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Syndrome of a long prelum


Syndrome dltelny sdavlniya (synonyms: kompartment-syndrome, krash-syndrome, traumatic toxicosis, syndrome (long) crush, compression injury, crush syndrome, epony: Bayuoters's syndrome (English Bywaters)).

Symptoms of the Syndrome of a long prelum:

After release from a prelum shock, as a rule, develops. Since 3 — the 4th day, local symptoms are shown: dense swelled, pallor, dysfunction of an extremity and a renal failure, the oligouriya passing into an anury. Because in the first days of a disease symptoms are not expressed, carry out ineffective overdue treatment.

Special form of a krash-syndrome is the position prelum — a prelum of a part of a body at a long dream in alcohol intoxication or in unconsciousness. Early symptoms are erased, on 3 — the 4th day acute clinical manifestations begin, the acute renal failure develops.

Reasons of the Syndrome of a long prelum:

There is owing to long disturbance of blood supply (ischemia) of the squeezed soft tissues a toxicosis which is characterized in addition to local, system pathological changes in a type of a hyperpotassemia and a renal failure. Occurs at victims at earthquakes, blockages in mines, collapses, etc.
N. N. Elansky (1958) explains development of a clinical picture at a syndrome of long crush with absorption of toxic products from the crushed muscles. It is established that the damaged muscular tissue loses 75% of a myoglobin, 70 — creatinine, 66 — potassium, 75% of phosphorus. After release from squeezing these substances come to a circulatory bed, there is acidosis, the heavy general and, first of all, hemodynamic frustration. It is necessary to emphasize that clinical manifestations arise only after elimination of a factor of squeezing.

There is a deep necrosis of fabrics leading to organism self-poisoning with decomposition products of fabrics and serious condition of the victim.

Treatment of the Syndrome of a long prelum:

On site an obligatory applying a tourniquet on the squeezed extremity above the damaged place, an extremity immobilization, cold on the damaged site. Further treatment is directed to recovery of blood circulation in the injured extremity (reperfusion), fight against a toxaemia, an acute renal failure. From surgical methods of treatment apply a fasciotomy, in hard cases carry out amputation of the damaged extremity segment. The forecast at development of an acute renal failure adverse.

At the correct and timely treatment by 10 — 12 day of the phenomenon of a renal failure gradually abate. Further swelled, and the injured extremity pains gradually decrease and by the end of the first month of treatment completely disappear.

The complete recovery of function of an extremity usually does not happen that is caused by damages of large nervous trunks and muscular tissue. Over time the most part of muscle fibers perishes, being replaced with connecting fabric that leads to development of an atrophy.

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