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Abstract
ABSTRACT
Objective. To describe the management of traumatic hemorrhagic shock in the emergency department of the University Hospital Center of Owendo. Patients and methods: This was a descriptive and prospective cross-sectional study carried out from December 1, 2018 to April 30, 2019. All patients who presented with post traumatic hemorrhagic shock were included. The study variables were: anamnestic, epidemiological and clinical, the mode of transport used, the time between the accident and admission to the emergency room, management, fate of the patients. Results: Thirty-six patients were collected (27 men and 9 women). The mean age was 34 ± 1.3 years. The main injury mechanism was a traffic accident (52.8%). Thirty-five patients (97.2%) reached the hospital by taxi. Hemoperitoneum was found in 38.8% of cases. The lesions involved the head and face in 40% of the cases. The average time between the onset of the trauma and the emergency room visit was 2 hours ± 1.2 hours. Conclusion: Post traumatic hemorrhagic shock is a vital emergency; its management is currently well codified according to the recommendations of learned societies. The railroad accident is the leading cause. The management of hemorrhagic shock still experiences enormous difficulties in our context and mortality remains high.
RÉSUMÉ
Objectifs. Décrire la prise en charge de l’état de choc hémorragique traumatique au service d’accueil des urgences du Centre Hospitalier Universitaire d’Owendo. Patients et méthodes. Il s’agissait d’une étude transversale descriptive et prospective réalisée du 01er Décembre 2018 au 30 Avril 2019. Tous les patients ayant présentés un état de choc hémorragique post traumatique ont été inclus. Les variables d’études étaient anamnestiques, épidémiologiques et cliniques, le mode de transport utilisé, le délai entre l’accident et l’admission aux urgences, la prise en charge, le devenir des patients. Résultats. Trente-six patients ont été colligés (27 hommes et 9 femmes). L’âge moyen était de 34 ans ± 1,3. L’accident de la voie publique était le principal mécanisme lésionnel (52,8%). Trente-cinq patients (97,2%) ont rejoint l’hôpital par taxi. L’hémopéritoine était retrouvé dans 38,8% des cas. Les lésions intéressaient la tête et la face dans 40% des cas. Le délai moyen entre la survenue du traumatisme et la consultation aux urgences était de 2 heures ±1,2 heure. Conclusion. Le choc hémorragique post traumatique est une urgence vitale, sa prise en charge est actuellement bien codifiée selon des recommandations des sociétés savantes. L’accident de la voie est la première cause. La prise en charge du choc hémorragique éprouve encore d’énormes difficultés dans notre contexte et la mortalité reste élevée.
Article Details
References
- Bougle A, Harrois A , Duranteau J. Prise en charge du choc hémorragique en réanimation : Principes et pratiques. Elsevier Masson Reanimation 2008 17,153-161.
- Orliaguet G, Vivien B, Riou B. Choc hémorragique et réanimation circulatoire du polytraumatisé. In : Traumatismes graves. Beydon L, Carli P, Riou B, Ed. Paris : Arnette ; 2000. p. 101-21.
- Murray CJ, Lopez A. Alternative projections of mortality and disability by cause 1990-2020: Global .Burden of Disease Study. Lancet 1997;349:1498504 doi: 10.1016/S01406736(96)074922 .
- American College of Surgeons. Comittee on Trauma and National Association of Emergency Medical Technicians (U.S.). Pre-Hospital Trauma Life Support Committee; PHTLS: Pre Hospital Trauma Life Support Committee 6th ed. St. Louis, MO: Elsevier Mosby, 2007; xxix: 594.
- Osterwalder JJ. Could a regional trauma system in eastern Switzerland decrease the mortality of blunt polytrauma patients? A prospective cohortstudy. J Trauma 2002; 52 :1030-6.
- Megevand B, Celi J, Niquille. Choc hémorragique .Revue Med Suisse 2012; 10: 1501-5.
- Iteke F R , Bafunyembaka M , Nfundiko K et al. Urgences Abdominales Traumatiques: Aspects épidémiologique, lésionnel et pronostique au service d’accueil des urgences de l’HGR de Panzi de Bukavu (RD Congo). Revue Africaine d’Anesthésiologie et de médecine d’Urgence tome 19 n°1-2014.
- Guerrini P. Traumatismes abdominaux. In : Beydou L, Carli P, Riou B eds. Traumatismes graves. Paris : Arnette ; 2000. P. 389-400.
- Gogler H. Abdominal surgery in Togo (West Africa) and central Europe Zentralbel chir 1997; 102: 548-52.
- Peitzman Ab, Heil B, Rivera L, et al. Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma. J Trauma 2000; 49: 177-87.
