Tricky health syndrome: signs, inadequate help. Tricky depression syndrome Ethiopathogenetic Lanka and factor

Syndrome of tricky blood pressure (traumatic anuria, Bywaters syndrome, traumatic rhabdomyolysis) is a pathological camp, dressings with renewed blood circulation in tissues, which are relieved for a long time. Winery of the SDS in case of additional injuries from blockages, kudi stench will be consumed for an hour of earthlings, man-made disasters, terrorist attacks. A typical type of pathology is a syndrome of positional depression, such as a disease in people’s pictures, most of the time it’s unbearable (coma, alcoholic intoxication). At the same time, there is a lack of signs of death.

Most often people suffer from a crash syndrome in regions, there are battles, with earthquakes, in car accidents. In the rest of the rock, all the greater relevance as the cause of the SDS swells terrorism, with any vibuhi awakening it can cause the injured people to collapse.

In all cich vipadkah, behind the blame of car accidents, the situation with the mass hopes of sufferers to medical mortgages is blamed. It is especially important for this to quickly develop the development of the SDS and to work on the development of the pre-hospital stage.

See Tricky Compression Syndrome

Classify the pathological camp immediately according to the decile criteria:

• according to the type of compression, it is possible to move to the pressure (traumatic ear pressure), direct and negative pressure;
• by localization - thoracic, cherevna, pelvic areas, hand, frontal, stegno, gomilka, foot in new combinations;
• According to the information about the following parts of the file:
  • internal organs;
  • kistok, suglobiv;
  • magistralnyh vessels, nerve stovburiv;
• on the face of acceleration;
• steps of gravity;
• Combinations with other types of injuries:
  • opikami or ice cream;
  • trade ailments;
  • wrenched, etc.

What to see in the body in case of crash syndrome

The basis of the cycle of pathology is the mass bending of the muscle tissue. The reasons for the process are:

• bezposredn їх ruinuvannya traumatic factor;
• pinching the bloodstending of the crushed muzzle;
• klinna hypoxia, associated with hemorrhagic shock, often supervises a massive trauma.

Pokey m'yaz is crushed - the crash syndrome is mute. I have to fix myself in order that the part of the body will be tightened in the last vise. With a lot of transmitted blood-bearing vessels, they open up, and shelter, filled with products, the growth of myazovykh cells, straighten into the main channel. Having reached the nirok, myoglobin (the main block of myaziv) clogs up the microscopic nirkovy tubules, Blocking viroblenya sechі. Tubular necrosis and bend of brunoks develop in a stretch of decilcoh years. Pidsumkom tsikh processes old gostra nirkova lack.

If the ailments are overrun, they will be left behind as a result of the pressure, so as for the injured tissue. So, with a delay before the plan stretching for 2-3 years, guests nirkova lack I will not, if I want to reduce the number of changes, all will be appreciated. There are no signs of intoxication, which are inevitable when it is too cold. It is practical to learn such ailments without inheritance.

Great pressures, lasts up to 6 years, leads to a crash syndrome average gravity... In a wide range of cases, there are diseases of endotoxicosis (intoxication) and deterioration of nirk functions by stretching and more. The forecast is based on the terms of the first additional help and freedom and a lot of intensive therapy.

With more than 6-year delay, SDS develop in important forms. Endotoxemia is a severe build-up, the symptoms are growing. Without hemodialysis and straining intensive therapy, people will inevitably fail.

Symptoms of the crash syndrome lie in the period of development of pathology.

In the early period (1-3 days), in the main, symptoms of shock are evident є: weakness, weakness, tachycardia, decrease arterial vise... Naybіlsh not a safe moment in the whole period - the unprecedented struggle of the sufferer s-pіd ulamkіv. As soon as blood circulation is renewed in a victimized woman, a great number of calories fall into the roof of the house, which should be brought to the heart's worthiness. Allegedly, in case of important forms of SDS, the symptoms of nirkovo-hepatic deficiencies and a lot of legends, as well as heart arrhythmias, are still developing in the first place.

For the early period, the characteristic mists show on the side of the suffered patterns:

• stan shkiri - stressed (through the interstitial embryo), bleed, cyanosis, cold on the dot;
• on shkіri є bulbs;
• pulse on the peripheral arteries during the day;
• all forms of sensitiveness, either driven or seen;
• Health before active people affected by the picture is reduced, for the day.

More than half of the sufferers are diagnosed with cysts as well.

In the intermediate period (4-20 days) on the first place, there are signs of intoxication and gostra nirkov deficiency. The camp of the ailing person will stabilize for a short term, but then he will start to quickly go down, and there will be a loss of svidomosty right up to the point of deafening. Cutting the old brown, її number of drops right down to zero, and the whole body can be trivial up to 3 types. at friendly perebіgu the ailment phase to move into the phase of polyuria, when the number of visions grows rapidly. Itself in the industrial period, the most frequent development of infections is accelerated, sick up to generalization (expanded for all organisms), and also you can create a lot of legends.

As soon as the ailments didn’t die out in the mid-period period, the third period is insisting. Trivial wine from 3-4 days to December months. At the end of the hour, the functions of all affected organs are gradually normalized - legends, liver, nygolovnishe, nirok.

It is possible to detect the development of the syndrome of trivial pressure on the stage. Information about the spontaneous dashing, about the trivial perebuvannі people under the rubble, zmushuє letting go of the powerful development at the new SDS. Ob'ktivnі danі allow the diagnosis of crash syndrome with a high percentage of performance.

In laboratory minds, it is possible to review information about hemoconcentration (thickened blood), electrolyte deterioration, added glucose level, creatine, sechovine, bilirubin. Biochemistry analysis of blood appears to increase pechin transaminases, decrease the concentration of blood cells. An analysis for the acid-pool of the blood shows the presence of acidosis.

In the analysis, there is a lot of change in the daytime, a little bit more than a cut of brown barnacles, the ability to move, in which there is a block, pH changes to the sour side. With microscopic dosage, there is a large number of cylinders, erythrocytes, leukocytes.

Come in first help with the syndrome of trivial delay to lie down because of the fact that you need it, and also because of the availability of strength and the availability of qualified personnel. Lyudin without special training is not enough to be able to grow up, to help develop important acceleration, and so as professional projectors, with their own actions, seriously reduce the forecast for a sick person.

In the first place, vityagnutiy s-pid yogo needs to be moved in a safe place. Revealed at a superficial examination of the wound, aseptic dressings. If there is evidence of bleeding, after coming in to the last one, the fractures are immobilized with special tires or handhelds. Yakshcho ear of infusion on the whole stage is uncomfortable, it is necessary to preserve the sick with a great number of hot drinks. Tsi come in can be a visonati be-yak lyudin, shho take care of the fate of the robotic robots.

Pitannya about the imposition of a jgut on a victim of a kintsevka in the Danish hour to debate. Practice, protest, showing the effect of the general method in yogo correct filling... Apply the jgut bazhano until the patient's sound, the place of the overlapping is the last time. Burning allows you to get high doses of calories, at once reach the heart's heart and lead to the development of collapse and fatal heart arrhythmias. It is recommended to use it only in two types:

• with repeated ruinuvannі kіntsіvki;
• with gangrene.

On the offensive stage, I will help nadayut people - ryatuvalniki, paramedics, nurses. On this stage of the patient, an internal catheter should be inserted into a ligament (if you want to ideally be able to complete the process until the end of the patient), for the additional help of how to repair the infusion of salt blood cells without any calories. Infusion therapy is guilty as much as possible, but do not interrupt it when evacuating the victim in medical pledge... Obov'yazkovyu є is adequate to zebolyuvannya. I will help nada fahivets, I can vikoristovuvati narcotic analgesics (promedol), but not ma - stasis of any kind of painless nachebto baralgin or ketorolak will be more beautiful, not vidmovy in analgesics. On the whole stage, it is possible to see odyag with a swiveling embryo of a suffering picture.

At the same time, we are averse to injecting sodium bicarbonate internally to correct acidosis, calcium chloride to neutralize excess calories, glucocorticoids using the stabilization of cell membranes.

In the minds of the stationary, go in, direct to the stimulation of the robotics - the introduction of sequential inputs in parallel with the infusion of salt solutions and sodium bicarbonate. You can use the methods of blood purification, moreover, the transfer is seen as the most sparing of them - hemosorption, plasmapheresis. Zastosovuvati їkh slіd safely and only in the time of the obvious cob of legends or uremia.

Antibiotic therapy stagnate only with obvious signs of early infection. Heparinoprofilactic allows for the development of DIC-syndrome - an especially important acceleration of SDS.

surgical treatment syndrome of trivial pressure in the amputation of an unpublished picture. With a swiveled embankment, before the delay of the main vessels, the operation of the fasciotomy is shown in a second case.

accelerating

The head of the accelerated crash syndrome gets involved in the gostra nirkova lack. Itself won є the main cause of death in cases of pathology.

Nabryak Legen is a threatening life of the camp, when Legene's tissue can seep through in a line, so go out from the blood-bearing vessels. At the same time, gas exchange in the alveoli, a build-up of hypoxia.

Hemorrhagic shock as a result of massive blood loss is spared in the presence of great Suddens. The situation is overwhelmed by those in the zone of damage, the health of fabrics is significantly reduced by the use of cost-effective factors.

DIC syndrome develops as lesions of bleeding, as well as due to the direct reduction of blood-bearing blood vessels by products of a drop in tissue tissue. The price is the most important for the acceleration of the SDS with a high level of mortality.

Infectious-septic acceleration often supervises the crash syndrome. In addition to the reduced living space of the fabric, the ear zone is easy to handle with microorganisms, especially anaerobic. As a result, it becomes important to become impaired, and to get rid of the main pathology.

In case of a crash syndrome, it is important є an hour to get an ear of extra help. If earlier there will be a lot of trouble, then there will be a lot of blockages, and more often there will be a lot of visits, there will be more chances for a vision.

Bozbei Gennady Andriyovich, likar shvidkoi medical aid

Trauma in peaceful minds is more important and more important than the middle of the sick. In patients from the zones of earthquakes, technogenic accidents, failures, the order of fractures, wounds, open and closed ears of internal organs, it is not easy to detect a large

The severity of the cich is not possible to underestimate, as it is the part of the victims with the great debauches in the guinea of ​​hemodynamic shock-like disorders or uremia. The knowledge of this pathology allows us to immediately put the correct diagnosis, to recognize the need for treatment, and also to carry out prophylaxis accelerated.

Tricky pause syndrome - a specific variant of injuries, tying with massive trivial crushes of soft tissues, or hindering of magistral ship stoppages, it occurs in 20-30% of cases in case of emergency, when the number of times of the earth is coming. important injuries, Lіkuvannya yakogo representє significant folding.

There is a lot of premonitions of this pathology (Bywaters and Bill, A.Ya. Pitel, N.N. Elansky, N.I. Pirogov, Bossara, Zilbershtern, Colmers, Frankenthal, Kuttner, Gakkard, Levin, Minamy, Kenyu.) they missed their mark, runtuyuchis on key manifestations, or the pathogenesis of illness:

Bywaters and Bill (Bywaters E., ABeall, 1940 - 1941) - "crash syndrome";

A.Ya. Pitel (1945) - "syndrome of rash and traumatic squeezing of children";

NN Elanskiy (1950) - "traumatic toxicosis";

NI Pirogov - "Mistseva curse (Mistsev torpor)";

Bossara, Zilbershtern (Bossar 1882 rotsі, Silderstern 1909) - "nephritis with albuminuria and hematuria";

Lab (Laborit) - "Bywaters syndrome";

M. I. Kuzin (1953) - "tricky crush syndrome";

- "VerschuttungsnekrosederMuskelen" - nimetskі prelіdniki.

