Compression (traumatic)

Prolonged compression of a large area of ​​soft tissue, resulting in complications ktyazhelym-traumatic toxicosis.
Prolonged compression of, often of the lower extremities, there are changes in the body. This injury occurs when collapses, earthquakes, bombings, railway accidents, and others. Within a few hours after the release of the limbs on the severity of the victim indicated satisfactory overall (traumatic shock eliminated the usual anti-shock therapy). But after 2-4 days suddenly developed renal failure and general condition of the patient deteriorates. There lethargy, listlessness with periods of dramatic excitement. There are jaundice, vomiting, thirst, pain, light-headedness. In the future, developing azotemia, oliguria, anuria and uremia. Intoxication, causing liver and kidney failure, resulting in death of about 60% of the victims. Local changes are expressed in enormous swelling, soft tissue become dense, limbs - cyanotic with white spots, the pulse of them is missing.
The task - to reduce muscle necrosis, intoxication, improve liver and kidney. For this:
1. Carry out the struggle with shock and vascular spasm with bromides, chloral hydrate, alcohol, atropine, povokainovoy blockade, glucose, oxygen, and others.
2. The affected limb is cooled with ice to reduce the swelling of traumatic, producing skin and fascia incision to reduce the compression of the muscle edema. In severe cases, prior to the hepato-renal syndrome produce an amputation to save the patient's life.
3. Restore backup of blood by introducing the alkalinity of 20-25 g of sodium carbonate in 3 l of isotonic solution orally, intravenously or dropping enema.
4. Strengthen diuresis using diuretics.
Sepsis. Severe infection of the body, caused by a variety of pathogens and their toxins. Characterized by a reaction of the body with the same type of clinical picture, in spite of the difference is due to its originators. Sepsis can be primary or secondary. At the beginning of the disease, you can find the entrance gate - the presence of the primary tumor, but in the development of its influence on may decrease and become unnoticeable during sepsis. In rare cases, when the cause of sepsis can not be established, it is called kriptogepnogo.
The source of general purulent infection can also be traumatic injuries (open fractures, extensive burns, wounds, etc..), As well as such purulent inflammation as carbuncles (especially on the face), cellulitis, purulent lesions of the paranasal sinuses, pleura, peritoneum, joints and et al. Sepsis can develop in the presence of inflammatory lesions of any location and magnitude, but is more common in large purulent processes.
Clinical sepsis is determined by three factors: 1) form of sepsis (fulminant, acute, chronic, recurrent, metastatic, without metastasis); 2) progressive decompensation of functions of all organs and systems of the patient, his exhaustion; 3) complex of symptoms, which are different relationships.
When fast sepsis disease develops rapidly, leading to the appearance of symptoms of the complex just a few hours, a maximum of 1-2 days.
In severe sepsis it takes a few days to give the full picture of general purulent infection. In subacute symptoms of sepsis is not so pronounced as in the first two forms and the process develops slowly over several weeks.
Chronic sepsis determined sluggish flow and the presence of subtle changes that occur for months.
Sepsis is characterized by recurring periods of change of exacerbations, when all symptoms gets a vivid manifestation, and periods of remission, when it is not possible to identify any noticeable signs of infection.
Sepsis with metastases seen the development of multiple ulcers in different tissues in organs, which is accompanied by worsening of symptoms. Opening of ulcers results in a reduction of its brightness, for example, to lower temperature, but in the new formation of ulcers these manifestations occur again.
Clinical sepsis without metastases are usually more severe and constant, there is no remission. Great influence on the sharpness of clinical manifestations has a reactivity of an organism to a stimulus.
All the symptoms of the common purulent infection, divided into general and local, related to manifestations of the primary tumor.
Assumptions General symptoms. Frequent signs reflecting disorders of general condition and activity of the nervous system include headache, irritability, insomnia, nervous system depression, dizziness or even loss (in severe cases) consciousness. Permanent is a rise in temperature, which in sepsis without metastases usually kept at a high level (39-40 ± C) and varies considerably in the morning and evening in the presence of metastases. An important symptom is expressed in shaking chills and heavy pots. Typically weight loss, progressive deterioration of health, despite treatment. Sometimes there is a hemorrhagic rash on the skin.
Since the cardiovascular system is usually observed: sudden increased heart rate, a decrease in its content, reduced arterial and venous pressure, deterioration of cardiac function, and vascular trophic disorders (bedsores, thrombophlebitis, thrombosis, edema).
Functions of parenchymal organs also significantly violated. Observed deterioration of the kidneys (reduction of relative density of urine and the appearance of protein in it and formed elements), the liver (often develop jaundice and hepatitis phenomenon), increased spleen.
Usually observed violations of the gastrointestinal tract: loss of appetite, dry coated tongue, persistent septic diarrhea, nausea and vomiting.
Local symptoms. Rana in sepsis pale swelling, granulation limp, pale, scanty discharge dirty muddy appearance, often with a putrid odor.
Observed vascular thrombosis, lymphangitis and lymphadenitis. These symptoms in sepsis have considerable resistance.
Treatment of sepsis is one of the most difficult problems of medicine. Being as well as the treatment of any infection, but the general purulent infection should be etiological and pathogenic, ie provide comprehensive event management and means acting on the microflora, the local center as well as the function of organs and body systems affected. Numerous therapeutic measures in sepsis require their classification:
1) control of the microflora and intoxication;
2) stimulating immune-biological body's defenses;
3) improvement of impaired functions of organs and systems of the patient;
4) carrying out of symptomatic therapy.
The problem of surgical treatment of the local chamber includes: a) the timeliness and efficiency of surgery; b) the creation of a good drainage from the wound, c) wound disinfection chemical and biological agents; g) wound rest with immobilization and rare dressings; e) ultraviolet irradiation, UHF; e) strict monitoring of the condition of the wound and the identification of possible complications.
If necessary, a second surgical intervention (opening of the abscess, vein ligation when ascending thrombophlebitis, amputation of limbs, and others.). To be successful you must have an individual treatment plan for each patient, drawn up taking into account the characteristics of the organism and the flow of septic process, its phases, and others.
General measures are as follows.
1. Creation of the most favorable patient sapitarno and hygienic conditions, providing him complete rest, a thorough general care, dental hygiene, etc.
2. Power being curative factor is very important for the outcome of sepsis. It must be a full, high-calorie, tasty, vitamin-rich and diverse. This is particularly important in view of severe intoxication in a patient with sepsis, lack of appetite and high energy costs. In case of violation of the secretory and motor function of the gastrointestinal tract of the patient it is recommended to feed in small portions, giving it before eating hydrochloric acid with pepsin. Necessarily be administered 2 to 3 liters per day as soups, tea, milk and vitamin drink (juice, juice and others.).