BY HEMORRHAGIA:
CLINICAL SIGNS:
* pallor , sweat , cold extremity, mottling of the knees .
* disturbance of consciousness: agitation or prostration, incoherent remarks, obnubilation.
* pulse rate : frequency> 120 / min and weak pulse.
– attention: sometimes paradoxical bradycardia by vasovagal reflex.
– absent tachycardia if associated negative chronotropic treatment.
* polypnea , cyanosis.
* drop in blood pressure (<80 mmHg), pinch differential.
* increase in the coloring time> 3 seconds, discolored conjunctiva.
* Collabated veins, oligo-anuria, thirst.
* risk of vital distress: coma, respiratory distress, cardiorespiratory arrest.
DIFFERENTIAL DIAGNOSIS:
* cardiogenic shock.
* anaphylactic shock.
* septic shock.
ETIOLOGY:
* post-traumatic hemorrhage, external or internal (make rectal examination, vaginal examination, gastric tube): hemothorax, tamponade, rupture of aneurysm of the aorta, rupture of spleen or liver, pelvic fracture, fracture of the femur.
* gastrointestinal haemorrhage, acute pancreatitis.
* gyneco-obstetric bleeding: GEU.
bleeding with anticoagulants: retroperitoneal hematoma or right
* burns.
ADDITIONAL TESTS:
* scope, SpO²: unreliable if persistent shock.
* ECG.
* groupage, RAI.
* NFS: normal hemoglobin and hematocrit at the beginning to repeat regularly if diagnostic doubt, sometimes early leukocytosis.
* hemostasis.
* chest X-ray after clinical stabilization.
TREATMENT:
* gestures of hemostasis : compressive dressing, surgery, Blackemore probe, gynecological tamponade, …
* Trendelenburg position or raised legs.
* warming up the patient.
* set up two G14-G16 venous lines, bulbous tubules.
* oxygen therapy mask: 8 to 10 l / min.
* filling thanks to the device of Jouvelet:
– crystalloid if hypovolemia not important: NaCl 0.9%, Ringer-Lactate.
– colloids if greater shock or if TA <80 mmHg:
– Plasmion (20 ml / kg in 15 minutes in children) or Elohès.
– if doubtful diagnostic, make a filling test in 10-15 minutes:
Either with 50-200 ml of colloids or with 200-600 ml of crystalloids.
* hospitalization.
* treatment of the cause: surgery.
* transfusion to maintain hematocrit at 20-25% after ABO grouping:
– if hemoglobin <7 g / 100 ml
– if hemoglobin <10 g / 100 ml in subjects with cardiopathy, angina, stroke, respiratory disease or if taking beta-blockers or ACE inhibitors.
The unit of globular concentrate raises the hemoglobin by 1 g / 100 ml.
* if failure:
– Dobutrex or Dopamine with the electric syringe.
– Adrenaline, 0.25 μg / kg / min by electric syringe or more.
* if severe sub-diaphragmatic hemorrhage:
– shockproof trousers at 30 mmHg (then 60) for the abdomen and 50 mmHg (then 80) for the lower limbs.
* if vital distress: intubation and assisted ventilation after anesthesia (Hypnovel + Fentanyl)
BY DEHYDRATION:
CLINICAL SIGNS:
* those of dehydration:
– thirst , dryness of the mucous membranes (on the lower side of the tongue), skin fold.
– frequent fever , weight loss .
– arterial hypotension .
– confusion, disturbances of consciousness.
ETIOLOGY:
* fever, vomiting, diarrhea especially in the old man.
* diuretics, IEC.
* adrenal insufficiency.
* intestinal obstruction .
ADDITIONAL TESTS:
* scope, SpO².
* urine strips, capillary blood glucose.
* standard assessment, blood ionogram, urinary ionogram, serum calcium, ECBU.
TREATMENT:
* venous route, oxygen therapy mask.
* Sodium chloride 0.9% immediately if moderate hypovolemia otherwise filling with Elohès or Plasmion if persistent shock.
* hospitalization.
