SDS - a syndrome of prolonged compression: symptoms, treatment and prevention

Everyone is practically not insured against various accidents. It can be anything you like, from an accident in transport to an earthquake and a collapse of the mine. In any of these cases, VTS can develop. The syndrome has various causes, pathogenesis, mandatory treatment is required. Let's consider these questions further.

The concept of VTS

As a result of compression of soft tissues, SDS can develop. The syndrome in women occurs with the same frequency as in the male population. It has other names, for example, crash syndrome or compression trauma. The cause of the syndrome can be:

• Compression of parts of the body with heavy objects.
• Emergency situations.

Such situations often occur after earthquakes, as a result of road accidents, explosions, collapses in mines. The force of compression may not always be great, but here the duration of such a state plays its part. Typically, SDS (long-term compression syndrome) occurs if there is a prolonged effect on soft tissues, usually more than 2 hours. First aid is an important stage on which human life depends. That is why it is important to be able to distinguish the manifestations of such a state.

Varieties of VTS

In medical practice, there are several approaches to the classification of the compression syndrome. Given the type of compression, these syndromes are distinguished:

• Developed as a result of the collapse of the soil. Occurs as a result of prolonged exposure under a concrete slab or various heavy objects.
• The position SDS develops due to squeezing parts of its own body.

Localization can also be different, hence the SDS:

• Of course.
• Heads.
• Belly.
• Breasts.
• Taza.

After emergencies, SDS is often developed. The syndrome is often accompanied by other injuries, so distinguish:

• Syndrome of compression, accompanied by trauma to internal organs.
• With damage to the bony structures of the body.
• SDS with damage to nerve endings and blood vessels.

The degree of severity of the syndrome may be different. Based on this fact, they distinguish:

• An easy form of the syndrome, which develops when squeezing the limbs for a short time. Disorders from the cardiovascular system, as a rule, are not diagnosed.

• If the pressure on the tissue is more than 5-6 hours, then the average form of SDS develops, at which there may be renal failure in mild form.
• Heavy form is diagnosed when squeezing more than 7 hours. Signs of renal failure are expressed .
• If the soft tissues are pressured for more than 8 hours, then we can talk about the development of an extremely severe form of SDS. It is possible to diagnose acute heart failure, which often leads to death.

It often happens when SDS (long-term compression syndrome) is accompanied by various complications:

• Myocardial infarction.
• Diseases of various organ systems are fraught with SDS. The syndrome in women, affecting the lower part of the trunk, that is, the organs of the small pelvis, is fraught with severe complications and a violation of the normal functioning of organs of this sphere.
• Purulent-septic pathologies.
• Ischemia of damaged limb.

The result of injury: VTS

The reason is as follows:

• Pain shock.

• The loss of plasma, which leaves through the vessels in the damaged tissue. As a result, the blood becomes thicker and thrombosis develops.
• As a result of the disintegration of tissues, the organism becomes intoxicated. Myoglobin, creatine, potassium and phosphorus from injured tissues enter the bloodstream and cause hemodynamic disorders. Free myoglobin is converted to hydrochloric acid hematin and provokes the development of acute renal failure.
• All these reasons must be eliminated as soon as possible so that the salvation of human life becomes possible.

Periods of clinical course of VTS

The course of the crash syndrome has several periods:

• The first is directly compression of soft tissues with the development of traumatic shock.
• In the second period there are local changes in the injured area and the beginning of intoxication. Can last up to three days.
• The third period is characterized by the development of complications, which are manifested by the defeat of various organ systems.
• The fourth period is reconvalescence. It begins with the restoration of kidney function.
• Further, the affected persons show factors that speak of immunological reactivity, bactericidal activity of the blood.

Symptomatic of tissue compression syndrome

If the strong pressure on soft tissues is not immediately eliminated, the SDS progressively progresses. The symptoms are as follows:

• The skin on the squeezed limb becomes pale.
• There is swelling, which only increases with time.
• The pulsation of the vessels is not felt.
• The general condition of the victim worsens.
• There is a pain syndrome.
• A person has psychoemotional stress.

The blood test shows an increase in fibrinogen, fibrinolytic activity decreases, the coagulating blood system also accelerates.

