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Prolonged pressure syndrome
Last reviewed: 18.10.2021
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The syndrome of prolonged compression develops with prolonged (for several hours) pressing down any part of the body. After releasing the limb, endotoxic shock can develop. The liberated limb is enlarged in volume due to edema, cyanotic, bubbles with hemorrhagic fluid are formed. Rapidly developing acute renal failure due to toxic ("medium molecules", myoglobin) and circulatory damage.
In connection with the rapid rate of deterioration in the condition of children with the syndrome of prolonged compression, even before the limb is released, it is necessary to inject intramuscularly narcotic analgesics - 1-2% solution of trimiperidine (promedol) or omnopon 0.1 ml per year of life. Sedation treatment is carried out with diazepam (seduxen) 0.1-0.3 mg / kg intramuscularly. It is necessary to impose 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 strands of the tourniquet, which children are recommended to apply for up to 30 minutes, then dissolve for 1 minute and reapply for 30 minutes, until the child enters the hospital. A thorough examination of the victim is necessary to exclude fractures of bones. It is important to ensure transport immobilization: the limb is covered with ice, the child is placed on the shield in a horizontal position, and the injured limb is raised by 15-30 °.
In connection with the increased burden on the kidney caused by massive myoglobinuria, in order to prevent shock and improve microcirculation in the kidney tissue, intravenously drip crystalloids - 0.9% solution of sodium chloride, 5% glucose solution, sodium acetate + sodium chloride (disol), 10 ml / (kghh) under the control of arterial pressure. Infusion therapy should be combined with micro-jet dopamine administration of 1-4 μg / (kg-min) at a preserved arterial pressure or 5-12 μ / (kg-min) during development of shock. It is advisable to introduce broad-spectrum antibiotics (cephalosporins III-IV generation, aminoglycosides), immunoglobulins. In a hospital with the development of acute renal failure, plasmapheresis and hemodialysis are carried out.
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