Classification :

1. By type of compression:

Small objects, soil, slabs, і ін.

Position (part of his own body)

2. For localization of the press:

Kintzivok (segments)

3. For submission of the SDS with the following items:

internal organs

Kistok i suglobiv

Main vessels and nerves

4. Beyond the degree of gravity:

Middle

important

5. For a key interruption:

compression period

Post-compression

Early (1-3 dobu)

Promіzhny (4-18 dobu)

Пізній (пізніше 18 Діб)

6. Combination of strikes:

SDS and thermal distribution

SDS and radioactivity

SDS і otruunnya

SDS and ін. Bydnannya

7. Folding:

SDS accelerations - captured organs and systems

Gostra ischemia pozhkojenoi kintzivki

Gn_septic accelerated

pathogenesis:

Providnymi pathogenetic factors of the syndrome of trivial pressure є:

1) toxemia is traumatic, as it develops as a result of products falling into the bloodstream of products;

2) internal vascular blood drainage, which can be triggered by products to reduce blood loss;

3) Plasma loss as a result of a rotated pattern of popping;

4) it is painful to tease, to lead to the deterioration of the coordination of processes in the central nervous system;

The result of a trivial reduction of the symptoms is the diagnosis of all the symptoms of any segment in the presence of venous congestion. Nerves are also injured. The mechanics of the fabrication of the tissue from the statements of the great number of toxic products in the metabolism are taken into account, the first for everything - to the methemoglobin. Due to arterial deficiency and venous stasis due to the severity of ischemia of the symptoms. grow metabolic acidosis However, in the past they entered the bloodstream with myoglobin to produce up to the blockage of the tubules, damaging the reabsorption of health. Intravascular laryngeal blood flow blocking filtration. Otzhe, myoglobinemia and myoglobinuria are the main officials who cause the severity of toxicosis in victims. Suttuvo is injected onto the camp of the sickly hyperkaliyemia, which reaches 7-12 mmol / l. Toxemia will also support the need for nutritional secretions in gistamine, products in the blood sugar, adenilic acid, creatine, phosphorus, and others.

Already in the early period, the syndrome of tricky blood pressure slows down the thickening of blood as a result of plasma waste, so as to develop a massive patch of tissue. In important cases, plasma loss reaches up to 1/3 of the BCC.

Nayvazhche accelerated, which is more likely to be spared in the syndrome of trivial depression is a state of nirkova deficiency, in a simple way manifests itself on the stages of development of debility.

clinika

Compression period: Most of the sufferers take on evidence, but depression does not develop quickly, as it turns into a headache, apathy or drowsiness. Among them, it is a matter of confusion or loss of quality. Ridshe buvak zbudzheniy stan. Those who suffered were screaming, gesticulating, vimagayut nadati їm help or sleep.

Skargi are amazed with pains and popping in health dilenks til, spragoy, complicate dichannes. In case of significant injuries, especially in cases of pneumonia of the internal organs of the cranial and thoracic emptyness, fractures of the large tubal folds, of the enlargement of the magistral vessels and nerves, the manifestations of traumatic shock, as well as of the hemorrhagic ear,

Post-compression period. I see 3 periods in the development of a pathological process.

The first period is up to 48 (72) years after the sound from the press. The period of time can be characterized as the period of local changes and endogenous intoxications. At the end of an hour in the clinic, you get overwhelmed by a traumatic shock: bends pain syndrome, Psycho-social stress, instability of hemodynamics. Anyone who suffers gains testimony. The deyaki from them are found in the awakened camp, a little more viglyadayut mlyavim, overgrown, drowsy, galvanized. The children suffered from walking without a median on the mission, or in the near-term hospitalization, as a rule, because of injuries that were insane in their lives.

It was because of the delay of suffering to screech on pains in small parts of the body, weakness, spoiled, boring, sprawling. Shkira curl up with cold sweat. Rukhs in kintzivkah encircled through bil. Tachycardia, hypotonia, daily appetite begin.

When you look at the little pictures of some of the parts of the house, which are aware of the pressures, the most common trophies appear in soft fabrics... Shkіrni pokryvi nabuvayut cyanotic zabarvlennya abo marmur look, kіlka vibuhayut over the immutable dіlyanka shkіri. In the middle of the building, there is a change in the display of shkiri, one with a crimson-cyanotic display. It is not often on the shkіrі є blood, sadness, maceration, hematomas and beats pressed on only objects. Moreover, what is the rotation of the video beats on the shkiri, tim, otzhe, the bullet is greater than the power of the compression. The visibility of such bits is more likely to show up when the soil is pressed by the soft rock (earth, sand, etc.). At times of the greatest pressure of soft tissues, one can see the epidermis as a result of conflicts, reminiscent of a serous or hemorrhagic birth. With a large amount of debris from the step of tissue tissue under epidermis, the surface of the white-erysipelatous or dark-red tissue can be exposed, and with significant damage to the muscular blood circulation - cyanotic, chorna, dry surface of the tissue.

At school-age children, it is not often possible to get sick, very painful with palpation of infiltration. At the top of the stench, the stench will start to grow along the course of the neurovascular bundle.

With the build-up of the crust, the skin grows as cold, bland. Dilianki vm'yatin smoothed. The health of the cakes is fast and significantly increased in general, an hour by 10 cm and more in cola. Fabrics melt with stress, shilnoelastic,

mіstyami "woody" consistency, inodі nabuvає look. Palpation of nodular fabrics wicked a strong beat through the tension of fascial cases, pummeled by the increase in the amount of mutilations that got stuck with them. I will roundly hunt for the whole picture, for only a part of the day, without any pressure, and quickly expand to the child and live at the same time lower kintzivok... Nadal (5-10 additional post-compression period) on the other complex therapy in the world of change in naprya, sprains, infiltration in soft fabrics, sensitivity and hands in the slopes can step by step, and the pains subside.

For the differential diagnostics of SDS and the other pathological stanes, the sample "lemon scorinka" is shown for a second time / Komarov B.D., Shimanko I.I. / - optional i with great fingers To climb into the fold of the zoni shkіru, scho knew the pressure, which could not be spared during the filling of the іnshiy genesis.

Shkіrnі curl over the zone of battle in the whole period of time, the lemon-jovty color (as a result of the blotching of the myazo pіgment) from the clear boundary when passing to the unshkodzhena fabric. In the world of renewal of blood circulation, build-up of swellings and strains in the pressure of tissues against the background of disruption of metabolic processes and the introduction of secondary infections, secondary necrosis of tissues is developing.

With a swollen swelling, pulsation of the arteries in the distal parts of the pattern is weak, or it does not appear. Kintzivka is getting cold on the dot. At once a small growth of embryos and a load of soft tissues will accept hemo-, lymphodynamic and neurological problems. Intercourse, for the rise of the daylight in the slopes of the little pictures, most often through severe pain, Amplified by the pressure of the nerve stubs and the development of ischemic neuritis. The pain of the floor is strong, but the victim is beaten, it is impossible to know the position of the hand, for which the intensity has changed. Immediately, the stench will be seen as a result of the rooting in the postcard, the postponement in it. Some of the sufferers are more likely to feel sick when they are out, or because they are very sensitive to sensitiveness, which is tied, as they are, due to the humoral nature of their judgment. More in small parts and in small parts, the most turn is the first 3-5 dB of post-compression period.

Mysterious changes of young women are superfluous to suffer from small decreases, for all types of sensitiveness (large, tactile, temperature), the turn of which to stay due to the strength and triviality of health. So, when the upper symptoms are reduced, there is a deterioration of the superficial and extreme sensitivity, a decrease in either the visibility of tendon and periostal reflexes, atony of the muscles, the development of paresis of the paralysis of the paralysis In case of lower symptoms, hypesthesia is promoted, weakening or the visibility of colonic, abnormal and adolescent reflexes, the deterioration of glibocy, sensitiveness, unreasonable

A frequent manifestation of the syndrome of tricky health is traumatic neuritis and plexitis, which occurs at the time of injury and in the early post-compression period in the presence of sensitiveness, active rucks, a combination of other pains, and sometimes after 4-5 days Nichny sleep and do not fall for the supportive analgesics. In case of proper ailments, up to 80% can be observed.

Nabreak of soft tissues of reduced blood pressure is accompanied by a thin blood loss with the development of hemoconcentration (it grows instead of hemoglobin, hematocrit, changes in blood volume and blood pressure), changes in blood pressure. Plasma loss in the meaning of the world is summed up by the increased penetration of capillaries as a result of the infusion of endogenous toxins on them, and not the main, but a secondary factor. Thickening of blood, overwhelmed by the development of a traumatic embryo, collapse of the physical and chemical authorities, allowing blood flow in the face of a serious malady, lead in the early period of the syndrome of trivial pressure to hypercoagulability. All tse, insanely, by dint of showing a shock and a spraying to a fake growth of toxic products, damaged by trauma, the exchange of rechovins.

Snakes in soft tissues, especially in sufferers with a large zone of damage, are supervised by endogenous intoxication, the change in which pathological snakes are growing in the pressures of tissues in the world. With a large amount of intoxication, it manifests itself in non-dullness, blasphemy, malnutrition, tediousness, repeated blues, dryness in the mouth, increased temperatures up to 38 ° C and in food. The cyst of the phenomenon is tied in the main with the necessary in the roof of the products of the damaged metabolism, the loss of ischemic tissues. There is a tachycardia, which supervises the backwardness, weakening of the tone of the heart, in the case of the sufferers, they are spared to suffer from the arterial grip.

In the early post-compression period, the syndrome of trivial depression does not develop frequently manifestations of dysfunctional deficiency. This phenomenon can be informed about the results of massive fatty embolism. At the same time, fat embolism manifests itself as mild and low-specific symptoms, lesions, perspiration for all impaired blood circulation in the organs. Prevalence diagnosis of fatty embolism is important. They develop a legeneva (most often), brain and generalized form of fatty embolism. In the last manifestation of the clinii of fatty embolism of all forms, neurological symptoms begin to reestablish, then there is a state of mental deficiency with post-arterial hypoxemia. The Legenev form on the wall is characterized by tachycardia, cyanosis, cough, progressive decrease in ventilation function. Viniknennya vologicheskogo rales, piny sputum from the house of blood to tell about Come to the pack of legends. On the roentgenogram, there are disseminations of the darkening ("snow storm"), the enlargement of the bronchial babies, dilatation of the right views of the heart. Proof of the fact that the cause of the mental deficiency can be fat embolism, є an increase in the early post-compression period, the syndrome of tricky depression of hypoproteinemia and hypoalbuminemia - indirect signs of fatty embolism. So, on the 2nd additional period, the syndrome of trivial depression of the albumin-globulin index in sufferers becomes 0.98 ± 0.85. Intensive catabolism occurs when there is a high level of nitrogen and sevine excess in the blood. With a stretch of the early period, the syndrome of trivial pressure instead of glucose in the blood will be added. It should be explained, in the first place, by the high concentration of catecholamines in the blood, which increases the active glycogenolysis in liver and myases, so that the level of hyperglycemia, other proportions of the severity of aggressive organisms, The result is that there is a large number of amino acids, the main part of which in case of energetic deficiency, which develops in the minds of the syndrome of tricky depression, transforms into glucose.

