In disaster medicine, one of the current issues is a syndrome prolonged compression(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 blood begins to circulate through the vessels again injured hand or legs, and the breakdown products of injured tissue enter the general bloodstream of the entire 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 stays in one position for a long time, in which, under his weight, own body The vessels and nerves of the limbs are compressed. 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. In persons with alcohol intoxication or those under the influence of drugs, the feeling of pain is dulled and they may remain 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.
Signs of prolonged compression syndrome 1. At the time of injury, intense pain is noted in the compressed area of the body, speech and motor agitation. After release, inadequate reactions to the environment are possible, chills, increased heart rate, decreased blood pressure up to the point of collapse. 2. 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.
3. 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 tissues 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. 4. 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.
Providing assistance at the scene of an incident. Assistance at the scene of an 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 an 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 count on 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.
The second stage - assistance after release - must be extremely reduced. Tight bandaging, application of transport splints and administration of blood-substituting fluids, rapid delivery of the victim to the intensive care center, where there must be an artificial kidney apparatus, give reason to expect a favorable outcome.
Treatment of long-term compartment syndrome Treatment of patients should, if possible, be carried out in a specialized clinic where there is access to hemodialysis, which will be indispensable in eliminating kidney disorders. When transporting people with long-term compartment syndrome, it is advisable to cover the injured limb with ice and perform a novocaine blockade. The hospital provides adequate pain relief therapy. Correction of disturbances in the water and electrolyte composition of the blood is mandatory. When symptoms are relieved, life-threatening patient, plastic surgery of the vessels and nerves of the affected limb is performed. If symptoms renal failure grow, the question of amputation arises.
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 tissue compression, characterized by severe 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 Development timeframe Main content Early 1-3 days With SDS mild degree hidden current. In moderate and severe cases of SDS, the picture is of traumatic shock and subsequent instability in the respiratory and circulatory systems Intermediate 4-20 days Acute renal failure and endotoxicosis (pulmonary and cerebral edema, toxic myocarditis, disseminated intravascular coagulation syndrome, intestinal paresis, anemia, immunosuppression) Late (restorative) From the 4th week to 2-3 months after compression Restoration of the functions of the kidneys, liver, lungs and others internal organs. High risk of developing sepsis
4 slide
Slide description:
Light form When a segment of the limbs is compressed for 3-4 hours. It is characterized by mild hemodynamic disturbances 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. Release the head and top part 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: i.m. promedol solution 2% 1 ml and seduxen solution 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 an alkaline drink (soda, water, salt), if necessary, reintroduce promedol, if signs of shock are pronounced - prednisolone 90 mg. 7. Urgently evacuate to the first stage of medical evacuation in a lying position on a stretcher; at unconscious– 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. Conduct novocaine blockades: when damaged lower limbs– paranphral, upper – cervical vagosympathetic. 3. Perform case novocaine blockades of damaged limbs. 4. Carry out an intensive infusion therapy to correct hemodynamics, acidosis, 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.
This syndrome was first identified as a separate
disease in 1941 by the English doctor Eric
Bywaters, who treated people injured
from the bombings in London during the Second
world war.
There are several possible names for this
syndrome: compartment syndrome, compression
injury, crash syndrome (from English crush -
"crushing,
crumple"),
traumatic
toxicosis.
rubble
with
squeezed
limbs,
observed special shape shock. Peculiarity
is that if not too severe
damage
after
complex
medicinal
measures, the condition of the patients is significant
improved, but then there was a sharp deterioration.
Most patients developed acute
kidney failure and they soon died.
Stages of development of the syndrome
Bywaters was able to identify three consecutivestages leading to the development of crash syndrome:
compression of the limb and subsequent necrosis
fabrics;
development of edema at the site of compression;
development of acute renal failure and
ischemic toxicosis.
Pathogenesis of the syndrome
Bywaters syndrome occurs as a resultcompression of the limb, damage to the main
vessels and main nerves. Similar injury
occurs in approximately 30% of people affected
as a result of natural or man-made
disasters.
In the pathogenesis of this disease, the leading role is
have three factors: regulatory, associated with
painful effect on the body, significant
plasma loss and, finally, tissue toxemia.
Pain factor
The painful effect affects the person caughtunder
blockage,
most
strongly.
Noted
reflex spasm of peripheral vessels
organs and tissues, which leads to disruption
gas exchange and subsequent tissue hypoxia.
Vascular spasm and developing hypoxia
cause dystrophic changes in tissues
kidneys, blood filtration drops significantly.
