Traumatic toxicosis (synonym: long crush syndrome, crush syndrome) is a syndrome that develops in the affected people after prolonged crushing (4-8 hours or more) of soft tissues of the extremities, especially the lower ones. More often, traumatic toxicosis occurs when collapses in mines , crushing under the ruins of buildings, etc. The crushed limb immediately after release is pale, then acquires a purple-cyanotic color, swells, its skin becomes covered with blisters filled with bloody fluid.
Severe common signs of traumatic toxicosis develop a few hours after the release of the limb. In case of traumatic toxicosis from the mashed muscles, a large amount of tissue decomposition products enter the blood, poisoning the body. Due to edema, plasma loss (up to 30% of the mass of circulating blood) develops. These disorders, combined with severe pain, cause a breakdown in the functions of the nervous system, heart, kidneys, liver, and vascular system. Blockage of the renal tubules by the products of the decomposition of muscles leads to acute renal failure . In the urine appears protein.The
There are three periods of traumatic toxicosis. For the first (early - in the first 2 to 3 days), the period is characterized by an increase in the edema of the damaged limbs, their cooling, disappearance of the pulse, sensitivity, movements. The patient is in shock, pale, inhibited. He has a faster pulse , lowering blood pressure. Urine at first lacquer-red color, in the subsequent becomes brown. The amount of it is reduced to 50 - 250 ml per day. In the second period (from the 3rd to the 9th - the 12th day) the patient's well-being improves, the pain subsides, the swelling begins to subside. The blood pressure is normal or slightly increased. Despite this, kidney damage is increasing. There may come a complete anuria and develop uremia (see). Mortal uremia is also possible in those affected, who in the first period did not have severe shock disorders and did not seem seriously affected. For the third period (from the 9th to the 12th day to the end of the second month), the prevalence of local symptoms over general symptoms is characteristic. The edema gradually passes, the sensitivity and movements are restored. The pains intensify again. On the site of the greatest crushing in some patients, the skin is necrotic and rejected. Sometimes pieces of dead muscles are torn away. With a favorable outcome, the amount of urine released sharply increases.
Treatment: immediately after the release of the patient, morphine (1 ml of 1% solution), camphor oil (1-2 ml of 20% solution), cordiamine (1-2 ml) is injected into the patient. The affected limb is tightly banded, after which it must be placed in the tire. Above the dressings, bubbles are placed with ice. If the patient's condition is severe, ephedrine is injected under the skin (0.5-1.0 ml of a 5% solution), intravenously polyglukinum up to 300 ml. The victim must be transported on stretchers, even if the condition does not seem heavy. In hospital conditions, complex anti-shock treatment is performed. Blood, plasma, polyglucin, neocomensane, mannitol, 5% glucose solution, 4% sodium hydrogen carbonate solution - up to 3-4 liters of liquid are transfused. Using a permanent catheter, measure the amount of urine released within 1 hour. If diuresis is below 40-50 ml per hour, increase the amount of injected fluid, produce a pericardial blockade (see Novocaine blockade). The injured are prescribed antibiotics, if necessary, produce wide sections of affected tissues. With persistent anuria, an artificial kidney is used (see Kidney ).
The prognosis , especially with the adherence of acute hepatic insufficiency, is unfavorable.