In sufferers in the early period of the syndrome of trivial depression, there is a lot of problems with electrolyte exchange. So, the lower norms appear instead of calcium (2.23 ± 0.05 mmol / l), just for the transition to the tissue space at the same time with plasma and albumin, and also as a result of the hardened life, in the process of bleeding. instead of phosphorus (1.32 ± mmol / l), obviously, for the improvement of the strength of its reabsorption in the tubular apparatus of nirok for the infusion of calcitonin. At my own heart, hyperphosphatemia is circulating to indicate about serious damage to the body in the body instead of salts of calcium, sodium, calories, the manifestation of dystrophic processes in the oven, especially in the case of malfunctioning є Tricky depression syndrome, characteristic of the early period. Calm and sodium alleviation is often observed in sufferers with an important stage of the syndrome of tricky depression. In the place of chlorides, especially in the first period of the early period, it grows over the normal value (140 ± 16 mmol / l), so that it is possible to tie up with the deterioration of the secretory function of nirok.

The number of visions will change drastically from the ear of the early post-compression period. Vaughn nabuva lakovo-chervone zaparvlennya, amazed with the vision of hemoglobin and myoglobin, so that it goes into the bloodstream from the youngsters, and there is a high visibility, swings in the sour side. Piznish is cutting off a dark brown color. They have a large number of blood cells, leukocytes, erythrocytes, and in the sediment there are cylindrical and cyclinod-like brownish swarthy apparitions, similar to the malignancy of a scintillating canalicule, small crystals

As a rule, it is the standard of visual functions to judge the severity of the SDS, the efficiency of the preventive visits, predict the SDS and the poor result. More important than compression trauma, endogenous intoxication is more pronounced, lower duresis. With an important stage of SDS, even in the early post-compression period, anuria may occur, which is triple before the death of the victim. In the first 12 years of age, there is a feeling of depression in sufferers with the syndrome of tricky depression, to the extent of intensive treatment, which includes infusion therapyі forcing duresis, the average number of seen section becomes 604 ± 69 ml / day, incrementally increased until the end of the first time to 1424 ± 159 ml / day, 2 dib - up to 1580 ± 503 ml / day,. The value of the add-on function is an active indicator of the update of the visual function of nirok. However, only these numbers do not give a real statement about the normal function of nirok, as well as a decrease in dyuresis in sufferers with a syndrome of tricky depression during a period of caution can be found in the intervals between 0 and 500 ml. More precisely, about the function of nirok even before the release of creatine. Yogo in the blood in the beginning of the early post-compression period I change the normal value by 2 times, and on the 2nd dobu - 5 times.

The emergence of new erythrocytes in the section is the result of an important use of endotoxins for the judgment apparatus of glomeruli in the early period of trivial pressure syndrome. The first indicator of the level of success is the appearance in the section of leukocytes, the number of which incrementally grows.

The block in the cross section is practical for all sufferers. At the end of the first addition, the concentration reaches 0.28 ± 0.077%, for the third addition - 0.2 ± 0.06%. Tse also confirms the presence of important nephropathy in sufferers, the basis of which is the deterioration of the glomeruli and the basal membrane of the tubules, which in its own right before the destruction of the filtration and tubular reabsorption. At the end of the hour, for the data of ultrasonic dosage, the sufferers of the grievous lack of nirk appear to be persuaded by the nirk parenchyma and the expansion of the empty system.

Familiar important endogenous intoxication with trivial pressure syndrome є the presence of granular cylinders in the section in the 1st post-compression period. Їх manifestation of evidence of glyboki degenerative changes that occur in nirkovy tubules. It is especially important to note that the graininess is surrounded by bloody particles or specks of fat. At the connection of the cysts, it is possible to form granular cylinders in the section with an active sign of fat globulemia.

In the pathogenesis of SDS in the early post-compression period, the main role is to shape the changes in the microcirculation system, as it may generalize the character, and not to intermingle just a little bit of a middleless injection of a squeezing agent on a very patient. Tsia obstavina є pathogenetic grounding carried out during the early period.

Regardless of the triviality of compression, the scale, the localization, and the reduction of the pressure of soft tissues and the individual reaction of the body to the aggression, there are three stages of severity overcoming the syndrome of trivial health.

1) easy steps of gravity- small glybin і area urazhennya, 4-6 years. At the same time, there are many wrinkles, the backward clinical manifestations of endogenous intoxication are insignificant. Pomirnі and last day of the fabulous and nirkova hemodynamics. In the sech, there is no sign of gross damage to the function of nirok. It can be either a red-brown or a brown barb, it can quickly sound out from myoglobin and nabuv an extraordinary color. In case of greater swelling of myoglobinuria mucosa, it is necessary to trim for a long period of time to help prevent lung nephropathy. Oligouria take a stretch of 2-4 dB. Until the 4th-6th day, during the course of intensive intensive therapy, you will become aware of more pains and swellings, renewed sensitivity in tissues, normalize the temperature of your body, dyuresis. Laboratory indicators come up to rates of up to 5-7 dB due to injuries. Writing a lot of patience can be written at an outpatient clinic. If the function is continued, after 15-20 days, there will be no signs of injury due to injuries. Conducting intensive complex therapy in sufferers with mild severity of the syndrome of tricky pressure, as a rule, before the possible development of important slowdowns.

2) the middle stage of gravity- with more great events, not less than 6 years old, supervise around the same signs of endogenous intoxication. The impairment of the function is typical for nephropathy of the middle stage of severity, and is manifested in the form of myoglobinuria nephrosis with more severe pathological changes in the fold of blood and cuts, less in case of SDS of the mild degree. Myoglobinuria and oliguria will grow in size for 3-5 dB. In the blood, it is more important than the increase in the place of surplus nitrogen, serum and creatine. Indicators of nitrogenous metabolism at the middle stage of SDS start to rise to the norm for 12-20 after injuries. When the functional state is reached, there is a decrease in the concentration index of creatine, glomerular filtration and tubular reabsorption of water. In peripheral blood, in all sufferers, leukocytosis due to leukocyte formula is present. An unfortunate or lack of qualified medical aid at the stage and carrying out an intensive and intensive infusion therapy infectious diseases.

3) an important step of gravity- even more large ear, more than 6 hours. At a wide stage of SDS, the most terrible and initial share of the patient with a pathological process є ARF. With an unfortunate provision of medical assistance, as well as with a lack of effective intensive therapy, the hematodynamic disorders of the patients will progressively go down, and the part of them in the world in 1-2 need to be used for herbal compress.

It’s insanely, so that after the triviality of the trivial reduction of my tissues from the ears of the internal organs, cysts, blood vessels, nerve stubs, it is a signi fi cant accelerated slowing down of the health problems of the tricky syndrome, - tightness syndrome.

In such a rank, even from the moment I pour into the patient compression of the wine key picture systemic and organ failure, as it is possible to characterize the syndrome of multiple organ failure. A particular syndrome in SDS is the early development (fixing during the compression period) and saving is signified by prolonged periods of time during the main period of interruption to the syndrome of trivial depression.

If, as a result of surgical and therapeutic treatment, the sick person stays stable, then there is a short light progression, when the sick person starts to burn.

Promіzhny period.

The present is the 2nd period for the syndrome of trivial depression - the period of the state of disability, trivial wines from 3-4 to 8-12 days. At the end of the period, the surge arrester is not safe for life, it represents a rapidly progressing hypergidration and hypoproteinemia (anemia). At the same time, the growths of degenerative-necrotic changes in the muscle are added to the pressure agent, which will accelerate the development of the infection. In addition to the deterioration of the secular and metabolic disorders, to supervise the increase in endogenous water products in the body, the growth of growths of growths, the growth of the health problems, are coming up. On pocky shkіrі, we pretend to be plump, filled with kalamutnaya rydinoy, and there is bloodshed. Progression of local changes in soft tissues, the leading rank of gross-necrotic ones, add to the severity of endogenous intoxication and the prevalence of ARF. There may be more severe symptoms of disease and septic diseases, such as pneumonia, nasal pleurisy, Pericarditis, peritonitis, osteomyelitis, parotitis, etc. It is not easy to come to an anaerobic infection. One of the reasons for the development of infectious diseases in the intermediate period is metabolic immunodepression.

A clear picture of a hostile disability in sufferers with a syndrome of tricky hindering is mainly due to the severity of this key interruption and to appear, as a rule, when the patient is suffering from shock, as a rule, when the patient suffers from shock, a correction of the hemodynamic malfunction occurs. However, an arrester can be detected during the period of compression, especially on the case of hypothermia, hypovolemia, hunger, and in the case of a lack of further development in the early and intermediate periods, the syndrome of trivial delay.

The severity of being overwhelmed by the state of health and lack of deficiency in the meaning of the world is to lay aside the quality of medical aid on the basis of the process, the freedom to diagnose and the ear of the complex therapy. In addition, for the severity of the breakdown of the ARF, it is significant to inflate the accelerated, uncommon breakdown of the disease - hepatitis, pneumonia, and other diseases.

The clichéd picture of the surge arrester in the industrial period develops in such a rank. If you want to feel self-respect, you should be able to get away with injuries for 2-3 days, and the patient’s camp will start to lose heart. to appear head bill, Possiluєtsya adynamia, zagalmovan_st, in important vipadki an infusion of coma, z'yavayutsya sudom, tachycardia abo, navpaki, bradycardia. Suffered turbuє nudota, frequent blues, spraga. In some cases, intoxication paresis of the intestine with peritoneal ulcers develops, which can serve as a reason for carrying out an unprinted operation. It is not often that there are pains in the dialect of nirok, zooming in to the expansion of the fibrous capsule of nirok, in conjunction with what, in the case of the sufferers, the picture of a hostile abdomen can be clinically evident.

Prodovzhu reduce the function of nirok with the development of oligurii. The blood grows instead of surplus nitrogen, sechovine, creatine, which is a precursor to the development of uremia. Step by step, if you do, oliguria in the row of vipadkiv goes into anuria. Uremic toxicity is associated with metabolic acidosis and hypochromic anemia. I will look around at the buildup of the uremia camp of the ailments. It is not rare to be periodically attacked by the rukhovoy unconscious, scho to be guided by fear, madder. Before serious neuropsychiatric disorders, there can be a turn of the deterioration of the white and water-electrolyte exchange, especially on the back of a hostile deficiency.

The excess of the hostile deficiency of the light step is characterized by a short period of oliguria, in contrast to the severity and creatine in the blood, and by the appearance of hypercaloria. Concentration index of creatine, chilinous duresis and tubular reabsorption are lost in the boundaries of normal values. With a whole glomerular filtration, it is significantly lower. Timely implementation of a straightforward therapy allows you to finish fast (lasting 7-10 days) normalization of dyuresis, instead of more and more creatine in the blood.