Plasma loss factor
Plasma loss develops soon after injury andeven after eliminating the cause of the compression.
Plasma loss
tie up
With
increase
capillary permeability due to trauma, which
leads to the release of blood plasma from the bloodstream.
Toxemia factor
INplace
damage
develops
edema,
numerous hemorrhages, outflow of blood from
the compressed limb is disturbed, up to
complete blocking. As a result, it develops
ischemia
limbs,
V
fabrics
intensely
products of cellular metabolism accumulate and
etc. After blood circulation is restored, they
“in one gulp” they begin to enter the vascular bed.
At this point, a number of symptoms appear,
characteristic of ischemic toxicosis.
Severity of the syndrome
Mild degree – compression of a small segmentlimbs for no more than two hours. IN
In this case, toxemia is weakly expressed, although
acute renal failure and
hemodynamic disorders. In most cases
with timely therapy, improvement
occurs within a week.
Severity of the syndrome
Averagedegree
arises
at
compression
entire limbs for four hours.
Similar
state
characterized
intoxication, myoglobinuria and oliguria.
Severity of the syndrome
Long-term limb compression (4–7 hours)leads to the manifestation of symptoms characteristic of
severe Bywaters syndrome. Marked
significant
violations
hemodynamics,
symptoms of intoxication are pronounced, quickly
acute renal failure develops.
Untimely
And
wrong
rendering
medical care in most cases leads
To fatal outcome.
Severity of the syndrome
Extremely severe crash syndrome. Suchdiagnosis is made when there is compression of the lower extremities
for 8 or more hours. Developing
ischemic toxicosis will be detrimental to
patient shortly after decompression.
The mortality rate of such patients is extremely high even with
carrying out timely treatment.
First aid during rescue operations
Conductanti-shock
Events:
introduce
analgesics,
drugs
For
normalization
blood pressure.
After releasing the injured limb into place
compression, a tourniquet is applied, which helps not
admit
"volley"
emission
accumulated
toxic substances into the bloodstream.
After moving the victim and eliminating
compression of the limb is bandaged using an elastic
bandage, and only then remove the tourniquet. Also
Cooling of the injured limb is recommended.
Treatment of the syndrome
For mild surgical treatment syndromeare not carried out; often such patients are treated
outpatient.
With moderate severity of hemodynamic disturbances
expressed quite clearly, however, surgical
Treatment in this case is not always indicated. Held
therapy of acute renal failure.
In cases of severe and extremely severe
severity of crash syndrome conservative treatment
ineffective and surgical treatment is necessary.
In parallel, therapy for acute renal disease is carried out
insufficiency. Syndrome
Bywaters
was
highlighted
How
nosological unit not so long ago - only in
mid 20th century. At salvation and beyond
treatment
victims
With
heavy
compression
injuries
important
coordinated actions of rescuers and doctors.
Quickly extracting people from the rubble and starting
carrying out therapy even before removing the press
minimizes severe consequences compression
limbs and helps save the patient’s life.
Trauma is an effect on the body external factors(mechanical, thermal, electrical, radiation, etc.), causing damage to organs and tissues anatomical structures, physiological functions and accompanied by a general and local reaction of the body.
Injury rates are the prevalence of injuries in certain population groups under similar conditions. They are distinguished: Manufacturing - industrial - agricultural Transport - automobile - railway Military Sports Household
CLOSED INJURIES Bruises (contusio) are closed mechanical injuries to tissues and organs without visible damage to the skin. Accompanied by rupture of capillaries and hemorrhage in soft fabrics.
Clinical signs– pain, bruising, swelling, dysfunction, possible hematoma formation. When a joint is bruised, hemarthrosis may occur, i.e. accumulation of blood in the joint. Treatment principles: cold, pressure bandage, ointments that relieve swelling - troxevasin, indovazin, heparin ointment. For hemarthrosis, joint puncture with blood evacuation, immobilization, and physiotherapy are performed.
CLOSED INJURIES Stretching (distorsio) is closed damage ligamentous apparatus of the joint without violating its anatomical integrity. In this case, there is a rupture of individual fibers joint capsule and pinpoint hemorrhages. Clinically, sprain is manifested by an increase in the volume of the joint due to swelling of the periarticular tissues, pain, and limited range of motion in the joint. Principles of treatment: cold, superficial anesthesia with chlorethyl or lidocaine, fixing bandage, plaster immobilization, use of ointments - finalgon, indomethacin, dolpig, fastum-gel, physiotherapy.
