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. Questionnaire-de-recueil-de-données-nom, Cancer : O/N Insuffisance rénale : O/N Insuffisance hépatique :O/N Insuffisance cardiaque/ Coronaropathie : O/N Insuffisance respiratoire : O/N Autres : Traitement : AINS : O/N Anticoagulants : 0/N Anti?agrégants plaquettaires : O/N Corticoïdes : O/N Béta?bloquants : O/N IPP : O/N Régulation SAMU : Provenance de l'appel : médecin sur place/patient ou son entourage/infirmière/ Autre : Motif d'appel : hématémèse/méléna, choc Transport : Primaire/Secondaire Clinique à l'arrivée SMUR : Délai entre appel 15 et arrivée SMUR : Paramètres vitaux : PAS : PAD : FC : SpO2 : Hémoccue : Signes de choc