The oligoanuric phase of acute renal failure develops into a triple 2-3 period and, with adequate management, step by step changes in the phase of polyuria, as it is supervised to develop a type of clinical symptomatology. However, in case of light and medium severity of the arrester, the polyuric phase should go for 3-5 additional oligoanuric period, it is not easy to reach the rapid growths of dyuresis. A handful of patient vids 150 ml / day are cut from growths up to 500-600 ml / day. At the same time, in the main, indices of homeostasis are kept unchanged. The growing camp will become stable for 2-3 days. We can repair the polyurethane phase completely, before the hour when I dobovy dyuresis change 1800 ml / add, step by step reach 4-7 l / day. What is more, it starts to see the light, it is relieved of myoglobin by cutting with a low tolerance. You can take revenge on a large number of leukocytes, epithelial cells, bacteria, and some erythrocytes.

Azotemia in the whole period, I want and not immediately, step by step decrease. If there is a change in the polyuria of the concentration of creatine, sevina and surplus nitrogen in the blood, it may not only decrease, but it may not be reduced. The price is summed up by the major innovations of nitrogen-visual function of nirok. In the whole period, it will be replaced if there is no glomerular filtration, and tubular reabsorption will become a deficiency. Pidtverdzhennyam tsiogo є low vist of the sech in the battle for the first time to the period of renewal of the deiurez.

The characteristic feature of the cob period is the renewal of the deiurez є hypercalcification, m'yazovoy fabric shkoggenikh pictures. At the same time, thickened plasmas are spontaneously promoted, as well as the concentration of blood cells. Tsya hyperproteinemia is associated with hemoconcentration as a result of the intake of salts and water from the cross section.

Polyuria, as a rule, supervises changes in mass, changes in peripheral growths and new births in empty spaces, normalization of arterial grip, changes in toxicity, polygonal losses.

The triviality of the phase of polyuria and renewal of disease is abundant in what to lie at the level of hydration and the degree of origin, which is introduced during infusion therapy.

However, the transition to the polyuric phase of the ARF is not safe, it is not very important to be carried over by the victims, that in the whole period it is necessary to strictly follow the signs of homeostasis and often coriguvati. Provider of polyuric phase є growing on the most extreme hypertension, which supervises overturned tachycardia. Hypertension is amalgamated by the displacement of the homeland from the small space to the roof, which is not often carried out until repeated hyperhydration of the legends and the growth of azotemia. All can be provided for active detoxification and hygiene. I am not safe in the period of polyuria to represent hydrolytic products, which can be recognized through great events and great losses of electricity. So, intensively reducing the calories to the body, especially when there is a lack of correction of the colibacillus in its worm, leading to a swollen hypocalmus, and when it can be a deterioration in the function of the myocardium up to the reduction.

The views develop in case of polyuricity of the hypocalypse and characteristic changes on the EKG: progressive reduction of the teeth T, prong T turn over with an adjustable amplitude (segment QT podovzheniy), pidvisheniintervali R-R, Ectopic anterior rhythm. In addition, hypochloremia and hyponatremia do not often appear, and later - hypochloremia and hypocalcemia. Evidently electrolytic destructions can appear asthenia, blasphemy, spitting, repeated blues, significant changes in the weight of the body and bring the winners of a comatose stun. normalization of input electrolyte balance I’ll be suffering until the end of the day.

Take an ear of ear in case of ARF in sufferers with SDS because of the moment of normalization instead of nitrogen in the blood. The time period of a surge arrester with SDS is the most trivial and can be trivial.

For the intermediate period, SDS is characterized by the development of hypochromic anemia. The increase in the decrease in the number of erythrocytes is indicated by 4-5 for the additional period of post-compression SDS, if before the deficiency of the erythrocytes, increased by the sequestration of blood in the microcirculation system, all Whole will take a progressive increase in the penetration of sudin, thickening of blood. Uninvolved in the infusion therapy, adapted to the admission of hemodilution and the improvement of rheological powers of the blood, hypohydration and hemoconcentration to continue the build-ups, reaching the highest compression values ​​up to 5 One hour, deformation and decrease in blood circulation are observed, which is tied by changes in the stages of tissue structures, zooming in the damage of water-electrolyte exchange, the transition of plasmas into the blood tissue We have a deformation of the erythrocytes before the destruction of the microcirculation, as well as rigid, rigid erythrocytes occluding the capillary bed.

In the intermediate period of SDS, as a result of proteolysis, an overhaul of catabolic processes, and a deterioration of the function of puddles, it is not only products of nitrogen metabolism that are lost in the blood, but calories, magnesium, phosphates, and sulphate debris. Moreover, hyperphosphatemia supervises the appearance of hypocalcemia. For 4-9 additional post-compression period in place of the blood plasma, the normal values ​​for the reduction of the catabolism of the blood plasma, However, for 2-3 years of the intermediate period, there will be a decrease in the amount of blood cells in the plasma, so that anabolic capacities are indicated to the body, as well as the development of important ones until the end of the hour, the first for all of them.

In the intermediate period of SDS, rotations in the system of laryngeal blood are prevented, which have a phasic character. Occasionally, hyperthyroidism and hypocoagulation develop, and I am familiar with thrombohemorrhagic syndrome. By starting the mechanism of development of this syndrome, we will serve as a massively reliable thromboplastin from tissue tissues. Thrombohemorrhagic syndrome has suffered and is unremittingly due to the development of important acceleration. In case of pre-existing indicators of the laryngeal system in the early period of acute renal failure, it is possible to develop ear signs of hypercoagulation: a slight decrease in the hour of the larynx of blood and recalcification of the plasma, reduction of the prothrombin, pre-venous hypertension. With a whole thrombin hour and concentration of fibrinogen, the suttau does not change, if the fibrinolytic activity of the trochie increases. Hypercoagulation is augmented by the activation of thromboplastic blood circulation not only for the development of the last, but also of the internal mechanisms, so that it is not only for the prevention of thromboplastic contact activity in the blood, as well as the phase of the tissue.

One of the frequent accelerations, which develop in the intermediate period of the SDS, є the deterioration of the liver - from an easy step to the development of the guest's poor quality. The stage of the deterioration of the function of the stove lies in the scale of production of soft fabrics and trivial compression. Gostrian hepatitis is manifested by yellowness of the sclera and small curvatures, malignant liver and ailments on palpation. Move in place of internal liver enzymes in blood plasma. An increase in the concentration of bilirubin up to 100 mmol / l and more. With a friendly interruption of the SDS, normal replacement of enzymes and bilirubin is renewed, step by step there are key signs of liver damage.

The most persistent manifestation of the clinical picture of SDS in the intermediate period є hypercalcium, especially at the middle and severe stage of SDS. Vona is poured in the main hopes in the blood of a great amount of calories from the garment fabrics. Nebezpeka hyperkalemia for sufferers with SDS should be the head of the toxic infusion of high concentrations of calories on the heart ointment. Moreover, the toxicity of calories increases in the minds of the development of acidosis and hypocalceration. At the connection with the EHC cycle, there are more informative indicators of hypercalculation, it is not possible to determine the results of an average blood loss.

Clinical signs of hypercalculation in sufferers in the intermediate period of the SDS є:

· Rizka myazova weakness, periodic sudom, inodi rukhove zbujennya, hallucinations;

Bradycardia;

· Decrease in the height of the P wave, podovzhenya to the QRS complex, the appearance of a giant T wave with the sharpening of the top, Sinoauricular block, A-B block, early fast shlunochkiv, їkh merykhtіnnya;

· Adjustment of plasma calories to food 6 mmol / l.

It is not possible to take into account the fact that hypercalculation with an important stage of SDS can be

the cause of the lethal result.

I am especially not safe for the life of the patient in the industrial period of the SDS, except for the hypercalypse, which is a hyperhydration, it was amazed, as a rule, inadequate and intensive therapy for olfactory use, inadequate It is very important to quickly diagnose through the primordial misconceptions of specific clinical signs, especially on the smallest manifestations of SDS, and it can also quickly lead to the development of an important dysfunctional lack of vision, inappropriate

Symptoms develop hyperhydration є:

· The appearance of pastiness, cyanosis and backwoods;

· Dry cough with the appearance of oral crepitations;

· Reduction of shinny veins;

· Tension pulse and tachycardia;

· Adjustment of arterial vise up to 160-200 mmHg., Yake becomes refractory to greater hypotensive conditions;

· Zrostannya TsVT ponad 130-150 mm water column;

· Dullness of the percussion sound of the legendary sound with the appearance of vologous dry wheezing;

· Zbіlshennya between the liver and the development of pain in the right pіdreber'ї;

· Appearing eksudatu in the empty;

· The appearance on the radiographs of the lungs of the picture of the "vologic lung".

Hyperhydration can be manifested by the overload of the brain, anasarca, ascites, or by the subcapsular overload of the brain. However, most often, hyperhydration is manifested by snakes on the side of the legends. In cich vipadkah, there is a lot of zadishka, zhorstke dikhannya, sharp bends of cyanosis, ricky wheezing. The number of wheezing sounds quickly grows right up to the appearance of classy pictures, as many as legends. The reason for the increase in the arterial clutch in case of hyperhydration can be explained to the build-up of the internal vascular support і, persh for all the degradation of the microcirculation function, as well as the development of the state of the nirkova deficiency. Sposter at a high frequency of heartbeat to indicate the destruction of the robot heart, swirling microcirculatory damage. At the end of the hour, the EKG shows signs of diffuse changes in myocardium, repolarization breakdowns and hypoxia, it is not often possible to bachet the extracts of extrasystoles.

In case of radiological preliminaries, there may be a start in the emptying of the pericardium, pleural and black empty... Before it allowed to control the effectiveness of methods of dehydration and disease, there were accelerated: pneumonia, pleurisy, pericarditis, inverted heart disease. X-ray examination begins to improve the strength of the bronchovascular baby from the roots to the periphery. For a rotated hyperhydration, the characteristic is an intensively inhomogeneous change in the sparseness of legacy fields and a lot of spills or cloudy terrains. The root of a great blizzard may be seen. The lower part of the light was intensely darkened for the rakhunok vipota. Beast on myself respect for the configuration of the heart for the overwhelming changes of the right people.

In case of trivial hyperhydration, especially with the vividness of pleural emptying and alveolar ridge, pneumonia often develops. However, the diagnosis of pneumonia on the basis of hydration is complicated, and in a number of cases it may be deprived of dehydration.

The intermediate period of the SDS is characterized by the manifestation of multiple organ deficiencies. At the most frequent development of the pathology of internal organs, it is overwhelmed, persh for everything, with the very injuries and endogenous intoxication. In the last period of SDS, the main form of secondary pathology of internal organs, such as severe-resorptive fever, anemia, myocardial dystrophy, pneumonia, hypertensive reactions, an increase in lungs. Moreover, they are overwhelmed by snakes, as for the rakhunok of backward syndromes, as well as for the rakhunok of secondary pathology.

Mortality in the whole period can reach 35%, unimportant to intensive therapy.

A build-up of blooms, anemic build-ups, bulbs, hemorrhages, thickening blood changes, anemia build-ups, grows anemia, and grows down to anemia. Significantly grows in the blood instead of blood and creatine.

Last (last) period.

The third period is the last time to be repaired in 3-4 days. At the time of the SDS period, there is a progress in the renewal of the functions of the organs. The rate of it lies in the turn and severity of the SDS. The camp of the sufferers deeds step by step, but it’s a trivial hour to become overwhelmed. The temperature is normalized. Sufferers are mostly affected by injuries in the area of ​​injuries, and the loss of ruffians in school children.