CLOSED INJURIES Tissue ruptures (rupturae) - occur when the physiological limit of elasticity and strength of tissues, ligaments, tendons, and muscles is exceeded. Clinically, ruptures are manifested by pain and loss of function, pathological mobility in case of ligament rupture, symptoms of blockade in case of damage to the menisci of the joint. Treatment of ruptures is only surgical - restoration of anatomical continuity with local tissue or plastic surgery.
DISLOCATIONS Treatment: Pre-hospital stage– transport immobilization with Kramer, Dieterichs splints, pneumatic splints, Deso fixing bandage, improvised means. Administration of analgesics (and narcotics). In the hospital: after clarification of the diagnosis, local anesthesia is performed with novocaine, lidocaine, ultracaine, administration narcotic drugs and reduction, which is based on stretching and relaxing the muscles and repeating the movements characteristic of of this joint. The method of Kocher and Dzhenilidze is used. After reduction, a control photograph is taken and fixation with a plaster splint for 1 - 2 weeks.
LONG-TERM COMPRESSION SYNDROME Synonyms used to refer to this term are crash syndrome, traumatic endotoxicosis, tissue compression syndrome, myorenal syndrome. DFS is the development of intravital tissue necrosis due to prolonged compression of a body segment, causing endotoxicosis and the development of acute renal failure.
CLASSIFICATION By type of compression: crushing compression (direct, positional) By localization: isolated (one anatomical area) multiple combined (with fractures, damage to blood vessels and nerves, head injury). By degree of severity: I degree. - mild (compression up to 4 hours) grade II. - average (up to 6 hours) III degree. - heavy (up to 8 hours) IY Art. - extremely severe (compression of both limbs for 8 hours or more).
I degree - slight swelling of soft tissues, the skin is pale, at the border of the lesion it bulges above the healthy one. There are no signs of circulatory problems. I degree - slight swelling of soft tissues, the skin is pale, at the border of the lesion it bulges above the healthy one. There are no signs of circulatory problems. II degree - moderate indurative swelling of soft tissues and their tension. The skin is pale, with areas of cyanosis. After 24-36 hours, bubbles with transparent yellowish contents form. Impaired venous circulation and lymphatic drainage leads to progression of microcirculation disorders, microthrombosis, increased edema and compression muscle tissue.
III degree- pronounced swelling and tension of soft tissues. Skin cyanotic or “marbled” appearance. After 12-24 hours, blisters with hemorrhagic contents appear. Indurative edema and cyanosis quickly increase, which indicates gross disturbances of microcirculation, vein thrombosis, leading to a necrotic process. IY degree - indurative edema is pronounced, the tissues are sharply tense. The skin is bluish-purple in color, cold. Epidermal blisters with hemorrhagic contents. The swelling practically does not increase, which indicates deep violations microcirculation and insufficiency of arterial blood flow.
CLINIC I period - early (period of shock) up to 48 hours after release from compression. In the clinic, manifestations of traumatic shock predominate: severe pain syndrome, psycho- emotional stress, hemodynamic instability, hemoconcentration, creatininemia, proteinuria and cylindruria. II period - the period of acute renal failure. Lasts from 3 to 12 days. In the clinic, swelling of the extremities, freed from compression, increases; blisters and hemorrhages are found on the damaged skin. Hemoconcentration is replaced by hemodilution, anemia increases, diuresis sharply decreases, up to anuria. Hyperkalemia and hypercreatininemia reach the highest L numbers – 35%. III period - recovery (3-4 weeks) Kidney function, protein content, creatinine and blood electrolytes are normalized. Come to the fore infectious complications. High risk of developing sepsis.
The experience of disaster medicine shows that highest value in determining severity clinical manifestations SDS have the degree of compression and area of damage, the presence of damage to internal organs, fractures and bleeding. The combination of even short-term compression of a limb with any other injury dramatically worsens the course and worsens the prognosis. The experience of disaster medicine shows that the degree of compression and area of damage, the presence of damage to internal organs, fractures and bleeding are of greatest importance in determining the severity of the clinical manifestations of SDS. The combination of even short-term compression of a limb with any other injury dramatically worsens the course and worsens the prognosis.
TREATMENT One of the first prehospital measures should be the application of a rubber tourniquet to the compressed limb, its immobilization and insertion narcotic analgesics(promedol, omnopon, morphilong) for removing pain syndrome and emotional stress.
TREATMENT PERIOD I Antishock and detoxification therapy includes: - intravenous administration of fresh frozen plaza (up to 1 liter per day), polyglucin, rheopolyglucin; administration of crystalloids (acesol, chlosol, disol, Ringer's solution); - detoxification blood substitutes (gemodez, neogemodez, neocompensan); - sorbent is used orally - enterodesis. Extracorporeal detoxification during this period is represented by plasmapheresis with the extraction of up to 1.5 liters of plasma.
