Compression Syndrome
Last reviewed: 23.04.2024
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Compression syndrome is formed by squeezing soft tissues or internal organs as a result of the disease with the development of a characteristic clinical picture, which can be regarded as a manifestation of this pathology or as its complication.
Compression syndrome of soft tissues can manifest itself in the form of three forms: crushing, prolonged crushing and positional compression. Pathogenetically, they are united by the formation of traumatic toxicosis and acute renal failure.
Compression Crush Syndrome (synonym - "crash syndrome")
The basis is a short-term squeezing of the soft tissues of the extremities with great force: tightening in the machine, a moving mechanism, pressing down with a heavy load, etc. There is a crushing of the tissues, accompanied by the formation of crushed wounds and open fractured fractures (78.4%). There may be closed damage. But in 83.1% of cases there is damage to the neuromuscular ray, which is accompanied by numbness of the limb and its immobility, an increase in volume after liberation on the scene. In all cases, there is a development of traumatic and hypovolemic shock. Due to the trauma of the neurovascular bundle, the limb is rarely maintained, and 78.7% of the affected patients have to be amputated. If it persists, from the 2nd to 3rd day after the injury, typical renal failure develops due to clogging of the renal tubules with myoglobin clumps. When the patient is connected to hemodialysis, she is allowed to 8-12 days.
Compression syndrome of long crushing
The basis is a long squeezing of the limb (more than four hours) with a heavy load. In 76-83% of cases, closed injuries: massive muscle crushing with extensive hemorrhages and bone fractures in 49.8% of the affected. This is a clinical statistic that only considers survivors. General manifestations in the form of traumatic, by the end of the first day and hypovolemic shock; from the third day, typical renal failure (with hemodialysis resolved to 12 days); autointoxication with peptides and blood slags. Locally: a violation of tactile sensitivity with sharp, bursting pains; rapidly growing edema during the day with compression of blood vessels and nerves; limitation of mobility; formation of blisters with serous or hemorrhagic contents. From the 6th to the 8th day, muscle necrosis begins, a purulent infection joins, often with the development of intoxication.
Compression syndrome of positional compression
It is formed with prolonged (6-8 hours) compression of the tucked limb (often the upper one) with one's own body when the victim is in a state of alcoholic or narcotic sleep. A pronounced but not exaggerated swelling of the limb develops, pulsation on the arteries decreases moderately, muscle necrosis does not occur, but metabolic acidosis is formed and products of proteolysis are formed, and they cause the development of toxicosis and renal failure, which has the form of a "toxic kidney" and is accompanied only by oliguria.
[10], [11], [12], [13], [14], [15]
Compression syndrome of internal organs
Has a bright specific picture, since it leads to a pronounced disruption of the function of the entire system. It can be a manifestation of a disease or injury, but is more often seen as a complication of them. In clinical practice, there are more: compression of the brain in tumors, hematomas, hydrocephalus, swelling and swelling of the brain in trauma, inflammation, etc .; compression of the lung with tumors, effusion into the pleural cavity, air or a relaxed diaphragm; pericardium with injuries and effusions; spinal cord and roots. With closed chest trauma, the lung compression occurs when the thoracic cage is broken in the type of a "flotating valve" (anterior or posterior with double fractures of the ribs) or "flotation chest," with bilateral fractures of the ribs, the pathological movement of the thoracic wall is noted, with the development of paradoxical breathing and respiratory insufficiency: during an inhalation the site of the chest wall does not bulge, but, on the contrary, it is drawn into the chest cavity, squeezing the lung; when exhaled - does not sink, but is pushed out. In the "flotation chest" such movements are characteristic for the entire anterior thoracic region, and respiratory failure develops very quickly and these movements can not be observed at all because of respiratory arrest.