In the classic picture of the past period, the SDS re-ferrying has a positive dynamics of change in the shkodgennyh pictures. With a friendly interruption of the process, the process of filling up and changing more and more and more changes in the process of updating the functions of the pictures is taking place. With the prelude to the chronaxis of the generational symptoms, the renewal of the electrical excitation of the generational nerve bursts is being seen. When there is a change in the size of the disease, excessive polyneuritis occurs, and it leads to atrophy of the disease, and some changes occur in the zone of a slow nerve stub, decreased tendon reflexes, and generalized In the sufferers, in conjunction with the development of traumatic neuritis, severe pains occur, which can cause causalgia. The smell is especially intense at night and takes a trivial hour. An hour of renewal of nerves and sensitiveness in young ideas is to lay down at the stage of the development of nerve problems and connections. A greater degree of renewal of nerve functions is characteristic of ischemic lesions. However, the main renewal of the functions of nerves and languages ​​in the cob terms of the past period is not yet to be considered, and it is still not possible to carry on the development of intercourse in the slopes, ruining the sensitiveness. Later, a part of the meat fibers of the with good cloth, Scho to produce up to the development of atrophy, contractures, intermingling of rukhiv in the slopes.

The function of nirok is normalized in full. The nitrogen-visual function of the metabolism is being renewed, so that the organism of the injured metabolic product is not purified. At the polishing of the visual functions, we will introduce the growth of the ekskretsy from the cross section of the molecules of the middle mass. It is a trivial hour to spare for the destruction of the partial functions of nirok. For those who are suffering, there is an oliguria, so that they continue to carry out intensive alcohol visits. Preserving the development of the surge arrester during the whole period of infectious delay and tight-fitting of the SDS overload. At least, septic slowing down with progressive dystrophic and necrotic changes in small tissues, which were found on aphids of poor health, є the main cause of death for sufferers in the second period of SDS.

Among organopathological changes, it is especially common to develop in the whole period of anemia, a stage of acute renal failure, myocardial dystrophy. In the world of changes in symptoms, gnarly-resorptive fever and azotemia are indicators of blood swelling, growth in the number of erythrocytes and hemoglobin. On ECG zberіgayutsya patologіchnі zmіni, SSMSC vkazuyut on nayavnіst elektrolіtnih i metabolіchnih for Change, difuzno for Change mіokarda, іshemії, perevantazhennya rights vіddіlіv sericite, blockade nіzhok beam Gіsa, ekstrasistolії scho in its Cherga svіdchit about rozvitok mіokardіodistrofії, mіokarditu i koronarnoї nedostatnostі in postrazhdalih of SDS ... In the world of the complex therapy, the function of the stove is being updated, key symptoms toxic hepatitis and normalization of enzymes in the blood, bilirubin, blood and indicators of the blood laryngeal system.

s key manifestations During the last period of the SDS, for its significance, the first plan is to include infectious diseases. The process of accelerating the development of metabolic immunodepression in the first place.

Decrease of immunobiological forces to the organism of the patient is clinically manifested in the diagnosis of reparative processes in the early and in the diagnosis of glandular-septic acceleration in the presence of purulent wounds, the development of phlegmon, abscess, abscess The sufferers at the time of the day are confused with the necrosis of the shkiri and the gangrene of the distal segment of the child. For the development of necrotic dairy products, it will be repeated again with the onset of development of important phlegmons. It is not easy to speed up the development of secondary infections due to the rapid progress of mucus necrosis, it is important to get sick. All sufferers with SDS and severe wounds are reliant on hope that they are not overwhelmed by the early process, unimpressed on the intake of antibiotics in a wide range of children. A low level of immunological disease in sufferers with SDS is not fast before the generalization of a septic-septic process. Moreover, the clinically manifested sepsis often looks through the similarities of uremic symptoms... Candidiasis does not often develop on a large number of aphids, the diagnosis of any type of antibiotics, which can be perceived as suffering.

Decreased early infections, as a rule, are superficially resorptive lychomanic, which manifests itself in neutrophilic leukocytosis due to the increase of palicose nuclear forms and SHOE, the middling of blood pressure, Lactic acidosis

Hypoproteinemia, hypocholesterolemia, hyperbilirubinemia and temporal activity of ALT are affected by the images of endogenous intoxication, which is indicative of the development of toxic hepatitis. When you get nagged, Hypercoagulation, if you want and do not reach critical values. In some patients, there may be signs of toxic and dystrophic lesions of the liver, myocardium, symptoms of coronary insufficiency, lack of blood circulation. Klinicheskiy manifest the gnarly toxicity of the core with the nature of laboratory indicators, which represent the furnace, systems and homeostasis, water and electrolyte balance, CBS.

Trivale zdavlyuvannya and tied up with cim gangrene of crushed pictures. The food about the life of the genre of art is often very difficult. The appearance of the embryo, the growing tension of the fabric and the subtle grip of the vessels, in the midst of the great pediatric bloodsheds, and the addition of the gangrenous viglyad on the very cob. The similarity with the economy, how to develop gangrene more and more grows with the appearance of cold weather and the appearance of pulsation of peripheral arteries on the basis of a few symptoms of tissue spasm and cramping.

Intercourse necrosis of shkiri to appear in 4-5 days with injuries on the site of a small tissue crushing. The dead skin is traded in 8-9 days, on the day of the day there is a wound in the far edges (7.8%). Some of the processes of necrosis of the shkiri are only intertwined with the sanctuary of a superficial wound, and in some cases of necrosis, there are fascia and mucus. Driving the deceased shkiri through a defect, to fix the vypirati nagryakli, often already deadened m'yazi. In cich vipadkah it is easy to come to a secondary infection, to find great phlegmon.

phlegmon stretching the syndrome of trivial depression, with a frequent frequent intake of antibacterial therapy and intake of sulfanilamide drugs, is not often developed. Often they see the penetration of infections in the tissue and the crushed tissue, either from the surface of the skin or the wounds, or from the wounds, because of the wounds, because of the necrosis of the skin, or, especially, early ... The possibility of hematogenous and lymphogenous infections is also not possible.

Especially cich phlegmon є the breadth of їх and difficult diagnostics. The injury is traumatized to navit when phlegmon is present, it seems like a swelling and soreness on palpation. The temperature in the first days of the year, as a rule, is adjusted, right away. Behind the change of education, in conjunction with the manifestation of great pediatric and internal bloodsheds, stitches are unfortunate. The function of the urazhenoi kintsevka has been destroyed. Dose for the appearance of a weak phlegmon of a vinikє with dynamical caution for ailments, if there is a problem, with the syndrome of a tricky slowdown, fix the quiet, or maybe, mali b change,

The most significant in terms of the severity of clinical manifestations of the syndrome of tricky pressure may be the steps of the contraction and the area of ​​damage, the appearance substitution internal organs, cysts, blood vessels. After a short time after the trivial reduction of the picture due to any trauma / fractures of the cysts, craniocerebral trauma, open internal organs / quickly slow down the prognosis.

Likuvannya.

Intensive therapy for tricky depression syndrome includes a number of stages.

Persha dopoga is guilty of including in itself the immobilization of the poshkojenoi kіntsіvka, її bintuvannya.

Persha likarska dopooga Polyaga in the improved infusion therapy, right away from the arterial vise, revision and correction of immobilization, the introduction of anti-painful and sedative diseases. In the quality of the first infusions of infusion, there is a mixture of rheopolyglyukin, 5% glucose, 4% sodium bicarbonate.

Likuvannya in the stationary based on a complex design treatment methods, Kozhen z yakikh in the singing period become ill-fated.

Judge:

Infusion therapy, including obovyazkovy vikorystannya fresh frozen plasmas,

· Low molecular weight dextrans / rheopolyglyukin /, disintoxicating agents / hemodesis and in. /;

Extracorporeal detoxification / plasmapheresis, hemosorption /;

Hyperbaric oxygenation with the addition of microcirculation and step change

· Intensity of peripheral tissues;

· Hemodializ by devices of a piece nirka during the period of a state of nirkowal lack;

· Operational involvement for the demonstration - fasciotomy, necrectomy, amputation of pictures;

It is necessary to take care of asepsis and antiseptics, quartzation of all applications,

daily regime / interconnection of water and inclusion of fruits / during the period of the guest house

disadvantages.

The peculiarities of the therapy lie in the period of development of the disease .

Therapy in the period of endogenous intoxication without signs of a hostile deficiency:

viroblyayut punctuation of the central veni;

1.Infusion therapy in the general community of at least 2 years for additional information. Before the warehouse of transfusion centers, the guilt includes:

Freezing plasma 500-700 ml / day,

Roschin glucose with vitamins of group C, B 5% up to 1000 ml,

Albumin 5% -200 ml (5% -10%),

Rozchin sodium bicarbonate 4% - 400 ml,

Disintoxication preparations,

· Low molecular weight drugs (dextran).

Warehouse of transfusion centers, obsyag infusions to be carried out in a fallow form of a dobovy deiuresis, given to an acid-and-leuke mill, the stage of intoxication, carried out prompt engagement... Necessary suvory oblikosti of the slash, if necessary - catheterization of the slash.

2. Carrying out extracorporeal detoxification, the first for all plasmapheresis, is shown to all ailments, which may indicate signs of intoxication, the triviality of health after 4 years, the turn of local changes in the health of the disease.

3. Sessions of hyperbaric oxygenation (HBO) 1-2 times to add a decrease in tissue hypoxia.

4. Drug therapy:

Stimulation of dyuresis for signs of diuretic diseases (up to 80 mg of lasix in doba, eufilin),

Stagnation of antiplatelet agents and microcirculation (curantil, trental, nicotinic acid),

For the prevention of thrombosis and disseminated intravascular coagulation, heparin is prescribed at 2500 OD s / c 4 r / day,

Antibacterial therapy for the prevention of severe diseases,

Sertsevo-sudinn_ preparations are indicated.

5. Hirurgicheskie lіkuvannya. The tactic is to stay in the camp and the stage of the ischemia of the genius of the film. Development of 4 steps of the ischemia of the film:

1 step - an insignificant, inductive swell of soft fabrics and springs. Shkira Blida, on the cordon strikes of a vibuha spine over health, Signs of a deterioration in blood circulation is dumb. Shown conservatively, yes, yes, a friendly effect.

2 steps - along the twists and turns, an inductive swell of soft fabrics and springs. Shkira blida, with little cyanosis. After 24-36 years, when a sound from the hiatus can be established, the bulbs can be set up with a clear-zhovtuvatim vstom - conflicts, when you see that there is a vologue on the surface of the skin, Lack of adequate conservative treatment can lead to a progressive deterioration of microcirculation, microthrombosis, build-up of filling and compression of tissue tissue.

3 steps - bends, inductive heave and tension of soft fabrics. Shkirni pokrivi cyanotic or "marmur" view. Shkirna temperature decreases as it decreases. After 12-24 years, after the release of the delay, the bulbs with hemorrhagic space appear. Before the epidermis, the vologue is exposed to the surface of the dark red color. Inductive swelling, cyanosis of a swelling growth, which is indicative of gross damage to microcirculation, vein thrombosis. conservatively in this vipadku is not effective, to produce a necrotic process. It is necessary to carry out wide stripes with rosettes of fascial cases to reduce tissue pressure and renew blood flow. Plasma loss decreases the steps of intoxication if they develop in their wounds.

