Hemorrhagic Shock in Children

Abstract

Hemorrhagic shock is a situation with a high risk of morbidity and mortality. The recovery widely depends on early and effective treatment. Diagnosis mainly relies upon physical examination and is usually easy in the case of external bleeding. However, diagnosis may be difficult in children because of some pathophysiological particularities, especially in the case of internal hemorrhage. The management of treatment includes the combination of hemostasis of the hemorrhagic lesion and hemodynamic resuscitation to maintain adequate tissue oxygenation. The effectiveness of treatment is first assessed on conventional hemodynamic parameters, including mean arterial pressure, which is the driving perfusion pressure for organs, as well as hourly urine output. Nevertheless, clinical signs may be insufficient to assess precisely the hemodynamic status, while noninvasive blood pressure measurement may be inaccurate. Therefore, it is often necessary to monitor blood pressure invasively, especially in the most severe cases. The concept of damage control resuscitation was first described in adults but can also be applied to children with uncontrolled bleeding; however, some anatomo-physiological particularities of children need to be taken into account. The concept prioritizes short-term physiological recovery and is mainly based on resuscitative maneuvers targeting the lethal triad (coagulopathy, acidosis, and hypothermia), in association with damage control surgery. Definitive repair of all injuries is performed once the patient is stabilized or when all patients have received primary care in case of multiple casualties. The damage control concept starts at the scene of an accident or at home and continues during transport and on admission to the hospital.