma and blood loss aggravating the phenomenon of shock and acute renal failure.
3 slide
Slide description:
Periods of SDS Timing of development Main content Early 1-3 days With mild SDS, latent course. With moderate and severe degrees of SDS, the picture traumatic shock and subsequent instability in the respiratory and circulatory systems Intermediate 4-20 days Acute renal failure and endotoxicosis (pulmonary edema, cerebral edema, toxic myocarditis, DIC syndrome, intestinal paresis, anemia, immunosuppression) Late (recovery) From the 4th week up to 2-3 months after compression Restoration of kidney, liver, lung and other functions internal organs. High danger development of sepsis
4 slide
Slide description:
Light form When a segment of the limbs is compressed for 3-4 hours. Characterized by mild impairments hemodynamics and the absence of acute renal failure. Locally, moderate swelling of the limb is observed. Death is rare.
5 slide
Slide description:
Moderate form When several segments of a limb or the entire limb are compressed for 3-4 hours. It is characterized by more pronounced hemodynamic disturbances and the development of acute renal failure. There is pronounced swelling in the compression area. Death rate is up to 30%.
6 slide
Slide description:
Severe form. When one or two limbs are compressed for more than 4-7 hours. The course is complicated by severe hemodynamic disturbances, shock, respiratory disorders and the development of severe renal failure. There is pronounced swelling and tissue destruction. The mortality rate reaches 70%.
7 slide
Slide description:
Extremely severe form. When two or more limbs, pelvis and other parts are compressed for 8 or more hours. Severe and often irreversible shock develops, severe kidney damage resulting in severe renal failure, uncontrollable hemodynamic disturbances. Locally, extensive swelling of the injured areas with severe anatomical damage is observed. Survival is sporadic and extremely rare.
8 slide
Slide description:
During the extraction process: 1. Free the head and upper torso. 2. Assess the condition, focusing on the victim’s complaints. 3. Eliminate breathing problems: release the upper Airways, give a comfortable elevated position. 4. Anesthetize and relieve the psycho-emotional impact of the situation: intravenous solution of promedol 2% 1 ml and solution of seduxen 2 ml. 5. At the moment of releasing the limb, apply a rubber tourniquet above the point of compression.
Slide 9
Slide description:
Immediately after removal: 1. Inspect the limb. If there is complete crushing or crushing of a segment, leave the tourniquet. 2. Loosen the tourniquet. If there is no bleeding from large arteries, remove the tourniquet. If bleeding occurs, apply a tourniquet. 3. Apply aseptic dressings to the wounds and tightly bandage the limb from the periphery to the center: from the fingertips to the top. 4. Carry out transport immobilization of the limb. 5. Cool the limb. 6. Give oxygen, wrap (warm), give alkaline drink (soda, water, salt), if necessary, re-introduce promedol, if pronounced signs shock - prednisolone 90 mg. 7. Urgently evacuate to the first stage of medical evacuation in a lying position on a stretcher; in an unconscious state - in a stable lateral position with the air duct inserted.
10 slide
Slide description:
At the first stage of medical evacuation (in the primary care hospital): 1. Continue pain relief. 2. Carry out novocaine blockades: if damaged lower limbs– paranphral, upper – cervical vagosympathetic. 3. Perform case novocaine blockades of damaged limbs. 4. Conduct intensive infusion therapy to correct hemodynamics, acidosis, and improve microcirculation. 5. Completely stop the bleeding. 6. When obvious signs if the limb is not viable, amputate it. 7. Eliminate other life-threatening conditions: asphyxia, pneumothorax, etc. 8. Evacuate to the second stage of medical evacuation first after stabilization of the condition.
3 periods of the course of long-term compression syndrome: 1. Early from the moment of release of the victim until 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 quickly increases, the skin acquires a woody density; - pulsation of peripheral vessels is not determined; - with deepening local changes: developing pain syndrome, psycho-emotional stress, blood pressure drops sharply. Ø The victim’s condition 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.
Period 2 - 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 Body temperature rises, the victim’s condition sharply worsens, lethargy and lethargy increase, vomiting and thirst appear, yellowness of the sclera and skin appears. Ø Pain appears in the lumbar region. Ø Swelling of the limb subjected to compression increases, blisters with transparent or hemorrhagic contents appear, and areas of necrosis of the limb appear. Ø If the patient does not die from renal failure, the 3rd period begins. Period 3 - late or recovery period (3-4 weeks). Ø Kidney function is normalized and complications from the affected limb - various suppurations - come to the fore. Ø In uncomplicated cases, swelling of the limb and pain in it disappear by the end of the month.
Pathogenesis of VDS Oxygen is delivered through the bloodstream to the tissues and waste products (acid, carbon dioxide) are removed from them. The first occurs through the arteries, the second through the veins. When the blood supply is disrupted, oxygen is not delivered to the tissues and toxic metabolic substances accumulate in them. As a result, cell death occurs first, then tissue death, and then the whole organ. The longer ischemia lasts, the more tissue dies.
First aid for SDS Providing primary care is carried out in two stages - before and after release from compression: Stage I: Cover the crushed limb with bags of ice, snow, and cold water. Anesthetize (3 - 4 tablets of analgin, 2 capsules of Tramal). Cardiovascular drugs (cordiamin, corvalol, nitroglycerin). Plenty of warm soda - salt drink (dilute 1 teaspoon of soda + 1 teaspoon of salt per 1 liter of water). Apply a tourniquet above the compression site.
Stage II: Immediately after release, tightly bandage the injured limb (to create an additional restraining case). Slow removal of the tourniquet. Mandatory immobilization of the limb. Repeated coldness to the limb. Take the patient to a warm, quiet place, give him a hot drink, and wrap him well. Careful and urgent hospitalization of the victim and only in a supine position.