4 steps - an inductive swell along with bends, protects against high tension. Shkirnі pokrivi bluish-crimson colora, cold. On the surface of the skin of epidermal fluff with hemorrhagic space. The cyanotic-black dry surface is visible to the epidermis. At the beginning of the day, the build-up is practically not a build-up, but it is indicative of a deterioration in microcirculation, a lack of arterial blood flow, and an extended thrombus formation of venous vessels.

A wide range of fasciotomy in cich vipads will provide the maximum possible renewal of blood circulation, allowing for the appearance of necrotic processes in larger distal areas, reducing the intensity of the absorption of toxic products. If necessary, amputation should be performed in more distal parts of the clinic.

Especially it goes to mean that ailing people have surgical engagement(Fastsiotomy, amputation) a large-scale treatment of infusion therapy for growth up to 3-4 years for a supplement. At the warehouse of the infusion centers, there is a supply of fresh frozen plasmas and albumin in conjunction with the circulating plasma loss through the wound surface.

In the period of nirkovo deficiency, there is a time when a child is born. With a decrease in dyuresis to 600 ml, hemodialysis should be carried out directly from the level of nitrogenous slags in the blood. Extraction is shown to hemodialysis є anuria, hyperkaliєmiya ponad 6 mmol / l, swelling of legends, swelling of the brain.

Infusion therapy in the interdisciplinary period includes highly frozen plasmas, albumin, 10% glucose products, 4% sodium bicarbonate solutions. The general infusion rate will change to 1000 - 1500 ml for extra.

In the third period, the syndrome of tricky slowing down on the first plan is the task of eliminating muscular manifestations and severe slowing down. Especially respect for the need for prevention of generalization of infection with the development of sepsis. The principles of treatment of infectious diseases are also used in cases of classical infectious diseases.

In such a rank, intensive therapy for the syndrome of tricky depression in active robots for a team of physicians - surgeons, anesthesiologists, therapists, nephrologists, traumatologists, skin diseases at the singing stage are old.

Syndrome of positional depression.

Syndrome of positional depression є one of the "by-beat" symptoms of the syndrome of trivial depression, a number of specific features on the other hand, which can be attributed to ethiology and pathogenesis, clinical interrogative tactics. For the development of tsyogo ailments, it is necessary to obtain decilkokh officials. On one side, it is necessary to trivially transfer a sick person to a coma, or in the camp of a deep pathological sleep, which is most often overwhelmed by alcohol or surrogates, drugs, or foul, or swirling gases. On the other hand, the necessary brain development of the syndrome of positional pressure є trauma to soft tissues, often pictures, is accompanied by the position of pressure from the pressure of the patient in non-manual positionі from pledging under yourself with pressures or bent in the slopes, or when trivially snapping the pictures over the edge of a solid object.

Pathogenesis.

The mechanism of development of the ATP is folding and linking with the main ethiological factors: We will be deprived of the words of a narcotic girl and a position of trauma. Exogenous intoxication with narcotic diaphragms (alcohol, yogo surrogates, chadny and vichlopnoy gases, etc.) lead to important breakdowns in homeostasis, breakdown of water-electrolyte balance, acid-puddle breakdowns, breakdowns To achieve often a comatose stun of supernatant overcooled organisms. Trivially comatose mill and position of tissue compression to produce yak up to mint changes in tissue health, as well as to outright intoxication.

Mіscevі zmenі are characterized by:

1.Suppression of blood circulation and lymphatic tissue, circulatory hypoxia, lymphostasis.

2. Violation of tissue metabolism, ischemic disorders nerve cells(ischemic

neuritis), damage to life and bending of soft tissues

3.Damage of lysosomal membranes and entry into the blood of products through proteolysis (myoglobin, creatinine, histamine, etc.).

Significant changes are developing:

1.Disorder of CNS function of neurohumoral genesis.

2.Disorder of blood circulation, hypothermia, microcirculation.

3.Digital function - hypoventilation with the development of dichotomous and circulatory hypoxia.

4. Violation of homeostasis - metabolic and mental acidosis, impaired water - electrolyte balance.

5. Development of myoglobinuria, myoglobinuria.

All the changes are brought to the intoxication of the ARF and nirkovo-hepatic deficiencies, which can lead to death of the sick.

Klinichna picture.

In a critical interruption, the syndrome of positional retardation is seen 4 periods:

1. Gostry period. Comatose stance, which develops in the form of exogenous intoxications (triviality from decilcoh years to decilcoh dib).

2. Early period. Period of local changes in soft tissues and early endogenous intoxication (1-3 add to the exit from the coma).

3. The intermediate period is the period of the arrester and the delay from the side of the other organs and systems (from 5 to 25 dB).

4. A short period of time, if the first plan is to include an infectious delay.

During the period of clinical manifestations of hostile exogenous intoxication, symptoms are characteristic that are specific for rechovins, where the rejection has wicked.

In the other period, the problem of growing illnesses and trying to change the position of illnesses, in the case of health problems in the health of the trees, the decrease or the loss of sensitivity, in the absence of When looking around in the rooms, there is a change in the display of the shkiri, one of the red-blue ones. Herpetic viscera, sadness, maceration, hematomy are not often seen on schools.

At the most recent health problems, one can see the epidermis from the statements of puhirts (flicken), resembling a serous or hemorrhagic birth. In all ailments, there are severe, acute pains with palpation of infiltration.

Nadal, in the world of renewal of blood circulation in the pressurized tissues, it means a quick development of the tissue. With the build-up of the crust, the skin grows as cold, bland. Tissues are tensely stressed, delicately elastic, and with small woody consistency, very painful on palpation, which is encumbered with a different facies cases in the context of a thin fatty lump With a sharp swell, the pulsation of arteries in distal view kintzivok, either out of the day, or very weak, interconnected or on the back of the day in the slopes of the bright, most often through a strong bile, summed up by the pressures of the nerve storms and rosacea.

The changes in the soft tissues already in the early period of the ATP, when the comatose starts to go out, start to suffer a severe endogenous intoxication, as it will take part in the world of changes in the health of the tissues. Intoxication is manifested by non-dullness, blasphemy, baldness, tediousness, blues, dryness in the mouth, temperature changes up to 38 ° C and higher. A tachycardia will appear, which will supervise a slowness, a weakening of heart tones and a decrease in the arterial grip. In the blood analyzes, leukocytosis appears due to the lack of blood, thickened blood, hematocrit and number of erythrocytes appear.

Myoglobinemia begins. Like myoglobinemia, there is myoglobinuria. At the sech there are blocks, leukocytes, erythrocytes, cylindri. Oliguria develops gradually and ailments move into the third period.

Withdrawal Rice ATP for Tricky Compression Syndrome є:

Exotoxic treatment and coma in the state period;

Visibility of traumatic shock;

Less rotation and more and more development of different kinds of change;

Increasingly increasing plasma loss.

The clinical picture in the period of the state of nirkovo disability and the current period is similar to that in the syndrome of trivial depression.

The treatment of the syndrome of positional pressure is carried out according to the same principles, as well as the syndrome of trivial pressure. At the state institution, Komi therapy is carried out, zooming, exogenous, toxicity and acceleration.

Dodatok 1.

Zvedennya of the main signs of the syndrome of trivial pressure.

Winter in school

- tse shokopodіbny camp, scho winyє I will manifest myself with pain, I will become degraded, with a lot of problems, with a great lack of strength. Without medical assistance, the patient should be guided by a hostile deficiency, an increase in toxicity, a legacy or a heart-and-urinary deficiency. Treatment includes disintoxication and plasma replacement therapy, extracorporeal hemorrhage, antibiotic therapy, susceptibility to necrosis and amputation of a crushed bone.

ICD-10

T79.5 traumatic anuria

Country houses

Tricky crush syndrome (SDS), Інші name - traumatic toxicosis, crash syndrome, Bywaters syndrome, moronal syndrome - pathological shock-like stun, as a result of trivial health of the tulub, pictures or segments of important objects. Crash syndrome develops as a result of ill health and renewal of blood and lymph flow in the affected parts of the body. Supravodzhuyutsya pogirshennyi zagalny camp, development of toxemia and hostility nirkova lack, with great area The battle will not end quickly with the death of the patient. In traumatology and orthopedics, they see a type of crash syndrome - this is the name of the syndrome of positional pressure (PCA), which develops as a result of trivial (more than 8 years) health of parts of the body before the hour of unerringly firmly placed on the surface of the people.

cause SDR

Call the syndrome of tricky wine crushing in sufferers for an hour after an hour, earthquakes, collapses in mines, emergency robots, road accidents, harvested lice, vibuhi and waking up as a result of bombing.

Syndrome of positional delay tends to appear in patients who, at the time of the injuries, had been in the camp with sodomy drugs, narcotic or alcoholic sleep. More often people are waiting for the tulubs of the upper kintzivki. For reasons of development, symptoms and methods for eliminating the syndrome of positional depression, it is practically not possible to be attributed to the syndrome of tricky crushing, however, you will develop against a greater likelihood of a smaller area of ​​damage.

pathogenesis

The diagnosis of tricky crushing syndrome is based on three factors:

• pain syndrome;
• massive injections of plasmas, zoomed in by the entrance of a certain part of the blood through the walls of the sudins in the tissue;
• traumatic toxemia (intoxication to the body by tissue breakdown products).

Trivially painful teasing in case of crash syndrome leads to the development of traumatic shock. Plasma retention is the cause of thickened blood and wicklica thrombosis of other sudins. Toxemia is traumatic in case of a crash syndrome; it develops in the presence of soaked products in the roof of a tissue loss of traumatized mucus. Immediately after the sound of the picture from the small fabrics, there is a small number of calories in the water course, which can cause arrhythmias, and in important cases - robotic legends and heart.

The crushed tissue of a patient with a crash syndrome consumes up to 66% of calories, 75% of myoglobin, 75% of phosphorus and 70% of creatine. The products fall into the roof, acidosis and hemodynamic deterioration (including the increase in the size of the nerve glomeruli). Myoglobin pozhkozhu and clogging up nirkovy tubules. Everything should be brought up to the development of a hostile nirkova disadvantage, yaka will load the life ailing crash syndrome.

Classification

Beyond the degree of gravity:

• Mild form of crash syndrome. Winikє when crushed segments of the cake with a stretch of 4 or less years.
• Moderate form of crash syndrome. It develops as a result of the distribution of a single cake over a period of 4-6 years. With the right cob, the prognosis is friendly.
• The form of the crash syndrome is important. Winikak when crushed one kintzivka stretching 6-8 years. Supravodzhuyutsya distribution of hemodynamics and guest nirkovy lack. With a quick cob of liking, the prognosis is obviously friendly.
• The form of the crash syndrome is very important. It develops as a result of the distribution of two and more colors lasting 6 or more years. Supernatural shock. Forecast of unpleasantness.

For clinical symptoms:

• early period (from the moment of sounding up to 3 dB);
• toxic period (to be repaired for 4-5 dobu);
• the period is slower (to develop, after 20-30 dB from the moment of injury).

symptoms of SDR

Immediately after the decline, the patient’s camp was abandoned. A patient with a syndrome of tricky crushed turbine bladder and crushed ruffles in crushed bones. With a stretch of the first years of life, a step-by-step outgrowth of the growth of a patient dilyanka, which is becoming shy, woody. Bulbashki with serous-hemorrhagic space are installed on the screen. When you look at the part of the body, you will see a weakening of the pulsation of the arteries, a decrease in the sensitivity and temperature of the world.

