Methodical references for practical lesson
Subject:Syndrome of long squeezing. First-aid treatment
Specialty: 051301-General medicine
Syndrome of long squeezing. First-aid treatment
Purpose: Working off of practical skills on urgent medicine.
Problems of training:
- Syndrome of long squeezing.
- First-aid treatment.
Main questions of a subject:
1. Syndrome of long squeezing
The long squeezing of soft fabrics represents a special type of a trauma, which develops owing to more or less long squeezing of soft fabrics (more often - extremities) breed fragments in mines, stones in mountains
Long squeezing of muscles (or their squeezing at compelled position of a body) are accompanied by hypostasis of the injured extremity because of extensive death of muscles and development of shock in the first 1-2 days, emergence of sharp nephritic insufficiency from 3 days to the 5th week after a trauma, bad mobility develops in joints, emergence of wounds in a zone of a necrosis and a violation of conductivity on nerves in the late period.
The major factors causing a serious condition of victims of long squeezing are:
- hit in blood of products of disintegration from the destroyed muscles (a myoglobin, potassium, etc.). - sharp and long pain at a trauma which leads to the spasm of vessels of kidneys leading to emergence of sharp nephritic insufficiency.
- hemorrhage and plasmorrhagia (in the squeezed fabrics permeability of walls of vessels for liquid therefore after squeezing elimination plasma directs from vessels in muscles - on the one hand sharply increases, there is an extremity hypostasis, with another - the amount of blood circulating in vascular system decreases).
2. Clinical signs of a syndrome of long squeezing
External signs of a syndrome are rather deceptive. Right after squeezing elimination (extraction of the victim from a blockage, change of position of a body after long stay in the compelled pose) the condition of the victim can seem satisfactory. The patient is disturbed by the injured extremity pain, restriction of mobility of an extremity and its hypostasis. The extremity is pale, on the sites which have undergone a squeezing, there can be dents, bruises. On an extremity it is usually possible to probe a pulsation of vessels.
Soon after release from squeezing the extremity increases in volume at the expense of quickly accruing hypostasis, gets ligneous density. Painful feelings start to accrue. Hypostasis tends to extend quickly out of limits of the injured sites. Places of the former dents smooth out. On sites of skin which underwent the greatest squeezing , there are bubbles with transparent or bleed contents. The pulsation of vessels of extremities weakens. Extremities become cold, the victim can't move them, in attempt to bend or unbend the injured extremity by means of "doctor" there is a sharp pain. Sensitivity of skin on the injured extremity is broken - the patient, for example, doesn't feel touches or having pricked with a pin.
The general condition of the victim progressively worsens. Pulse becomes frequent, arterial pressure falls. The raised euphoria victim actively reacting to all events becomes languid, apathetic, indifferent to surrounding. Body’s temperature decreases. At the big area of a squeezing and long influence of a crushing subject the specified symptoms of shock develop quicker.
In the first days after a trauma urine of the victim has varnish-red coloring.
With the 2nd, more often than 3rd day after a trauma increase of sharp nephritic insufficiency begins. The amount of urine, separated by the victim, decreases up to its total absence. An affected extremity pains decrease. In places of the greatest a squeezing, skin and hypodermic fatty cellulose quite often death also are torn away. The injured muscles are bulging. In the formed wounds are looking like boiled meat. Body temperature raises, the patient starts to be in a fever. Pulse remains speeded up. The general condition of the patient, at first sight, ceases to fill with misgivings. However to 4-5 day the patient has violations of breath and warm activity (pains behind a breast, feeling of asthma, short wind - the quantity of breaths exceeds 30 in a minute). By this moment the victim at any situation should be in a hospital.
3. Disease forecast
At patients with a squeezing is both extremities lasting more than 8 h, it is not enough chances. After release from under a blockage the heavy shock, which is badly giving in to treatment quickly develops. All victims, as a rule, die in 1-2 days.
At a squeezing of one or two extremities within 4-6 hours shock, violation of function of kidneys develops. A lethal - from 50 to 70 %.
If duration of a squeezing doesn't exceed 4 hours, the lethality doesn't exceed 30 %. At a squeezing only shins or forearms within no more than 4 hours, all victims usually survive.
4. First aid
- to release from under a blockage the head and the top part of a body of the victim, for access of air to clear an oral cavity and a nose of foreign matters, to wash out an oral cavity;
- a violation of breath it is necessary to carry out artificial ventilation of lungs by a method "a mouth to a mouth" silt "a mouth in a nose";
- to anaesthetize;
- wounds and grazes to apply aseptic bandages (sterile napkins). After release from -under crushing subjects the injured extremity hardly to bandage elastic bandage, since a brush or foot;
- an extremity immobilize by rules of treatment of changes. Over a bandage to impose packages with ice or snow (if they aren't present - with cold water). A plaitimpose only on an impractical extremity;
- as much as possible quickly to transport the victim in the next hospital.
Equipment:plait, roller, system for liquid transfusion, physiological solution of chloride sodium 0.9, tires, air line, hot-water bottles with ice, elastic bandage, styptic plait.
Training and teaching methods: small groups, discussion, situational tasks, work in pairs.
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