Introduction : The objective of this study was to write the epidemiological, etiological and therapeutic aspects of shock in children in the paediatric medico-surgical emergency unit of the National Donka Hospital. Method: This was a forward-looking, descriptive 6-month study, including all children aged 0 to 15 who were received in the paediatric medico-surgical emergency unit at The Donka National Hospital, where the shock diagnosis was retained and the patients received care. Results: In our study, 26 out of 1123 patients were received in a state of shock. Hypovolemic shock was more common at 24 (92%). Vascular filling by Ringer’s milk was the basic treatment. The 6 to 11 month age group was the most affected and the sex-ratio M/F was 1.6. The acute febrile gastroenteritis and dehydration status were the most frequent causes. The outcome was favorable in 25 patients (96%). Conclusion: Rapid and effective management would improve the vital and functional prognosis of children in shock.
Shock is a vital emergency due to acute circulatory insufficiency characterized by inadequate supply and oxygen requirements. It can result either from a decrease in the oxygen supply, or from a lack of oxygen utilization by the cell, or from a combination of both [
Several etiologies can be at the origin of a state of shock. However, regardless of the etiology and mechanism of this state of shock, it is characterized by hypo-infusion or inadequate tissue perfusion with hypoxia, or even cellular anoxia, resulting in the metabolism of the aerobic pathway to the body anaerobic pathway with a defect in the production of adenosine triphosphate, the main energy source of the cell [
In the United-States, a survey by Watson found an incidence [
In Western Europe and North America, hemorrhagic shock is the most common cause among other shock conditions in children [
In sub-Saharan Africa, specifically in Senegal, the prevalence of shock among hospitalized newborns is 9% [
The state of shock is a vital emergency; its diagnosis is based solely on the clinic. The identification of nature is based on a group of essentially anamnestic and clinical arguments. The para-clinical examinations provide only additional information to clarify the mechanism [
The aim of this study was to write epidemiological, aetiological and therapeutic aspects of the state of shock in children at the pediatric unit of the medical-surgical emergencies of Donka National Hospital.
This is a transversal, prospective type descriptive six months, from March 9 to September 9, 2015. We included all children aged 0 to s 15 years in which the diagnosis of shock has was retained and treated at the pediatric unit of the medical and surgical departments of the National Donka Hospital during the period.
The epidemiological data (age, gender), clinical (reasons for consultation, physical signs, diagnosis) etiological (hypovolemic shock, or septic shock) and therapeutic (drugs) were studied. Informed consent was obtained from any parent of the patient before inclusion of the patient in the study.
Have been defined as cases of shock, any patient with Tachycardia, TRC > 3 seconds, a small pulse or shooting, hypothermia, cold extremities, agitation, respiratory distress, Hypoxia, Oliguria.
The research was conducted according to the principles of the Helsinski Declaration.
We collected 26 cases of shock on 1123 children admitted to consultation during the study (2.3%), including 16 boys (61.54%), 10 girls (38.46%) and a sex ratio. M/F of 1.6. The average age was 33 months with extremes of 5 and 180 months (Tables 1-3).
24 cases (92%) of hypovolemic shock were recorded against 2 cases (8%) of septic shock.
We recorded 24 cases (2%) of acute febrile gastroenteritis with dehydration associated with severe malaria and meningitis; 1 case (4%) of haemorrhage due to open collarbone fracture with frontal wound and 1 case (4%) of septicemia due to abscess of the right thigh with anal wound.
