Abstract
Two hundred and seventy-three acute hemorrhagic shocks were treated in 1984 in a pre-hospital emergency care unit. Twenty patients (7%) had a paradoxical bradycardia: they were conscious, 9 of them had an undetectable systolic arterial pressure with the sphygomomanometric method but the femoral pulse was still present. All of them recovered from bradycardia with fluid loading alone. The comparison between patients with paradoxical bradycardia and those with tachycardia showed that the former had more severe and rapid hemorrhages. During 1985, 7 new cases of acute hemorrhagic shock with paradoxical bradycardia were treated with an antishock trouser. These patients recovered from bradycardia more quickly (p<0.01) and with a less important fluid loading (p<0.01) than those previously treated without the antishock trouser. Two other patients were treated with atropine before antishock trouser inflation and experienced ventricular premature beats and one developed ventricular fibrillation. A paradoxical bradycardia can occur in hemorrhagic shock and denotes a rapid and severe hemorrhage requiring a massive and rapid fluid loading. The preliminary results of the antishock trouser in this setting are encouraging. The treatment of bradycardia per se may be deleterious and atropine must be avoided in conscious patients with hemorrhagic shock and paradoxical bradycardia.
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Barcroft H, Edholm OG, McMichael J, Sharpey-Schafer EP (1944) Posthaemorrhagic fainting. Study by cardiac output and forearm flow. Lancet 1:489
Bond RF, Manley ES, Green HD (1967) Cutaneous and skeletal muscle vascular responses to hemorrhage and irreversible shock. Am J Physiol 212:488
Eckberg DL (1980) Parasympathetic cardiovascular control in human disease: a critical review of methods and results. Am J Physiol 239:H581
Jansen RP (1978) Relative bradycardia: a sign of acute intraperitoneal bleeding. Aust NZ J Obstet Gynaecol 18:206
Kaplan BC, Civetta JM, Nagel EL, Nussenfeld SR, Hirschman JC (1973) The military anti-shock trouser in civilian pre-hospital emergency care. J Trauma 13:843
Little RA, Randall PE, Redfern WS, Stoner HB, Marshall HW (1984) Components of injury (haemorrhage and tissue ischaemia) affecting cardiovascular reflexes in man and rat. Q J Exp Physiol 69:753
Murray RH, Thompson LJ, Bowers JA, Albright CD (1968) Hemodynamic effects of graded hypovolemia and vasodepressor syncope induced by lower body negative pressure. Am Heart J 76:799
Öberg B, White S (1970) Circulatory effects of interruption and stimulation of cardiac vagal afferents. Acta Physiol Scand 80:383
Öberg B, White S (1970) The role of vagal cardiac nerves and arterial baroreceptors in the circulatory adjustments to hemorrhage in the cat. Acta Physiol Scand 80:395
Öberg B, Thoren P (1972) Increased activity in left ventricular receptors during hemorrhage or occlusion of caval veins in the cat. Acta Physiol Scand 85:164
Pavek K, Wegmann A (1981) Kardiale Mitbeteiligung beim anaphylaktischen und anaphylaktoiden Schocks. Eine kooperative retrospektive Studie. Fortschr Med 99:1994
Secher NH, Jensen KS, Werner C, Warberg J, Bie P (1984) Bradycardia during severe but reversible hypovolemic shock in man. Circ Shock 14:267
Secher NH, Bie P (1985) Bradycardia during reversible haemorrhagic shock. A forgotten observation? Clin Physiol 5:315
Thoren P (1979) Role of cardiac vagal C-fibres in cardiovascular control. Rev Physiol Biochem Pharmacol 86:1
Vatner SF, Franklin D, Braunwald E (1971) Effects of anesthesia and sleep on circulatory adjustments to hemorrhage in the cat. Am J Physiol 220:1249
Vatner SF, Higgins CB, Braunwald E (1974) Sympathetic and parasympathetic components of reflex tachycardia induced by hypotension in conscious dogs with and without heart failure. Cardiovasc Res 8:153
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Barriot, P., Riou, B. Hemorrhagic shock with paradoxical bradycardia. Intensive Care Med 13, 203–207 (1987). https://doi.org/10.1007/BF00254705
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DOI: https://doi.org/10.1007/BF00254705