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CHOC HEMORRAGIQUE

CHOC HEMORRAGIQUE. PHYSIOPATHOLOGIE. Keller Geoffray mai 2008. ESTIMATION DES PERTES SANGUINES. VST = 70 ml/kg Hémorragie massive: perte de la moitié du VST en 3h. ESTIMATION DES PERTES SANGUINES. PST = VST x Ln(Ht i /Ht f ). DEFINITION. Hemodynamic monitoring in shock

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CHOC HEMORRAGIQUE

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  1. CHOC HEMORRAGIQUE PHYSIOPATHOLOGIE Keller Geoffray mai 2008

  2. ESTIMATION DES PERTES SANGUINES VST = 70 ml/kg Hémorragie massive: perte de la moitié du VST en 3h

  3. ESTIMATION DES PERTES SANGUINES PST = VST x Ln(Hti/Htf)

  4. DEFINITION Hemodynamic monitoring in shock ICM 2007: 33 575-90

  5. DO2 = CaO2 x Qc CaO2 = 13,4x[Hb]xSaO2+ 0,03xPaO2 VO2 = Qc x (CaO2-CmvO2) O2ER= VO2/DO2 (n=25%) ALTERATION DU TRANSPORT EN O2 DO2crit

  6. HYPOVOLEMIE RV= PSM-POD / RRV RV RV POD POD 0 7 Guyton AC Am J Physiol 1957

  7. CHOC HEMORRAGIQUE Réponse neuro-humorale sympathique Redistribution macro-vasculaire Hypoperfusion hépatosplanchnique et rénale Ischémie-Reperfusion

  8. REPONSE SYMPATHIQUE HEMORRAGIE % 40 40 0 0 PAM (mmHg) 80 80 Phase 1 Phase 2 0 0 Modèle de WIGGERS

  9. EFFET TEMPS Hysteresis Pression/volume Choc prolongé Dalibon et al. BJA 99

  10. EFFET DE L’ANESTHESIE Vatner et al. NEJM 1975

  11. REDISTRIBUTIONVASCULAIRE

  12. CHOC DISTRIBUTIF

  13. Ischémie-Reperfusion Activation leucocytaire Dysfonction endothéliale Médiateurs de l’inflammation Augmentation de la perméabilité microvasculaire Hyporéactivité vasculaire Altération de la réponse immunitaire Trouble de l’hémostase microthrombi Dysoxie tissulaire

  14. DYSFONCTION VASCULAIRE Hypoxie cellulaire Canaux K+ NO Cytokines AVP Morales et Al Circulation 1999

  15. ACTIVATION LEUCOCYTAIRE

  16. MEDIATEURS DE L’INFLAMMATION

  17. LES MESSAGES Physiopathologie complexe Course contre la montre Dysoxie tissulaire responsable du MOF

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