- Vivien B, Langeron O, Riou B. Prise en charge du polytraumatisme au cours des premières 24 heures. Encycl Méd Chir (Elsevier, Paris), Anesthésie-Réanimation, 2004, 36-725-50.
- American College of Surgeons. Committee on Trauma, Advanced Trauma Life Support ATLS). 8th ed. Chicago; American College of Surgeons, 2012.
- Yeguianyan JM, Garrigue D, Binquet C et al. French intensive care recorded in severe trauma study group. Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study. Crit Care 2011;15: R34.
- Ajao OG. Abdominal emergencies in a tropical African population. Br. J. Surg 1981, 68 : 345-7.
- Annane D et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock; randomized trial. JAMA 2013; 310: 1809-17.
- Spahn DR, Cerny V, Coats TJ, Duranteau et al. Management of bleeding following major trauma: a European guideline. Crit Care 2007;1:R17.
- Poloujadoff MP, Borron SW, Amathieu R et al. Improved survival after resusscitation with norepinephrine in a murine model of uncontrolled hemorrhagic shock. Anesthesiology 2007; 4:591-6.
- Hébert PC, Wells G, Blajchman MA et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;6 :409-17.
- CRASH-2 trial collaborators, shakur H, Roberts I et al. Effects of traxénamique acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010;376:23-32
References
Bougle A, Harrois A , Duranteau J. Prise en charge du choc hémorragique en réanimation : Principes et pratiques. Elsevier Masson Reanimation 2008 17,153-161.
Orliaguet G, Vivien B, Riou B. Choc hémorragique et réanimation circulatoire du polytraumatisé. In : Traumatismes graves. Beydon L, Carli P, Riou B, Ed. Paris : Arnette ; 2000. p. 101-21.
Murray CJ, Lopez A. Alternative projections of mortality and disability by cause 1990-2020: Global .Burden of Disease Study. Lancet 1997;349:1498504 doi: 10.1016/S01406736(96)074922 .
American College of Surgeons. Comittee on Trauma and National Association of Emergency Medical Technicians (U.S.). Pre-Hospital Trauma Life Support Committee; PHTLS: Pre Hospital Trauma Life Support Committee 6th ed. St. Louis, MO: Elsevier Mosby, 2007; xxix: 594.
Osterwalder JJ. Could a regional trauma system in eastern Switzerland decrease the mortality of blunt polytrauma patients? A prospective cohortstudy. J Trauma 2002; 52 :1030-6.
Megevand B, Celi J, Niquille. Choc hémorragique .Revue Med Suisse 2012; 10: 1501-5.
Iteke F R , Bafunyembaka M , Nfundiko K et al. Urgences Abdominales Traumatiques: Aspects épidémiologique, lésionnel et pronostique au service d’accueil des urgences de l’HGR de Panzi de Bukavu (RD Congo). Revue Africaine d’Anesthésiologie et de médecine d’Urgence tome 19 n°1-2014.
Guerrini P. Traumatismes abdominaux. In : Beydou L, Carli P, Riou B eds. Traumatismes graves. Paris : Arnette ; 2000. P. 389-400.
Gogler H. Abdominal surgery in Togo (West Africa) and central Europe Zentralbel chir 1997; 102: 548-52.
Peitzman Ab, Heil B, Rivera L, et al. Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma. J Trauma 2000; 49: 177-87.
Vivien B, Langeron O, Riou B. Prise en charge du polytraumatisme au cours des premières 24 heures. Encycl Méd Chir (Elsevier, Paris), Anesthésie-Réanimation, 2004, 36-725-50.
American College of Surgeons. Committee on Trauma, Advanced Trauma Life Support ATLS). 8th ed. Chicago; American College of Surgeons, 2012.
Yeguianyan JM, Garrigue D, Binquet C et al. French intensive care recorded in severe trauma study group. Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study. Crit Care 2011;15: R34.
Ajao OG. Abdominal emergencies in a tropical African population. Br. J. Surg 1981, 68 : 345-7.
Annane D et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock; randomized trial. JAMA 2013; 310: 1809-17.
Spahn DR, Cerny V, Coats TJ, Duranteau et al. Management of bleeding following major trauma: a European guideline. Crit Care 2007;1:R17.
Poloujadoff MP, Borron SW, Amathieu R et al. Improved survival after resusscitation with norepinephrine in a murine model of uncontrolled hemorrhagic shock. Anesthesiology 2007; 4:591-6.
Hébert PC, Wells G, Blajchman MA et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;6 :409-17.
CRASH-2 trial collaborators, shakur H, Roberts I et al. Effects of traxénamique acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010;376:23-32