PubMed Health⌕ Search

Biomedical subjects

E F Block

Publications and source records attributed to E F Block.

26 records · Page 2Linked to original sources
PubMed1995

Guided percutaneous drainage for posttraumatic empyema thoracis.

BACKGROUND: Guided percutaneous drainage (GPD) is used in the management of posttraumatic empyema thoracis; however, its equivalence to decortication has not been evaluated. METHODS: We retrospectively reviewed the records of 12 patients who underwent GPD and nine who were treated with decortication. RESULTS: No primarily GPD-managed empyemas necessitated a subsequent thoracotomy. The size and number of fibrinopurulent loculations treated by each technique were equivalent. Sterile purulent collections were found in 55.6% of decortication-treated patients and in 33% of patients who underwent GPD. Intrapleural analgesia was administered to 71.4% of decortication-treated patients and 28.6% of GPD-treated patients. Five patients undergoing decortication required intensive care unit monitoring after operation (average, 2.8 days), compared with no GPD-treated patients. The catheter was left in place at discharge in 41.6% of GPD-treated patients and was removed on an outpatient basis. CONCLUSIONS: The efficacy of GPD in handling loculated pleural space infections equals that of decortication. An intensive care unit stay is avoided. The ability to discharge patients with external drainage catheters and the decreased requirement of pain control should reduce the number of inpatient hospital days. GPD is an effective first-line approach for posttraumatic empyema thoracis.

Algorithms↗
PubMed1995

Compartment syndrome in the critically injured following massive resuscitation: case reports.

Compartment syndrome of the extremities is usually associated with locally mediated events such as ischemia or injury. Three cases are presented of patients who did not sustain direct extremity trauma, but who developed compartment syndrome following massive fluid resuscitation. Global ischemia/reperfusion may be responsible for the observed morbidity. Patients undergoing large volume resuscitation should be closely monitored for this entity.

Adolescent↗
PubMed1995

The need for aggressive nutritional intervention in the injured patient: the development of a predictive model.

Early nutritional intervention has been advocated in trauma patients. We have developed a model to identify those patients who will most benefit from the invasive and costly measures that are required to provide injured patients with early enteral feedings. Four hundred forty-two patients admitted to a level I trauma center during a 2-month period were evaluated using 21 clinical variables. Time to tolerance of a regular diet was used as the dependent variable in a step-wise regression, and then the selected variables were used to build a classification and regression tree to predict tolerance of a regular diet within 5 days. Our findings demonstrate that intensive care unit disposition, Injury Severity Score, Abdominal Trauma Index, and the need for early surgical intervention are important predictors regarding the need for early nutritional intervention. When the model was applied to the study population, it had a sensitivity of 83%, a specificity of 84%, and an accuracy of 84%.

Adolescent↗
PubMed1994

Nutritional support of the gut: how and why.

Trauma, sepsis, and other conditions of stress are characterized by a hypermetabolic state, in which markedly increased substrate availability is required to meet energy demands for tissue repair and host defenses. Inability to meet these increased metabolic demands results in accelerated visceral protein depletion, impaired immune function, and impaired wound healing. In addition, alteration of the gut flora, impaired host immune defenses, or direct gut mucosal injury may result in gut barrier failure. All of the above derangements, acting in concert, may ultimately lead to sepsis or multiple organ failure. Since enteral nutrition improves resistance to experimentally induced infections, blunts the hypermetabolic response to injury, and maintains intestinal structure and function better than parenteral nutrition, there are many reasons to favor a policy of early enteral feeding in critically ill patients. We demonstrated the safety and efficacy of immediate enteral feeding in patients with major thermal injury, and have found this practice to be applicable to a wide variety of other critically ill patients. These patients had not been felt to be candidates for enteral nutrition due to unfounded fears related to the presence of ileus or fresh gastrointestinal anastomosis.

Animals↗
PubMed1994

Urgent lobectomy and pneumonectomy.

A small number of trauma patients with penetrating thoracic trauma will require formal pulmonary resections to repair severe injuries or control massive haemorrhage. Although previous reports on this subject have addressed the management of these injuries in battle conditions, civilian experience with this type of chest injury is limited. In a 3-year period, 259 patients underwent urgent thoracotomies for penetrating thoracic trauma. We retrospectively reviewed 43 patients who underwent lobectomies or pneumonectomies to control bleeding (93%) or bronchial injuries (7%). Handguns were the aetiologic agent in 41 patients (95%). The most common complication, pneumonia, was seen in 21 patients (87%). Fifteen patients (62%) developed respiratory failure. The complications of wound infection, post-operative haemorrhage and empyema were seen in equal frequency in four patients (16%). Two patients (8%) developed bronchopleural fistulas. Nine pneumonectomies and 34 lobectomies were performed with mortality rates of 66% and 38%, respectively (overall mortality, 44%). Ten (53%) deaths occurred in the operating room, late deaths (2-15 days) were secondary to sepsis and multiple organ dysfunction syndrome (MODS). Currently, the management of patients with devastating thoracic injuries to the thoracic cavity is divided into two stages. First, initial resuscitation with rapid surgery to control major bleeding, cardiac tamponade, tracheal disruptions and potentially lethal air embolism is indicated. Once the life-threatening conditions have been resolved, definitive surgical procedures are performed to repair injuries to any of the thoracic structures.

Adolescent↗
PubMed1988

Value of creatine phosphokinase isoenzyme determinations in the diagnosis of myocardial contusion.

Myocardial contusion is an injury often missed in the patient with severe multisystem trauma. Fifty patients with physical findings or mechanisms of injury that were suggestive of possible nonpenetrating injury to the heart were studied with serial creatine phosphokinase isoenzyme (CPK/MB), continuous arrhythmia monitoring, and ECGs for at least 72 hours. Two-dimensional echocardiograms were obtained on all patients within 48 hours of admission. Seventy-two percent (36 of 50) had detectable CPK/MB. Ten patients had echocardiograms suggestive of cardiac contusion. Of these ten, three had no detectable CPK/MB and six had CPK/MB of less than 5%. CPK/MB had a sensitivity of 70% and a specificity of 27.5%. We conclude that in the patient with multisystem injury, CPK/MB determinations are not reliable. The decision to evaluate the patient with echocardiography should be made on the basis of physical findings and, more importantly, on mechanism of injury.

Adolescent↗