The growth is the symptomatology. The patient's camp with a crash syndrome will go down. Writing for a short period of time, the child will grow up, we will be spoiled. The decrease in arterial pressure and temperature is indicated, arrhythmia, tachycardia, and the degree of curvature is rotated. The skin of the ailing crash syndrome is covered with sticky cold sweat. It can be a waste of evidence, mimic defecation and secular loss. Inodi develop a lot of legends. Changes in the number of chapters, how to see. Without adequate medical assistance, the probability of a fatal result is 1 or 2 add.

On the crushed kintzivka middle necrosis is formed. When dead fabrics are removed, the meat is exposed, which may cause the characteristic look of boiled meat. Suppuration of wounds and erosive surfaces develop. There is a step-by-step build-up of GOST Nirkov's lack. On 5-6 dobu patients with trivial crush syndrome develop uremic syndrome. Addition of calories in the blood of a wikipedia for arrhythmia and bradycardia.

At 5-7, signs of a legacy lack appear. An increase in intoxication, is summed up in the bloodstream of products of tissue loss and bacterial toxins from crushed symptoms, toxic hepatitis. May endotoxic shock. The manifestations of polyorganic deficiencies in patients with a crash syndrome gradually change over a span of 2-3 times.

Gostra nirkova lack of crash syndrome can be stopped approximately through the month of injury. The patient's age is normal, the temperature is normal. Changing bіl і nabrya kіntsіvki. The necrotized mucosa is replaced by a new tissue, which can lead to atrophy of the mucosa and the development of contractures. With uncomfortable development, the pod_y of mossy (suppuration) and zagalny (sepsis) is accelerated.

diagnostics

To compensate for metabolic acidosis, a person with a crash syndrome should drop a dose of 4% sodium bicarbonate. Antibiotics mean a wide range of internal activities. to conduct symptomatic therapy(Diuretics, analgesics, antihistamines and antiarrhythmic drugs). In case of trivial depletion syndrome, extracorporeal hemocorrection (hemodialysis, plasma and hemosorption) should be performed in the yakomoga more early term.

When sparing the life of the muscle tissue and the swirling subfascial swelling with damage to the muscle blood circulation, the traumatologist will see the fasciotomy with the revision and the visible necrotizing muscle bundles. I do not have a suppuration, the wound is sewn in for 3-4 days, in order to change the embryo and polish the backward cure of the sick with a crash syndrome.

In the case of non-vasculature ischemia, amputation of kintzivka is carried out as a miscellaneous jgut. In інshih vypadki the hanging of necrotic dalyanoks is shown from the preservation of life-edition meazovyh bunches. The publication of the language of visas begins in the course of the surgical engagement. Living criteria є preserving normal health, building up to bleeding and speed. Clean the wound with antiseptics. Shvi do not apply. The wound is covered with a secondary interference.

In the case of a long-term illness, we have a syndrome of tricky crushing, the courses of rehabilitation therapy (massage, exercise therapy) are shown, which are directly related to the renewal of muscular force and the reduction of contractures.

In the most important period, the SDS sees three periods: early, intermediate and early.

early period I would like to see the first 3 add up to injuries, characterized by overhanging hemodynamic changes. Immediately after the loss of self-esteem of the patient, he will be perceived as being unrepentant. Yogo turbuyu b_l in the school of the cinema and of the intercourse and decay. Hemodynamic deterioration with no turn. The posture of the bladder is cyanotic, in the dylyankas of the greatest pressure, dents, sints are visible, the pulsation of the bladder is weakened.

Even after a few years, the growth of the growth and the growth of the embankment, the growth of the growth in the volume, the growth of the woody profession, will grow. Nabryak expands to non-shkodzheni dilyanka kintsivka. Mice of colds will be smoothed, and in the moments of the most crushed bulbs appear with blood. The pulsation of the sudin in the distal visualization changes. Kintzivka grows cold on the dot, active hands in slower or out-of-the-way, passive - wicked up. Superficial and glib sensitivity is ruined.

With the build-ups of the mythical manifestations, the zagalny camp endured a progressive start. The arterial grip decreases. Destruction, euphoria wavering to bliss, baiduzhism to navkolishny. Ailing turbuyut weakness, zapamorochennya, nudota. Svidomost is saved. Shkira sira, covered with sticky sweat, cold cakes. The temperature is lowered. When there is an effective therapy of patience in 1-2 knocks, and with very important hemodynamic breakdowns - in the first year.

The function of nirok deteriorates rapidly: the weather flow is close to critical, often not exceeding 30 ml / year. The normalization of hemodynamics most often does not lead to an increase in dyuresis. The slaughter, taken in the first 10-12 years of age, with injuries of low varnish-and-chervone recharge, the reaction of a very sour, viscous strength. At microscopic siege one can see crystals of hematin, all types of cylinders, and some blood detritus. On the side of the blood there are signs of thickening (hematocrit, hemoglobin increases, the number of erythrocytes increases), changes in the number of blood fractions, the growth of thrombosis and fibrinosis.

I have a lot of patience to cope with hemodynamic and experiencing the early period, by pulling the SDS into another, intermediate period.

intermediate period To develop from 2-3 times after injuries, it is characterized by a general development of clinical manifestations of hostile deficiencies. During the early period, the stage of oligoanuria and renewal of dyuresis occurs. With the help of, for the liquidation of hemodynamic ones, the zagalny camp of the patient should be rapidly reduced. The pain in the genius of the picture will change. At the time of the greatest compression of the shkira of the dead and the trade (necrosis in the case of dehydration). The wounds were set to vibrate the crushed dead meat, like the look of boiled meat.

The arterial grip tends to grow. Pulse part. The camp of the patient at the first glance, the fight is not a wiklikє. However, after 1-2, add progressively build-ups of symptoms of a severe deficiency. Up to 5-6 dib of oligoanuria can be clearly indicated for the development of uremic syndrome: a decrease in the water-salt balance, CBS with an important hypothermia. The flared manifestation of uremic syndrome, as a rule, is preceded by hyperkalinemia. Hypercalculation of supervise is carried out by the clear changes of the EKG, right up to the development of atrioventricular blockade. Due to the concentration of calories in the blood plasma, there are three stages of hypercalculation:

In case of hypercalculation of the I stage (concentration of calories 5.5-5.9 meq / l), the pulse is 80-90 beats per quill, EKG without special features.

In case of hypercalculation of the II stage (concentration of calories 6-6.5 meq / l), the pulse is 95-110 beats per quill, on the EKG it is approximately expanded to the P-Q interval, the T wave is shifted;

with hypercalis III stage(The concentration of calories in the blood is 6.5 mmol / l) in a sick person, convulsions of musculoskeletal and other skeletal muscles, pulse 115-130 beats in quiline, on the EKG of enlargement of the interval PQ, high is the highest.

Up to 5-7 dib of oligoanuria are signs of an important legacy deficiency. The dichotomous shortage is taken by stretching out the period of oligoanuria and in the first 5-6 dib for renewal of dyuresis. The triviality of oligoanuria varies from 3 days to 3 days.

Decompensations of metabolic acidosis, hyperphosphatemia, hyperphosphatemia, hypocalceration and anemia are developing.

With the renewal of diuresis (up to 1500 ml and more), the development of the polyuria from 5-7 to the concentration of the second, the steps are reduced. CBS normalizes. Damage to the water-salt exchange is saved in a stretch of 2-3 days.

new period insist on getting through the month of trauma and evolving the stage of hospitality and lack of disability. Typically, the dominance of the muscular manifestations and symptoms of a further renewal of the functional health of the body is characteristic. The zagalny camp is suffering and growing stiff, the temperature is normalizing. Nabrek and pain in the schooling of the picture gradually changes and until the end of the month, I grow up to know. Repeated renewal of the discs does not occur. The fold of the thread of the fabric is folded with a good one. Some necrotic snakes develop in tissues; Secondary infections often lead to the development of sepsis, which are important early wounds.

Exercise nirok with SDS.

The stage of battle is based on the terms of formulating anuria and triviality and awareness of urahuvannya gallonnichnyh indicators, changes in slaughter and biochemical parameters of blood.

Among the laboratory methods in the evaluation of the patient and the changes in the early and intermediate periods of the SDS, the most significant is the analysis of blood and blood, the value of the concentration of blood creatine and blood cells.

When assessing the severity of the defeat of nirok in sufferers, especially when there is a mass reliable before the hospital, if there is a lack of laboratory capabilities and instrumental doslіdzhen, On the first place, one does not come up with biological criteria, but classy tributes;

To help important damages in microcirculation systems, acidic reaction of the cut, macrohematuria is used. Slashing old chervona through great bloodshed, in the sech will appear the little ones.

The reliability of the section is visualized to the level of concentration and distribution. At the first year and day, the formulation of a patient with SDS is meant to increase the level of this problem, but it can be reached in the vicinity of 1040-1050, however, unfortunately, it does not mean to develop anxiety, because it doesn’t mean Decrease in the specificity of the section can be obtained in a stretch of 1-3 m / sec.

In a third of the victims in the first 2 days of injury with SDS on the basis of normal concentration of glucose in the blood, glucose appears, which indicates a decrease in the proximal appearance of the nephron, which is indicative of normal glucose reabsorption.

In the midst of key methods, the ultrasound diagnostics As it allows in the dynamics of creating a classical picture, as well as laboratory data on the geographical structure of the situation in the period of the arrester, it is necessary to monitor the interruption and in the range of the polypredicts of predicting oligarchy. Normalization, for the data of the ultrasonic picture of the nirok, is displayed in the period from decilcoh conditions up to 1-2 minutes and to lay down at the stage of the surge arrester.

Proteinuria of the developmental stage of turnover, which does not turn over 2 g / l, appears practically in all sufferers with SDS. The diagnosis of myoglobin in the presence of an apparent anamnesis and local changes in the tissues in the minds of the mass hopefulness of the victims before the hour of the earthquake, for any other disasters, are not of great significance. About the manifestation of myoglobin in the battle with great vitality can be judged by the її barriers - dark brown or practically black. Microhematuria is the head of the supervisor of the SDS and the snake of the trauma is closed.

Sechaovy sieges among the victims of the SDS are characterized by the manifestation of different types of cylinders - from gialin to epithelial; when the ignition changes are introduced into the sečovy systems, it is caused by abnormally abnormal leukocyturia. In the first 2-3 years, uraturia appears in the middle of a large period, it is accompanied by a massive drop of meat fibers, as a result of injuries of soft tissues.

During the transition from the oligoanuric stage of the OPN to the polyuric one, in the first place, it becomes more important to go through a slash siege from the outgrowths of the cylindrical structure, leukocyturia, and the new ones. sečovyh nobles... The purpose of the change is not to be rocked like an igniter, but to be explained by the so-called "prompts" for the education of tubules and small tubes of nirk on the basis of the renewal of glomerular filtration and the growth of dyuresis.

In addition to metabolic breakdowns associated with structural and functional deficiencies of nirka, in sufferers with SDS, it is possible to see such situations, if pathological processes in their organs are so significant, as well as the function of non-functional reserves.

