Compression Syndrome (Crush Syndrome, Crash Syndrome, Traumatic Toxicosis)

Compartment syndrome (Crush syndrome, Crash syndrome, Traumatic toxicosis)

Compartment syndrome is a pathological condition caused by prolonged (2 or more hours) compression of soft tissues (usually limbs), which is based on necrosis of muscle tissue. The syndrome develops after the compression is eliminated due to the entry into the general bloodstream of a large amount of decay products of damaged tissue. Severe disseminated intravascular coagulation syndrome develops, which, together with the deposition of myoglobin in the renal tubules, leads to acute renal failure.

Symptoms and course
After release from the compression, traumatic shock develops. Already from the first day, oligo- or anuria may occur. A sharp, dense swelling of the injury site and distal areas develops. Edema contributes to the progression of tissue ischemia. Resorption of cytolysis products can lead to hyperkalemia.

With timely intensive treatment, acute renal failure resolves within 10-15 days. At this time, septic and purulent complications occur.

Treatment
Anti-shock measures are carried out directly at the scene of the incident - vein puncture and administration of rheopolyglucin and narcotic drugs. The compressed limb is tightly bandaged with an elastic bandage, which helps slow down the rate at which toxic substances enter the bloodstream. During transportation, the limb is immobilized.

Hospitalization is carried out on an emergency basis. Treatment is carried out in the intensive care ward or resuscitation department. In the very first hours, plasmapheresis is carried out in a volume of up to 1500 ml, large volumes of fresh frozen plasma are transfused (1000-1500 ml/day), hemodesis, saline solutions (total volume of transfusion up to 2500 ml/day).

Heparin, antiplatelet agents, Trasylol, Lasix, and antibiotics are prescribed. When diuresis decreases to less than 600 ml/day, hemodialysis is performed. Hyperbaric oxygenation sessions are carried out 1-2 times a day. If necessary, perform fasciotomy, necrectomy, or amputation.

Forecast
With timely and correct treatment, it is favorable. Late complications may include the development of neuritis with flaccid paralysis.