La Revue du praticien
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Hemorrhagic shock generates a prolonged alteration of organ perfusion due to the decrease in oxygen delivery. Hemorrhagic shock is mainly due to three etiologies: traumatology, gastrointestinal bleeding and high risk surgery. If intensive cares are not rapidly performed, severe complications occur, as organ failure with a high mortality rate. ⋯ Priority during initial treatment is to restore tissue perfusion and achieve haemostasis in vital functions. Fluid resuscitation and transfusion are common to every case of hemorrhagic shock but the strategy to localise the hemorrhage and stop the bleeding differs between the situations. Key factors in the management of hemorrhagic shock are the communication between surgical, anaesthetic, and critical care teams and the application of pathology.
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Altered states of consciousness are a common reason for visits to the emergency room and admission to intensive care unit. Management of unconscious patient can be difficult because the potential causes of an altered mental status are considerable and the time for diagnosis and effective intervention is short. ⋯ Technical investigations like CT-scan and laboratory tests should make part of a careful diagnostic plan. The prognosis for recovery depends greatly on the underlying etiology as well as its optimal treatment, which seeks to preserve neurologic function and maximize the potential for recovery by reversing the primary cause of brain injury, if known, and preventing secondary brain injury from anoxia, ischemia, hypoglycemia, cerebral edema, and electrolyte disturbances.
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Acute respiratory distress is a common cause of emergency admission to hospital. Clinicians may face difficulties in terms of diagnosis (etiology), especially in older subjects, often presenting with multiple medical conditions. ⋯ Symptomatic treatment of respiratory distress (oxygen therapy and/or respiratory support) is essential. Except from some clearly identified medical conditions (for instance cardiogenic pulmonary edema in hypertensive subjects, acute asthma attacks or tension pneumothorax), the effect of a specific treatment is often limited, at least in terms of immediate outcome.