Traumatic toxicosis

Traumatic toxicosis (synonym: the syndrome of prolonged crushing syndrome crush zone) - a syndrome that develops in casualties after a long crushing (4-8 hours or more) soft tissue of the limbs, especially the bottom. More often traumatic toxicity occurs when the landslides in the mines, crushing under the ruins of buildings and so on, Crushed limb immediately after the release pale, then gets a bluish-purple color, swollen, the skin is covered with blisters filled with bloody liquid.
Heavy common signs of traumatic toxicity develop within a few hours after the release of the leg. With traumatic toxicosis of mashed muscles, the blood receives a large number of products of tissue decay, poisoning the body. Due to the swelling develops of plasma loss (up to 30% of the mass of circulating blood). These violations in combination with severe pain cause the disorder of the nervous system, heart, kidneys, liver, cardiovascular system. Corking of the renal tubules decay products of muscles leads to acute renal failure. Urine protein appears.
There are three periods traumatic toxicity. For the first (early - in the first 2 to 3 days) period is characterized by growth of edema damaged limbs, their cooling, the disappearance of the pulse, sensitivity, movements. The patient is in a state of shock, pale, stalled. He quickens the pulse, blood pressure decreases. Urine first lacquer red, subsequently becomes brown. The number decreases to 50 - 250 ml per day. In the second period (from 3rd to 9th - 12th day) the patient's health is improving, the pain subsided, swelling begins to subside. Blood pressure is normal or slightly increased. Despite this increasing damage to the kidneys. There can be total anuria and develop uremia (see). Fatal uremia possible and in those affected that in the first period had expressed shock disorders and has not been seriously affected. For the third period (from 9 - 12th day before the end of the second month) is characterized by the predominance of local symptoms above General. Swelling gradually goes away, restores sensitivity and movement. Pain again increase. On the place of the greatest crushing some patients skin blackened dead tissue and rejected. Sometimes rejected pieces of dead muscles. The favorable outcome dramatically increases the amount of urine.
Treatment: immediately after the release of the victim he injected morphine (1 ml of 1% solution), camphor oil (1-2 ml of 20% solution), kordiamin (1-2 ml). The affected limb tight bontout, then necessarily placed on the bus. Over dressing place bubbles with ice. If the condition is severe, is injected under the skin ephedrine (0.5-1.0 ml of 5% solution), intravenous poliglyukin to 300 ml. of the Victim must be transported on a stretcher, even if the state does not seem difficult. In hospitals conduct complex for shock treatment. Blood transfusion, plasma, poliglyukin, neocompsa, mannitol, 5% glucose solution, 4% solution of sodium bicarbonate - up to 3-4 litres. With a permanent catheter measures the amount of urine released within 1 hour. If diuresis below 40-50 ml per hour, increase the amount of fluid, produce okolopochechnuyu blockade (see Blockade procaine). The victim prescribe antibiotics if necessary, produce a wide sections of the affected tissues. When resistant anuria apply artificial kidney (see artificial Kidney).
Forecast, especially with the accession of acute liver failure, adverse.