TREATMENT II PERIOD The composition and volume of infusions is adjusted depending on daily diuresis, degree of intoxication, acid-silk balance and character surgical intervention. Infusion and transfusion therapy is carried out in a volume of at least 2 liters per day: plasma, albumin, amino acids, sodium bicarbonate, glucose-novocaine mixture, glucose solution. Plasmapheresis is indicated for all victims who have had compression for more than 4 hours, have signs of intoxication and local changes in the injured limb. HBOT – 1-2 times a day to reduce tissue hypoxia. Forced diuresis - up to 80-100 mg of Lasix against the background of the administration of 3-4 liters of IV solutions. Antibacterial therapy Disaggregant therapy: heparin, chimes, trental The choice of surgical tactics depends on the condition and degree of ischemia of the injured limb.
The work can be used for lessons and reports on the subject "Philosophy"
In this section of the site you can download ready-made presentations on philosophy and philosophical sciences. The finished presentation on philosophy contains illustrations, photographs, diagrams, tables and the main theses of the topic being studied. Philosophy Presentation - good method submissions complex material in a visual way. Our collection of ready-made philosophy presentations covers all philosophical topics educational process both at school and at university.
Slide 1
INJURY. DIAGNOSTICS. TREATMENT. LONG-TERM COMPRESSION SYNDROME. Department of General Surgery SOGMA Lecture:Slide 2
Trauma is the effect on the body of external factors (mechanical, thermal, electrical, radiation, etc.) that cause disruption of anatomical structures and physiological functions in organs and tissues and are accompanied by a general and local reaction of the body.
Slide 3
Injury rates are the prevalence of injuries in certain population groups under similar conditions. They are distinguished: Manufacturing - industrial - agricultural Transport - automobile - railway Military Sports Household Each of these types of injuries is caused by certain factors and has its own characteristics. Thus, in industrial and military situations, injuries predominate, and in sports, bruises and sprains predominate.
Slide 4
CLOSED OPEN NON-PENETRATING PENETRATING SINGLE MULTIPLE COMBINED COMBINED ACUTE CHRONIC INJURY
Slide 5
CLOSED INJURIES Bruises (contusio) are closed mechanical injuries to tissues and organs without visible damage to the skin. Accompanied by rupture of capillaries and hemorrhage into soft tissues. Clinical signs include pain, bruising, swelling, dysfunction, and possible hematoma formation. When a joint is bruised, hemarthrosis may occur, i.e. accumulation of blood in the joint. Principles of treatment: cold, pressure bandage, ointments that relieve swelling - troxevasin, indovazin, heparin ointment. For hemarthrosis, joint puncture with blood evacuation, immobilization, and physiotherapy are performed.
Slide 6
CLOSED INJURIES Sprain (distorsio) is a closed injury to the ligamentous apparatus of a joint without violating its anatomical integrity. In this case, there is a rupture of individual fibers of the joint capsule and pinpoint hemorrhages. Clinically, sprain is manifested by an increase in the volume of the joint due to swelling of the periarticular tissues, pain, and limited range of motion in the joint. Principles of treatment: cold, superficial anesthesia with chlorethyl or lidocaine, fixing bandage, plaster immobilization, use of ointments - finalgon, indomethacin, dolpig, fastum-gel, physiotherapy.
Slide 7
CLOSED INJURIES Tissue ruptures (rupturae) - occur when the physiological limit of elasticity and strength of tissues, ligaments, tendons, and muscles is exceeded. Clinically, ruptures are manifested by pain and loss of function, pathological mobility when ligaments are torn, and symptoms of blockade when the menisci of the joint are damaged. Treatment of ruptures is only surgical - restoration of anatomical continuity with local tissue or plastic surgery.
Slide 8
CLOSED INJURIES Concussion (commotio) is a mechanical effect on tissues, leading to disruption of their functional state without macroscopically visible anatomical disorders.