Tse to produce, before being covered in blood, to come into the circulation from the zone of injuries of metabolites, toxins, biologically active speech. Metabolic azotemia develops.

It is self-explanatory to explain the frequent inconsistency between insignificant changes in creatine levels and a significant change in the norm to the level of serum (indicative of how to accumulate in the form of blood catabolism).

The increase in the level of creatine in the blood is 1.5-2 times higher than in the upper range of norms, and the increase in the increase in the level of nitrogen in the blood is 3-4 times higher, and the increase in the level of nitrogen in the blood is 3–4 times, and the increase in the level of the upper range in the norm is in the case of quiet ailments, but the role of a late-growing factor in the development of toxicity

With an easy step of the SDS, the function of nirok after 3-5 will be renewed. With an important stage of the SDS, without affecting the stabilization of hemodynamic indicators, the zagalny camp does not shrink. OPN will continue to develop and become dominant. ARF can develop without any prior shocks and clearly manifest up to the 3-5th day.

Likuvannya.

Likuvannya of ailments due to trauma of soft tissues in all stages of ailment to health due to urahuvannya of pathogenetic features of development of polyorganic pathology. So, in the early post-compression period, in ailments in a shock camp, the rate of internal introduction of changes is strictly controlled according to the dynamics of the CVP, arterial clutch, frequency and pulse, hematocrit and rate of vision. When carrying out a test, to eliminate the shortage of BCC in a short term, to update the microcirculation and oxygen transport function, to memorize the information on the interstitial process, to inactivate the LPO processes,. Yak pokazuє dosvіd lіkuvannya tsієї groupies ailments at incorrect spіvvіdnoshennі koloїdnih i kristaloїdnih rozchinіv and takozh at vvedennі great obsyagіv krovozamіnnikіv dextran vіdznachaєtsya number of knots in gіperosmіі rozvitkom osmolality nephrosis, and at pіdvischenіy v'yazkostі krovі, agregatsії eritrotsitіv i trombotsitіv rozvivaєtsya GOSTR nirkova nedostatnіst.

With a great ear of soft tissues, the tips for reducing the flow of toxic speech into the bloodstream are circulated directly from the proximal to the distal side. When the bandage is tightened, it is necessary to preserve an arterial flush of blood in the end. The control is the presence of pulsation in the distal form of the pattern. Kintzivka cover with ice and when transporting a sick person, lay it horizontally. The overlay of a jgut is not recommended, since it is necessary to keep the flow of arterial blood into the zone of poaching. When the blood flow is open, the ischemia of soft tissues is observed and destructive processes expand. Jgut is applied only in case of consumption of bleeding, or at an important stage of the reduction of the blood flow, but not for the general use. In the case of severe curvatures, carry out the first surgical treatment of the wound, inject antipravate syrovatka. In the process of mint lіkuvannya, I especially respect the meat weaving mill. At the time of life, the edge of the wound is brought together with small, discreet seams. When there is a lack of blood flow in the tissues and necrosis of the mucous membrane appears, necrotic tissue appears.

Bulbous growths do not vibrate, therefore, in a number of cases, they are shown in the form of information about the development of sepsis.

Making a rosette of small crotches makes it possible to show a typical picture for small fabrics: on the wider embankment of a small paddle over the surface of the screen, there are signifi cantly increased in all In addition to plasmorrhage and lymphorea, it is clear vision fabrics of origin. From 2-3 finish the information about the wound. With a good start, the growth of staphylococcus, blue sticks, enterobacteria begins. Інshim acceleration of massive bleeding from arrosis of sudin. Investigation of heparinization of a sick person when carrying out extracorporeal methods of detoxification of the body, as a rule, the development of a rapid acceleration. Embossing the bandages may cause a time-lapse effect. In case of infusion of soft fabrics for accelerated cleaning of the surface of the wound from the appearance of vicious sorbent fabrics, ferments. Wounds are treated with antiseptics - chlorhexidine, sodium hypochlorite (1200 mg / l). When melting soft fabrics with gnarly visions, they roll the stage of necrotomy in the boundaries of living fabrics.

The renewal of the dysfunctional function of the leg is not a part of intensive therapy. Superb control over the functioning of the legends є up to the level of pO2 in the dynamism and caution for the value of the high saturation of blood sour. When pO2 arterial blood is less than 70 mm Hg. bloodshed less than 85% healthy різні options oxygen therapy: oxygenation of oxygenation through a mask, with the help of a secondary ventilation system, or low-flow membrane oxygenation.

In a large number of ailments, as a result of sympathetic activation, hypoxia and increased concentration of biologically active speech disorders, the onset of motor activity shlunkovo-intestinal tract... The proximal portions of the small intestine are populated by the microflora of the ilocecal region, which leads to the development of dysbacteriosis. In the minds of the ischemia of the intestine, the glass has a bar'nu function and is penetrating for microorganisms. An enteral lack of decompensation systems, signs for the release, activation and release of toxic products. Gastrointestinal sorption is a good way to go to the organisms of toxic words. Ailments should be taken orally without a dose of 30-50 g, enterodez, enterosgel.

Zakhisna pechinkova therapy includes internal introduction of essential, vitamins in groups in and S.

Lіkuvannya also includes the correction of the throat and aggregate body of the blood. In case of hypercoagulation, intravenously inject heparin, trental, fresh frozen fibrinolytic activity, plasma.

Vitamin E, mexidol are used to adjust LPO processes internally.

Intensive treatment includes a complex of entries, direct to the prevention of sepsis and immunocorrection: injecting T-activin, immune plasma, leukomass, vaccines, gamma globulin, antibiotics and antiseptics (metronidazole, dioxidritin natrium) Antibiotics of the aminoglycoside series do not stagnate through the nephrotoxic effect.

UFO blood should be carried out at the viglyadi course treatment for 7-15 days for 3-8 procedures in 24-48 years. The procedure mode is based on a clinical picture of the disease. Photohemotherapy is complementary to the other active methods of detoxification of the body and antibiotic therapy. For the suppression of a load of soft tissues for the adjustment of the concentration of antibiotics and antiseptics in the injured area, the third part of the additional dose of antibiotics should be injected through the catheterization of peripheral lymphatic sudin.

The introduction of sodium hypochlorite is ill with signs of endogenous intoxication to reduce the level of molecules of the middle mass by 20-30%. Detoxification effect of accumulation of active acid and chlorine, which oxidizes toxic peptides.

With the help of the prevention of myoglobinuric nephropathy, alkalinization of intravenous injections of 4-8% of sodium bicarbonate, Lactosol, Tris buffer is used. in an efficient way alkalization of the section є the introduction of large doses of sodium citrate (25-30 g / dob). For the whole family, you can buy vicoristani preparations "Blemaren", "Magurlit", "Uralit-U". Stagnate a lot of cells with sodium bicarbonate.

In case of SDS of the middle and severe stage, hemosorption is shown, and with the development of severe deficiency - hemodialysis. Shown to non-removable hemodialysis:

Hypercalcium is more than 6-7 mmol / l;

Hyperhydration with a threat to the development of a pack of legends;

Uremic encephalopathy or coma.

Anuria with a stretch to finish with non-efficacy of conservative therapy, hyperazotemia (sechovina 20-25 mmol / l, creatinine 500-600 mmol / l), hyperhydration and metabolic acidosis (BE - 13-16 mmol / l) prevent planned hemodia.

Deterioration of the functions of nirok in sufferers with SDS with a free and adequate lykuvanni є werewolf camp. In the majority of sufferers up to 13-33 dB, the change in function is based on more normalization of indicators in nitrogen metabolism and the level of average molecules

Active detoxification of the body, including diaphoresis-filtration (hemodialysis, hemodiaphiltraction, ultrafiltration), sorption, feretic methods of elimination (plasmapheresis, plasma absorption, plasma absorption)

Amputations of kintzivka vyroblyayut in offensive vipad:

1) In connection with the ineffectiveness of blood flow of soft tissues sent to the renewal of blood flow in the development of arteries of symptoms and the appearance of symptoms of gangrene;

2) In case of unhappiness, the question of whether or not the efficiency of reconstructive surgeries is performed on zruynovanoy prints;

3) In case of progressive wounds and foreign infections with the development of sepsis and a threat to the life of the sick;

4) With increasing polyorganic deficiencies and clear key signs decompensation of systemic systems on the basis of intensive therapy.

LIST OF LITERATURE

1. Sakhno І.І. Disaster medicine (organization of nutrition) / І.І. Sakhno, V.I. Sakhno.- M: GOU VNTs MOZ RF, 2001.- 560 p.

2. Musselius S.G. Syndrome of endogenous intoxication in case of non-removable mills / S.G. Musselius. - M.: Vidavnitstvo BINOM, 2008. - 200 p.

3. Nechaev E.A. Diagnostics and pathogenetic meaning of the syndrome of trivial pressure / E.A. Nechaev, G.G. Savitsky. - M.: Vіyskove vidavnistvo, 1992. - 303 p.

4. Komarov B.D. Positioning tissue compression / B.D. Komarov, І.І. Shimanko. - M.: Medicine, 1984. - 176 p.

Postural hiatus syndromeє a type of syndrome of tricky crushing, even at the sight of the rest of the rice;

Obligate minds are responsible for the syndrome of positional depression є, in the first place, an unreasonable stance, which is tied to alcoholic spirits for some reason, in another way, it’s not handy, it’s innocent for a hard-to-find object in a pose, for some reason (for the duration of the period, but for the important ischemic damage, before the necrosis of the tissue of the autonomic become 10-12 years old).

key picture... Having progressed and arrived in oneself, ailments inevitably mean more and less deterioration of the functions of the affected child. Weakness, head b_l to fit the headstock. Miscellaneous rosters rotate in the cold and cold ailments of the disease, the decrease in the sensitivity of the school, the decrease in the interconnected functions, the little ones, weakened or increased in the presence of the pulsation of the arteries. The temperature is normal or slightly shifted, the arterial grip is not changed. If ailments have entered through a spike of years from an ear of ailment, then a growing bulge appears at the end, a shkira grows old. The correct description of the citizen has a great role to play in the anamnesis. Tim for an hour of illness is reluctant to talk about a strong sp'yaninny, to think about a trauma or about an uncommon cause. Most often it is necessary to diagnose "thrombophlebitis", and in some neglected cases - "anaerobic infection", in conjunction with preventing widespread growth. The growing quagmire The woody character, the bends of the nerves of the vessel are affected by the important deterioration of the functions of the nerves. Dobova number of this change rapidly, right up to the development of anuria. The result of the pathological process lies in the form of trivial health, early correct diagnosis and rational treatment. In ailments, for those who have diagnosed with life, they did not have a good diagnosis of great records, the prognosis is unimportant. Often, ailments have a lack of neurological and trophic problems due to positional delay.

principle of liking... The main drugs come with a positional depression of the blame, but are directed to the normalization of the function of the heart-vascular system and nirok, it is shown the introduction of analgesics, antihistaminal drugs, osmodiuretic drugs, antihypertensive drugs. For prophylaxis, it is tight to bandage with elastic bandage and cool down. With important curls, fasciotomy is shown with a small size of the shkiri. Vlivannya ridin is controlled according to the visual function of nirok. In case of a serious interruption, the process of stagnating hemosorption and hemodynamics for an additional device "piece nirka" in special editions.