{"id":361,"date":"2026-03-18T16:21:48","date_gmt":"2026-03-18T16:21:48","guid":{"rendered":"https:\/\/pratiquement.com\/?p=361"},"modified":"2026-03-18T17:01:06","modified_gmt":"2026-03-18T17:01:06","slug":"compilation-cemir","status":"publish","type":"post","link":"https:\/\/pratiquement.com\/?p=361","title":{"rendered":"Compilation CeMIR"},"content":{"rendered":"\n\n\n<article>\n  <h1>\u00c9tats de choc<\/h1>\n\n  <h2>I. G\u00e9n\u00e9ralit\u00e9s \u2014 \u00c9tats de choc &amp; insuffisance circulatoire<\/h2>\n\n  <h3>I.1 D\u00e9finition et physiopathologie de l&rsquo;\u00e9tat de choc<\/h3>\n\n  <h4>I.1.a D\u00e9finition \u2014 notion de \u00ab perfusion insuffisante \u00bb<\/h4>\n  <p>Le terme \u00ab choc \u00bb (shock \/ circulatory shock) d\u00e9signe une <strong>d\u00e9faillance circulatoire aigu\u00eb<\/strong> entra\u00eenant une <strong>hypoperfusion tissulaire<\/strong> inadapt\u00e9e aux besoins m\u00e9taboliques, pouvant conduire \u00e0 une d\u00e9faillance multivisc\u00e9rale.<\/p>\n  <p>En pratique clinique, un rep\u00e8re h\u00e9modynamique souvent retenu est : <strong>pression art\u00e9rielle systolique &lt; 90 mmHg<\/strong> ou <strong>pression art\u00e9rielle moyenne (PAM) &lt; 65 mmHg<\/strong>, m\u00eame si le diagnostic repose sur l\u2019ensemble du contexte clinique.<\/p>\n\n  <h4>I.1.b M\u00e9canismes pathophysiologiques communs<\/h4>\n  <ul>\n    <li>Quelle que soit l\u2019\u00e9tiologie (perte de volume, insuffisance cardiaque, vasodilatation, obstacle), le r\u00e9sultat final est une <strong>diminution du d\u00e9bit cardiaque et\/ou du retour veineux<\/strong> avec alt\u00e9ration de la perfusion tissulaire.<\/li>\n    <li>\u00c0 l\u2019\u00e9chelle cellulaire\u202f: r\u00e9ponse inflammatoire, dysfonction microcirculatoire, l\u00e9sions endoth\u00e9liales, alt\u00e9ration de l\u2019oxyg\u00e9nation cellulaire en cas de choc prolong\u00e9.<\/li>\n    <li>Les types de choc peuvent se combiner ou se succ\u00e9der (ex : choc hypovol\u00e9mique compliqu\u00e9 secondairement de choc septique).<\/li>\n  <\/ul>\n\n  <h3>I.2 Classification des chocs \/ insuffisances h\u00e9modynamiques<\/h3>\n  <p>On distingue 4 grands types de choc selon le m\u00e9canisme principal\u202f:<\/p>\n\n  <table>\n    <thead>\n      <tr>\n        <th>Type de choc<\/th>\n        <th>M\u00e9canisme principal<\/th>\n        <th>Exemples \/ \u00c9tiologies fr\u00e9quentes<\/th>\n      <\/tr>\n    <\/thead>\n    <tbody>\n      <tr>\n        <td><strong>Hypovol\u00e9mique<\/strong> (choc de bas volume)<\/td>\n        <td>Diminution du volume circulant \/ retour veineux insuffisant<\/td>\n        <td>H\u00e9morragie, d\u00e9shydratation, pertes digestives ou cutan\u00e9es importantes<\/td>\n      <\/tr>\n      <tr>\n        <td><strong>Cardiog\u00e9nique<\/strong><\/td>\n        <td>D\u00e9faillance de la pompe cardiaque \u2192 d\u00e9bit cardiaque insuffisant<\/td>\n        <td>Infarctus du myocarde, d\u00e9compensation cardiaque, myocardite, arythmies graves<\/td>\n      <\/tr>\n      <tr>\n        <td><strong>Obstructif<\/strong><\/td>\n        <td>Obstacle au retour veineux ou \u00e0 l\u2019\u00e9jection cardiaque<\/td>\n        <td>Tamponnade p\u00e9ricardique, EP