In the urine, a protein is found, red blood cells and cylinders appear.

Such manifestations can have SDS. The syndrome is characterized by a relatively normal state of the affected, if the squeezing of the tissues is eliminated. But after a while they appear:

• Cyanosis and pallor of the covers.
• Motley coloring of the skin.
• Over the next 24 hours the swelling is increasing.

• Bubbles, infiltrates can appear, and in severe cases necrosis of limbs arises.
• Cardiovascular insufficiency develops.
• A blood test shows its thickening and neutrophil shift.
• Tendency to thrombosis.

At this stage it is important to conduct timely intensive infusion therapy with the use of forced diuresis and detoxification.

Symptoms of the third period

The third stage of the syndrome (SDS) development is characterized by the development of complications, it lasts from 2 to 15 days.

Signs at this time may manifest as follows:

• The defeat of various organ systems.
• Development of renal failure.
• Puffiness becomes more.
• On the skin, bubbles with transparent or hemorrhagic contents can be observed.
• The anemia begins to show.
• Decreases diuresis.
• If you do a blood test, then the concentration of urea, potassium and creatinine increases.
• There is a classical picture of uremia with hypoproteinemia.
• There is an increase in the body temperature of the victim.
• The general condition worsens.
• There is a retardation and lethargy.
• Can be vomiting.
• Staining the sclera signals the involvement of the liver in the pathological process.

Even intensive therapy can not always save a person if a VTS is diagnosed. The syndrome, if he reaches this period, then in 35% of cases leads to the death of the victims.

In such cases, only extracorporeal detoxification can help.

Further development of the VTS

The fourth period is reconvalescence. It begins after the kidneys recover their work. At this stage, local changes prevail over common ones.

Symptoms can be as follows:

• If there are open injuries, then there are infectious complications.
• Possible development of sepsis.
• If there are no complications, then the puffiness begins to subside.
• How quickly the mobility of joints will recover will depend on the severity of the damage.
• Since the muscular tissues die, they begin to replace connective tissue, which does not have the ability to reduce, so develop atrophy of the extremities.
• Anemia still persists.
• The victims have no appetite.
• There are persistent changes in homeostasis, and if intensive infusion-transfusion therapy is used, they can be eliminated after a month of intensive treatment.

During the last period, the victims are detected a decrease in the factors of natural resistance, bactericidal activity of the blood. The leukocyte index has been changed for a long time.

For a long time, the victims experience emotional-psychic instability. Frequent depressive conditions, psychosis and hysteria.

How to recognize the VTS?

Syndrome, the diagnosis of which should only be done by a competent specialist, requires special attention and treatment. Determine the presence of pathology can be based on the following indicators:

• It takes into account the clinical picture and the circumstances of the injury.
• Do not disregard the results of the analysis of urine, blood.
• There is an instrumental diagnosis, which allows you to compare the dynamics of laboratory symptoms and the structure of the kidneys.

People who undergo heart diagnostics sometimes hear this diagnosis, but not everyone understands what a syndrome is. SDS in a cardiogram of the heart may indicate the presence of a pathology that affects the thorax. Being under the debris can significantly affect the work of the heart muscle.

Laboratory diagnostics is carried out with the purpose:

• Detection of the level of myoglobin and blood plasma: usually in this condition it significantly increases.
• Determination of myoglobin concentration in urine. If the indicators reach 1000 ng / ml, then we can talk about developing acute renal failure with SDS.
• The syndrome can also be manifested by increased transaminases in the blood.
• Increases in creatinine and urea.

On the analysis of urine, doctors determine the degree of kidney damage. The study reveals:

• Increase of leukocytes, if there is a complicated SDS.
• Increases the concentration of salts.
• The content of urea increases.
• There are cylinders.

A correctly diagnosed diagnosis allows doctors to prescribe effective therapy to help the injured as quickly as possible to restore all the functions of the body.

How to provide first aid?

From the provision of emergency care depends on the condition of the victim, and maybe his life, if the SDS is developing. Syndrome, first aid should be provided as soon as possible, will not lead to serious complications if you help the victim with the following algorithm:

1. Give an anesthetic drug.
2. Then start releasing the affected area of the body.

As such tools are suitable: "Analgin", "Promedol", "Morphine". All drugs are administered only intramuscularly.