Slide 9
DISLOCATIONS Clinic – pain, lack of active and passive movements, swelling, bruising or hematoma, hemarthrosis, forced position of the limbs, deformation in the joint area. The diagnosis is confirmed by x-ray
Slide 10
Dislocations (luksacio) are a persistent pathological displacement of the articular surfaces relative to each other, excluding active and passive movements. CLASSIFICATION CONGENITAL ACQUIRED INCOMPLETE COMPLETE PATHOLOGICAL HABITUAL COMPLICATED DISLOCATIONS
Slide 11
DISLOCATIONS Treatment: Prehospital stage - transport immobilization with Kramer, Dieterichs splints, pneumatic splints, Deso fixing bandage, improvised means. Administration of analgesics (and narcotics). In the hospital: after clarifying the diagnosis, local anesthesia is performed with novocaine, lidocaine, ultracaine, administration of narcotic drugs and reduction, which is based on stretching and relaxing the muscles and repeating movements characteristic of a given joint. The method of Kocher and Dzhenilidze is used. After reduction, a control photograph is taken and fixation with a plaster splint for 1 - 2 weeks.
Slide 12
Slide 13
LONG-TERM COMPRESSION SYNDROME Synonyms used to refer to this term are crash syndrome, traumatic endotoxicosis, tissue compression syndrome, myorenal syndrome. DFS is the development of intravital tissue necrosis due to prolonged compression of a body segment, causing endotoxicosis and the development of acute renal failure.
Slide 14
PATHOGENESIS TISSUE ISCHEMIA MECHANICAL DESTRUCTION TRAUMATIC TOXEMIA METABOLIC ACIDOSIS MYOGLOBINURIA AND MYOGLOBINEMIA RENAL TUBULAR BLOCK ACUTE RENAL FAILURE
Slide 15
CLASSIFICATION By type of compression: crushing compression (direct, positional) By localization: isolated (one anatomical area) multiple combined (with fractures, damage to blood vessels and nerves, head injury). By degree of severity: I degree. - mild (compression up to 4 hours) grade II. - average (up to 6 hours) III degree. - heavy (up to 8 hours) IY Art. - extremely severe (compression of both limbs for 8 hours or more).
Slide 16
I degree - slight swelling of soft tissues, the skin is pale, at the border of the lesion it bulges above the healthy one. There are no signs of circulatory problems. II degree - moderate indurative swelling of soft tissues and their tension. The skin is pale, with areas of cyanosis. After 24-36 hours, bubbles with transparent yellowish contents form. Violation of venous circulation and lymphatic drainage leads to the progression of microcirculation disorders, microthrombosis, increased edema and compression of muscle tissue. III degree - severe swelling and tension of soft tissues. The skin is cyanotic or “marbled” in appearance. After 12-24 hours, blisters with hemorrhagic contents appear. Indurative edema and cyanosis quickly increase, which indicates gross disturbances of microcirculation, vein thrombosis, leading to a necrotic process. IY degree - indurative edema is pronounced, the tissues are sharply tense. The skin is bluish-purple in color, cold. Epidermal blisters with hemorrhagic contents. The swelling practically does not increase, which indicates deep disturbances of microcirculation and insufficiency of arterial blood flow.
Slide 17
CLINIC I period - early (period of shock) up to 48 hours after release from compression. The clinical manifestations of traumatic shock predominate: severe pain, psycho-emotional stress, hemodynamic instability, hemoconcentration, creatininemia, proteinuria and cylindruria. II period - the period of acute renal failure. Lasts from 3 to 12 days. In the clinic, swelling of the extremities, freed from compression, increases; blisters and hemorrhages are found on the damaged skin. Hemoconcentration is replaced by hemodilution, anemia increases, diuresis sharply decreases, up to anuria. Hyperkalemia and hypercreatininemia reach the highest L numbers – 35%. III period - recovery (3-4 weeks) Kidney function, protein content, creatinine and blood electrolytes are normalized. Infectious complications come to the fore. High risk of developing sepsis. TREATMENT One of the first prehospital measures should be the application of a rubber tourniquet to the compressed limb, its immobilization and the administration of narcotic analgesics (promedol, omnopon, morphilong) to relieve pain and emotional stress. Slide 21 
TREATMENT II PERIOD The composition and volume of infusions is adjusted depending on daily diuresis, degree of intoxication, acid-silk balance and the nature of the surgical intervention. Infusion-transfusion therapy is carried out in a volume of at least 2 liters per day: plasma, albumin, amino acids, sodium bicarbonate, glucose-novocaine mixture, glucose solution. Plasmapheresis is indicated for all victims who have had compression for more than 4 hours, have signs of intoxication and local changes in the injured limb. HBOT – 1-2 times a day to reduce tissue hypoxia. Forced diuresis - up to 80-100 mg of Lasix against the background of the administration of 3-4 liters of IV solutions. Antibacterial therapy Disaggregant therapy: heparin, chirantil, trental The choice of surgical tactics depends on the condition and degree of ischemia of the injured limb.