massive, pneumothorax sous tension<\/td>\n      <\/tr>\n      <tr>\n        <td><strong>Distributif<\/strong> (vasopl\u00e9gique)<\/td>\n        <td>Perte du tonus vasculaire \u2192 maldistribution du flux<\/td>\n        <td>Sepsis \/ choc septique, anaphylaxie, certaines intoxications, l\u00e9sions m\u00e9dullaires graves<\/td>\n      <\/tr>\n    <\/tbody>\n  <\/table>\n\n  <p><em>\u00c0 savoir&nbsp;: ces cat\u00e9gories ne sont pas exclusives, un m\u00eame patient peut pr\u00e9senter des caract\u00e9ristiques mixtes ou \u00e9voluer d\u2019un type \u00e0 l\u2019autre.<\/em><\/p>\n\n  <h2>II. Approche diagnostique et prise en charge initiale du choc<\/h2>\n\n  <h3>II.1 Diagnostic et reconnaissance clinique<\/h3>\n\n  <h4>II.1.a Signes cliniques et h\u00e9modynamiques<\/h4>\n  <ul>\n    <li>Hypotension art\u00e9rielle (SBP &lt; 90 mmHg ou PAM &lt; 65 mmHg).<\/li>\n    <li>Tachycardie, tachypn\u00e9e.<\/li>\n    <li>Peau froide, marbrures, temps de recoloration prolong\u00e9.<\/li>\n    <li>Alt\u00e9ration de l\u2019\u00e9tat de conscience, oligurie.<\/li>\n    <li>Contexte \u00e9vocateur\u202f: h\u00e9morragie, infarctus, infection s\u00e9v\u00e8re, traumatisme, anaphylaxie, etc.<\/li>\n  <\/ul>\n\n  <!-- \u2026 et tu continues selon la m\u00eame logique pour les parties III, IV, V, VI \u2026 -->\n<\/article>\n","protected":false},"excerpt":{"rendered":"<p>\u00c9tats de choc I. G\u00e9n\u00e9ralit\u00e9s \u2014 \u00c9tats de choc &amp; insuffisance circulatoire I.1 D\u00e9finition et physiopathologie de l&rsquo;\u00e9tat de choc I.1.a D\u00e9finition \u2014 notion de \u00ab perfusion insuffisante \u00bb Le terme \u00ab choc \u00bb (shock \/ circulatory shock) d\u00e9signe une d\u00e9faillance circulatoire aigu\u00eb entra\u00eenant une hypoperfusion tissulaire inadapt\u00e9e aux besoins m\u00e9taboliques, pouvant conduire \u00e0 une &#8230; <a title=\"Compilation CeMIR\" class=\"read-more\" href=\"https:\/\/pratiquement.com\/?p=361\" aria-label=\"En savoir plus sur Compilation CeMIR\">Lire la suite<\/a><\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-361","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/pratiquement.com\/index.php?rest_route=\/wp\/v2\/posts\/361","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pratiquement.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pratiquement.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pratiquement.com\/index.php?rest_route=\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/pratiquement.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=361"}],"version-history":[{"count":9,"href":"https:\/\/pratiquement.com\/index.php?rest_route=\/wp\/v2\/posts\/361\/revisions"}],"predecessor-version":[{"id":372,"href":"https:\/\/pratiquement.com\/index.php?rest_route=\/wp\/v2\/posts\/361\/revisions\/372"}],"wp:attachment":[{"href":"https:\/\/pratiquement.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=361"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pratiquement.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=361"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pratiquement.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=361"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}