Many people ask, why apply a tourniquet in case of SDS-syndrome? This is done in the presence of severe arterial bleeding or extensive damage to the limbs, so that the victim does not die from loss of blood.

• Inspect the damaged area.
• Remove the harness.
• All available wounds must be treated with an antiseptic and covered with a sterile napkin.
• Try to cool the limb.
• Suffering to give abundant drink, tea, water, coffee or salt-and-salt solution will do.
• Warm the victim.
• If there are debris, the person should be provided with oxygen as soon as possible.
• To prevent heart failure, introduce the victim "Prednisolone".

• Send the victim to the nearest hospital.

Therapy of the syndrome of compression

There may be different degrees of SDS. The syndrome, the treatment of which should be carried out in a complex manner, will not cause serious complications, if we take into account the pathogenesis of the lesion. Complex influence - this means:

• Carry out measures to eliminate abnormalities of homeostasis.
• To exert a therapeutic effect on the pathological lesion.
• Normalize the microflora of wounds.

Medical measures should be carried out almost continuously, from the moment of rendering first aid and until the victim fully recovered.

If the injuries are significant, then the medical assistance consists of several stages:

• The first begins directly at the scene of the accident.
• The second is help in a medical institution, which can be quite far from the place of tragedy, so often used "flying hospitals", "hospitals on wheels." It is very important that there is appropriate equipment to assist with damage to the musculoskeletal system, internal organs.

• At the third stage, specialized assistance is provided. Usually this happens in a surgical or traumatological center. There is all the necessary equipment to help with serious injuries of the musculoskeletal system or internal organs. There are resuscitation services for removing a person from a shock state, treating sepsis or kidney failure.

Medication Therapy

The earlier this stage of therapy is started, the more chances a patient has to survive. Medical assistance at this stage is as follows:

• Victims are infused with a mixture of sodium chloride and 5% sodium bicarbonate in a 4: 1 ratio.
• If a severe form of the syndrome is observed, then 3-4 liters of blood or blood substitute are administered to the injured as an anti-shock measure.
• To prevent the development of complications, diuresis with the introduction of "Furosemide" or "Mannitol".
• Decreased intoxication of the body is achieved by blood substitution and the use of gamma-hydroxybutyric acid at an early stage. It has a retarding effect on the central nervous system and has a hypertensive effect.

If all conservative methods of therapy do not give the desired result, then surgical treatment is required, which is based on the following methods of detoxification:

• Sorption methods.
• Dialysis-filtration (hemodialysis, ultrafiltration).
• Feral (plasmapheresis).

It may be necessary and amputation of the extremities, which can not be returned to normal life.

Is it possible to prevent SDS?

If to avoid reception of serious traumas it has not turned out, in most cases SDS develops. Syndrome, whose prevention is mandatory, will not lead to disastrous consequences, if immediately begin to take action. To do this, you need to introduce antibiotics penicillin series. The use of antibacterial agents may not be saved from suppuration, but it is quite possible to prevent gas gangrene in this way.

Even before extracting the victim from under the rubble it is important to begin infusion therapy to normalize BCC. Often, Mannitol, a 4% solution of magnesium hydrogencarbonate, is used for this purpose.

If you carry out all these actions directly at the scene, then it is possible to prevent the development of serious complications of VTS, such as gas gangrene and kidney failure.

We have considered in detail SDS (a syndrome of long compression) of internal organs by mass of own body or heavy subjects. This state often occurs in an emergency. It should be noted that timely assistance provided can save a person's life. But in literature and in the pages of modern journals one can find quite a different interpretation. It is also called - SDS syndrome - female illness of the century. This concept is completely from another area and it should not be confused with such a serious pathology. This is a topic of a completely different article, but in brief it should be noted what this syndrome means. Often it affects women, burdened with power. Selfishness, lack of self-criticism, prejudiced attitudes toward men, confidence in one's own infallibility, and similar "symptoms" are characteristic of women's SDS syndrome.