Among the emergency checkups, a blood glucose, a hemoglobin level, a thick drop with parasite density, a TDR and white blood cells were realized in cases (100%); Lumbar puncture in 11 cases (42%) and blood grouping/Rh factor in 1 case (4%) (
Characteristics | n | % |
---|---|---|
Age group (months) | ||
0 - 5 | 7 | 2 7 |
6 - 11 | 12 | 46 |
12 - 23 | 0 | 0 |
24 - 59 | 4 | 1 5 |
60 - 119 | 1 | 4 |
120 - 180 | 2 | 8 |
Reasons for consultation | ||
Vomiting | 23 | 88 |
Fever | 21 | 81 |
Diarrhea | 18 | 69 |
Sweats | 3 | 12 |
Agitations | 2 | 8 |
Loss of consciousness | 2 | 8 |
Bleeding | 2 | 8 |
Inability to suck | 2 | 8 |
Respiratory distress | 1 | 4 |
Clinical signs | n | % |
---|---|---|
Cardiovascular | ||
Tachycardia | 20 | 77 |
Bradycardia | 17 | 65 |
TRC Peripheral > 3 s | 16 | 62 |
Running pulses | 14 | 54 |
Small pulse | 11 | 42 |
Cold end | 4 | 15 |
Cyanosis | 1 | 4 |
Neurological | ||
Obnubilation | 12 | 46 |
Coma | 4 | 15 |
Agitation | 3 | 12 |
Drowsiness | 1 | 4 |
Respiratory | ||
Polypnoea Respiratory distress | 15 10 | 58 38 |
Bradypnea | 6 | 23 |
Hypoxia | 5 | 19 |
Urinary, cutaneous and general | ||
Oliguria | 9 | 3 5 |
Hyperthermia | 21 | 8 1 |
Hypothermia | 1 | 4 |
Dryness of the mucous membranes | 22 | 8 5 |
Pallor | 7 | 2 7 |
Age (month) | Malaria Serious | Meningitis | Open fracture | Septicemia | Total |
---|---|---|---|---|---|
0 - 5 | 0 | 7 | 0 | 0 | 7 |
6 - 11 | 8 | 4 | 0 | 0 | 12 |
12 - 23 | 0 | 0 | 0 | 0 | 0 |
24 - 59 | 3 | 0 | 0 | 0 | 3 |
60 - 119 | 1 | 0 | 0 | 0 | 1 |
120 - 180 | 1 | 0 | 1 | 1 | 3 |
Total | 13 | 11 | 1 | 1 | 26 |
Treatment | Effective | Percentage |
---|---|---|
Lactated Ringer | 26 | 100 |
Saline serum | 2 | 8 |
Haemaccel | 2 | 8 |
Transfusion | 1 | 4 |
Paracetamol | 21 | 81 |
Vogalène | 16 | 62 |
Ceftriaxone | 9 | 35 |
Ampicillin | 5 | 19 |
Dexamétazone | 5 | 19 |
Diazepam | 3 | 12 |
Metronidazole | 1 | 4 |
Two (02) patients were transferred respectively to pediatric and trauma services for adapted care after managing the medical emergency (vascular filling, antipyretic perfusable, antiemetic, antibiotic and corticosteroid).
The weakness of equipments of the technical platform, and the non-realization of certain para-clinical investigations (ionogram and blood gasometry) were limits to the study without compromising the results.
From 09 March to 09 September 2015, we carried out a prospective cross-sectional study of the descriptive type at the pediatric unit of the medical and surgical departments of the National Donka Hospital on the state of shock of the child. It represented 2.3% of consultations of this period. This low result could be explained by the epidemic of Ebola virus disease that erupted during this period, leading to a decline in patient attendance in the service. The 6 to 11 month age group was the most affected followed by the 0 to 5 month age group. Our results are similar to those of Touzani [
In addition, vomiting, fever and diarrhea were common reasons for consultation. These same causes were also mentioned by Nada [
Tachycardia, TRC > 3 s, pulse rate, obstruction, polypnea and fever were the most common signs of shock in this study. This observation, similar to the suggestive signs reported by literature data [
Among the types of shock encountered in this study, hypovolemic shock was by far the most represented. This observation is explained by the presence of absolute hypovolemia in the majority of our patients due to digestive losses reported at the time of admission (diarrhea, vomiting).
The treatment was based first on the vascular filling and this was done mainly with Ringer Lactate. This conduct is similar to that stated in the Nada [
Ts antipyretic, antiemetic and antibiotic were administered in more than half of patients. This support is superimposable to that of art work Touzani [
The shock is a medical emergency which is a frequent reason for admission in pediatrics and intensive care. The diagnosis is essentially clinical.
The treatment is based on vascular filling with solutes, antibiotic therapy, corticosteroid therapy, analgesics, antiemetics.
The quick and effective support would improve the vital and functional prognosis of children in shock.
The authors declare no conflicts of interest regarding the publication of this paper.
Lamine, D.M., Koolo, B.I., Emmanuel, C., Marion, O.H.L., Sita, S.E. and Bella, D.S. (2019) State of Shock: Epidemiological, Etiological and Therapeutic Aspects at the Pediatric Unit of the Medical and Surgical Emergencies of the Donka National Hospital. Open Journal of Pediatrics, 9, 302-308. https://doi.org/10.4236/ojped.2019.94029