Positional compression syndrome: definition, causes, emergency care

The syndrome of positional compression is a trauma associated with prolonged squeezing of the limb with a heavy weight. Such injuries occur quite often as a result of accidents, earthquakes, and also collapse of buildings. This syndrome is associated with complex injuries, the treatment of which is quite long and time-consuming.

Causes of the syndrome

In addition to emergency situations, the positional compression syndrome can be obtained as a result of prolonged stay in an uncomfortable position, when the limbs are squeezed by the weight of their own body. As a result, tissue necrosis may occur with the release of toxins. This can happen if a person has been unconscious for a long time or in a static position (more than 12 hours).

The result of the treatment will largely depend on how long the person was in the situation described, on the correctness of the diagnosis and the prescribed treatment. If the diagnosis was incorrect or the person received incomplete treatment, and also no first aid was given, then the prognosis is disappointing, as patients usually have irreversible trophic and neurological consequences.

Basic views

Syndrome positional compression is classified immediately by several criteria:

• Type of compression;
• Localization;
• Damage to other organs;
• The presence of complications;
• Severity.

In terms of severity, this syndrome is divided into light, medium and heavy:

1. An easy degree is characterized by the fact that the area of the damage and its depth are small. The general manifestations of intoxication are minor, small disorders of the kidneys are also observed, which are quickly restored. Urine has a reddish-brown color for some time. All indicators are normalized after 5-7 days of intensive treatment in the hospital.
2. The average degree is characterized by the presence of more extensive damage. Intoxication is moderately pronounced. A blood test shows an increase in the level of residual nitrogen and urea. If untimely first aid is provided, serious complications and infection may occur at this stage.
3. The third degree is characterized by a significant lesion of several zones, and severe intoxication can even lead to a fatal outcome.

What happens in the body with prolonged compression

When a certain part of the body is squashed, there is a violation of the blood supply of tissues below this area. Often, limbs suffer. Tissues are badly damaged, oxygen starvation is observed, a stiff leg or arm loses its sensitivity and gradually begins necrosis with the release of many toxic substances.

Often, even at the time of trauma, there is a strong destruction of the muscle tissue, there may be fractures of the bones, damage to the vascular system, resulting in bleeding. Also, a person feels severe pain, as a result of which even a traumatic shock can occur.

Symptoms of the syndrome

Symptoms of the positional compression syndrome directly depend on the time of squeezing and the volume of affected tissues. For example, when squeezing the forearm area for 2-3 hours, acute renal failure will not be observed, although there may be a decrease in urine production. There are also no manifestations of intoxication. Such patients recover very quickly without any consequences.

At this stage, there is pallor, severe weakness, tachycardia. The most dangerous in this case will be the extraction of the injured person from under the wreckage, as with the normalization of blood circulation, intensive production of potassium occurs, which can provoke cardiac arrest. For the initial period, there are signs such as:

• A swollen leg or arm does not function;
• The skin is pale and cold;
• There are bubbles;
• The pulse is practically absent.

In addition, fractures of bones are often diagnosed.

Prolonged compression, lasting up to 6 hours leads to the occurrence of violations of moderate severity. In this case, marked manifestations of intoxication and impaired renal function throughout the week. The prognosis of the disease largely depends on the period of first aid and the timeliness and quality of follow-up therapy.

With more than 6 hours of compression, severe poisoning occurs with toxic substances, and the kidneys are turned off completely. Without intensive intensive care and hemodialysis, a person dies.

Conducting diagnostics

Determine the presence of the problem can be immediately at the scene of the accident. If the victim has a painful shock, he may be unconscious. Objective data allows you to diagnose with a fairly high probability.

When carrying out laboratory tests, you can get all the required information on blood clotting, electrolyte disorders, increased glucose levels, urea, bilirubin. Biochemical blood test will help to determine the decrease in protein concentration.

In the initial studies, there may be no changes in the urine, but gradually it begins to acquire a somewhat brownish color, as well as a density increase, and a protein appears in it. With microscopic examination, leukocytes, erythrocytes and cylinders are determined.

First aid

The first aid in the syndrome of compression depends largely on who is providing it, as well as the availability of the required activities, the availability of qualified medical personnel. Professional doctors and rescuers by their actions improve the prognosis for the patient.

First of all, the victim must be taken to a safe place. Identified at a superficial examination, abrasions and wounds need to be treated and superimposed on them with special aseptic dressings. If there is bleeding, measures should be taken to stop it, apply immobilizing tires or other improvised means to fracture. If at this stage it is impossible to ensure the introduction of intravenous infusion, then the patient should be provided with a plentiful drink.

The tourniquet should be applied to the affected limb even before the person releases from the rubble to prevent the active release of potassium. Then an anesthetic is given and the patient needs to be taken to the hospital for further treatment.

To which doctor should I apply

If you suspect a prolonged compression syndrome, you should immediately seek advice from a traumatologist. In addition, a nephrologist, cardiologist, dermatologist and neurologist may need to be examined. Since pathology leads to various complications, the patient needs to conduct complex diagnostics.

Carrying out of treatment

Treatment should be comprehensive, and its specificity depends on the duration of the disease. Necessarily, an infusion of frozen plasma, as well as detoxification. In the period of acute renal failure, daily hemodialysis is performed. It also shows the observance of a special diet with a restriction of drinking regimen and the exclusion of fruits from the usual diet. It is necessary to observe measures to prevent the occurrence of purulent complications and sepsis.

Patients may have complications from many internal organs and systems, the development of irreversible limb ischemia, purulent-septic complications, thromboembolism. But the main complication is acute renal failure. It often leads to the death of the patient.