![]() Ultimately, patients go into shock affecting respiratory gas exchange due to lung edema. The released potassium in the circulation causes alteration in cardiac rhythm. ![]() Kidneys also tend to be edematous and show an increase in volume. The muscles are grossly swollen, hard, cold, insensitive and necrotic. The appearance, duration and gravity of oliguria and kidney damage are not related to the severity of muscle damage. It has also been noticed that an element of vasoconstriction of the afferent arterioles induced by myoglobin degradation products adds to this setting of tubular destruction.Įlevated lactic acid levels are well coordinated with muscle ischaemia time, but it is generally accepted that serum creatinine phosphokinase is the most important index of muscle damage. ![]() Myoglobin is filtered out of the glomerulus, but once the renal threshold is exceeded, it precipitates in the distal convoluted tubules causing obstruction. In turn, this releases myoglobin degradation products, lactic acid, uric acid and muscle enzymes like creatinine phosphokinase and aldolase, besides ions like calcium, potassium and phosphate into the circulation. Ĭasualties deteriorate only after being rescued out of the debris of collapse or entrapment, because once the tissue tension is released, reperfusion to the ischaemic damaged muscles disrupts sodium-potassium-ATPase mechanism. Nitric oxide system is activated and this further contributes to muscle vasodilatation and aggravation of hypotension. Regional ischemia caused by occlusion of micro and macrocirculation to muscles following crush, releases sodium, calcium and fluids leading to raised muscle volume and tension. Though essential for cell function, they are toxic when released into the circulation in large amounts. Muscles also contain potassium, magnesium, phosphate, acids, enzymes like creatine phosphokinase (CKMM) and lactate dehydrogenase (LDH). Our whole focus has to be centered on tackling this 10%, which has severe and extensive metabolic disturbances.Ĭrush and rupture of muscle cells releases myoglobin, which gets converted to methmyoglobin and finally acid haematin, which is released into the circulation. Of the 20% that reach hospital, 10% make an uneventful recovery. Depending on your child’s age and immunization status, the doctor also may order a tetanus booster.It is recorded that upto 80% of crush injury patients die due to severe head injuries or asphyxiation. In this case, antibiotics will be prescribed. A fracture underneath a cut is considered an “open” fracture and is susceptible to infection in the bone. If there’s considerable blood under the nail, the pediatrician may drain it by making a small hole in the nail, which should relieve the pain.Īlthough deep cuts may require stitches, often all that’s necessary is sterile adhesive strips (thin adhesive strips similar to butterfly bandages). An injured nail bed also must be repaired surgically to minimize the possibility of a nail deformity developing as the finger grows. A fractured finger can be straightened and set under local anesthesia. If the X-ray confirms a fracture-or if there’s damage to the nail bed, where nail growth occurs-an orthopedic consultation may be necessary. If your doctor suspects a fracture, he may order an X-ray. Do not attempt to straighten a fractured finger on your own. When there’s excessive swelling, a deep cut, blood under the fingernail, or if the finger looks as if it may be broken, call your doctor immediately. These may be signs of infection, and you should notify your pediatrician. But be alert for any increase in pain, swelling, redness, or drainage from the injured area, or a fever beginning twenty-four to seventy-two hours after the injury. If the swelling is mild and your child is comfortable, you can allow the finger to heal on its own. An ice pack or a soaking in cold water may relieve the pain and minimize swelling. ![]() When the fingertip is bleeding, wash it with soap and water, and cover it with a soft, sterile dressing. If bleeding occurs underneath the nail, it will turn black or dark blue, and the pressure from the bleeding may be painful. The skin, tissues below the skin, and the nail bed-as well as the underlying bone and growth plate-all may be affected. Usually the damaged area will be blue and swollen, and there may be a cut or bleeding around the cuticle. Fingers also sometimes get crushed when youngsters play with a hammer or other heavy object, or when they’re around a car door.īecause fingertips are exquisitely sensitive, your child will let you know immediately that she’s been injured. The child is either unable to recognize the potential danger, or she fails to remove her hand quickly enough before the door is shut. Children’s fingertips get smashed frequently, usually getting caught in closing doors.
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