Clinic of prolonged squeezing syndrome

During the SDS, the compression period and the post-compression period are distinguished. The latter is divided into early (up to 3 days), intermediate – from 4 to 18 days after the compression is removed and late – more than 18 days after the compression is removed (E.A. Nechaev et al., 1993). Clinically, one can also distinguish the period of the appearance of edema and vascular insufficiency (within 1-3 days after the compression is removed); the period of acute renal failure (from 3 to 9-12 days); recovery period (V.K. Gostishchev, 1993). During the compression period, the victims are conscious, but they may experience depression, apathy, or drowsiness. Sometimes consciousness is confused or even lost. Sometimes, on the contrary, the victims show violent excitement – they shout, gesticulate, ask for help. They develop a traumatic shock. The clinical picture of VDS depends on the location and severity of the injury. For example, when squeezing the head, in addition to damage to soft tissues of various degrees, signs of concussion or bruising of the brain appear. In case of chest damage, rib fractures, hemothorax, ruptures of internal organs, etc. are possible. During the compression period, immediately after the extremities are released, the victims complain of pain in the limbs, limitation of their mobility, weakness, nausea, and vomiting. The general condition of the victims in this case can be satisfactory or moderate. Their skin turns pale, tachycardia develops, blood pressure initially is normal, and then begins to decrease, body temperature rises. The extremity, which has undergone compression, is usually pale, with hemorrhages, quickly swells, the swelling progresses, the skin becomes purplish-cyanotic in color, and blisters with serous or serous-hemorrhagic contents appear on it. During palpation, the tissues are hard, with pressure on them there are no dimples. Ripple in the peripheral arteries is not determined. Limb sensitivity lost. Oliguria is rapidly developing – up to 50-70 ml of urine per day with a high protein content (700-1200 mg / l). First, the urine is red, with time it becomes dark brown. As a result of the release of plasma, blood thickens (the content of hemoglobin and erythrocytes increases in it), urea and creatinine increase. In the period of acute renal failure, the pain in the squeezed tissues decreases, blood pressure normalizes, the pulse rate is 80-100 beats per minute, body temperature – 37.2-38 ° С. However, against the background of improved blood circulation, renal failure develops. At the same time, oliguria is replaced by anuria. In the blood, the concentration of urea rises sharply. Uremia develops, which can result in death. With a more favorable course of SDS and its effective treatment, a recovery period begins. The general condition of patients and their laboratory indicators are improving. In the extremities, pain appears and tactile sensitivity is restored, tissue swelling is reduced. When examining the site of damage, areas of necrosis of the skin and muscles are revealed. 

local_offerevent_note November 19, 2019

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