The syndrome of compression

The syndrome of compression ( crush syndrome, crash syndrome) is an asymptomatic complex that develops as a result of compression of parts of the body (usually limbs) in accidents and earthquakes.

At the heart of pathogenesis is the absorption of toxic products of tissue decay, formed in ischemic tissues when blood flow is disturbed in them. A severe DIC-syndrome develops, which, together with the deposition of myoglobin in the renal tubules, leads to acute renal failure.

Symptoms and course. After liberation from compression, a traumatic shock develops. Already from the first day may come oligo- or anuria. A sharp dense edema of the site of the trauma and distal areas develops. Edema promotes the progression of tissue ischemia. Resorption of cytolysis products can lead to hyperkalemia. With timely intensive treatment, acute renal failure is resolved after 10-15 days. At this time, septic and purulent complications are added.

Treatment. Immediately at the scene, anti-shock measures-puncture of the vein and the introduction of rheopolyglucin, narcotic drugs are carried out. The depressed limb is tightly banded with an elastic bandage, which allows slowing the rate of entry of toxic substances into the bloodstream. During transport, the limb should be immobilized. Hospitalization is carried out in an emergency. Treatment is carried out in the intensive care unit or intensive care unit. In the first hours, plasmapheresis is carried out in a volume of up to 1500 ml, freshly frozen plasma (1000-1500 ml / day), hemodez, saline solutions (total transfusion volume up to 2500 ml / day) is poured in large volumes. Heparin is administered 2500 ED4 times under the skin of the abdomen, prescribe dezagreganty, trasilol in a dose of 100 000-200 000 units / day, laeeix, antibiotics. With a decrease in diuresis less than 600 ml / day, hemodialysis is performed. Sessions of hyperbaric oxygenation are carried out 1-2 times a day. When there is a tense edema that aggravates further limb ischemia and an increase in the necrosis zone, a fasciotomy surgery is performed, with the development of gangrene performing a necrectomy or amputation. Daily conducted plasmapheresis and hyperbaric oxygenation can avoid amputation even in cases when patients were under the rubble 5-7 days, as limited blood supply to the limbs is usually preserved and its appearance before the onset of plasmapheresis and heparin therapy can not give accurate information about the size of the necrosis zone and To serve as an indication for rapid amputation.

The prognosis with timely and correct treatment is favorable. Of late complications, neuritis with development of flaccid paralysis should be noted.