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Prolonged compression syndrome
Last reviewed: 07.07.2025
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Crush syndrome develops with prolonged (over several hours) compression of any part of the body. After the limb is released, endotoxic shock may develop. The released limb is enlarged due to edema, cyanotic, and blisters with hemorrhagic fluid form. Acute renal failure develops rapidly due to toxic ("middle molecules", myoglobin) and circulatory damage.
Due to the rapid deterioration of the condition of children with prolonged crush syndrome, even before the limb is released, it is necessary to administer narcotic analgesics intramuscularly - 1-2% solution of trimeperidine (promedol) or omnopon 0.1 ml per year of life. Sedative treatment is carried out with diazepam (seduxen) 0.1-0.3 mg / kg intramuscularly. It is necessary to apply an arterial tourniquet in order to prevent endotoxic shock.
After the limb is released, it is tightly swaddled in the distal-proximal direction to the lower turns of the tourniquet, which in children is recommended to be applied for up to 30 minutes, then released for 1 minute and reapplied for 30 minutes, until the child is admitted to the hospital. A thorough examination of the victim is necessary to exclude bone fractures. It is important to ensure transport immobilization: the limb is covered with ice, the child is placed on a shield in a horizontal position, and the injured limb is raised by 15-30 °.
Due to the increased load on the kidneys caused by massive myoglobinuria, crystalloids are administered intravenously by drip to prevent shock and improve microcirculation in the renal tissue - 0.9% sodium chloride solution, 5% glucose solution, sodium acetate + sodium chloride (disol) at 10 ml / (kg x h) under the control of arterial pressure. Infusion therapy should be combined with microjet administration of dopamine at 1-4 mcg / (kg x min) with maintained arterial pressure or at 5-12 mcg / (kg x min) in the event of shock. It is advisable to administer broad-spectrum antibiotics (III-IV generation cephalosporins, aminoglycosides), immunoglobulins. In the hospital, plasmapheresis and hemodialysis are performed in the event of acute renal failure.
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