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J Blansfield

Publications and source records attributed to J Blansfield.

6 recordsLinked to original sources
PubMed2001

Emergency room thoracotomy for penetrating chest injury: effect of an institutional protocol.

BACKGROUND: Emergency room thoracotomy (ERT) can be life saving in patients with penetrating chest injury. A protocol was established at our institution stating that ERT be performed for cases of cardiac tamponade secondary to penetrating chest trauma on patients with vital signs/mentation in the field or on arrival to the emergency room. To validate our protocol, we reevaluated patients undergoing ERT at our institution. METHODS: In our retrospective review, there were 49 patients undergoing ERT over a 6-year period. RESULTS: Survival in patients with vital signs was approximately 50%. Survival in those without was 0%. Compared with the preprotocol data, the number of ERTs declined from 32.2 cases per year to 8.1 cases per year. Overall survival increased from 4% to 20%. Neurologic outcome remained unchanged. CONCLUSION: We believe that the data validate our protocol, and the establishment of a guideline has enabled us to maximize patient survival and minimize exposure risks to our staff.

Boston↗
PubMed1995

Predictive accuracy of the TRISS survival statistic is improved by a modification that includes admission pH.

OBJECTIVE: To determine if pH measured at the time of hospital admission and corrected for PCO2 was an independent predictor of trauma survival. DESIGN: Phase 1 was a retrospective case-control analysis of 1708 patients, followed by multivariate multiple logistic regression analysis of a subset of 919 patients for whom the Revised Trauma Score (RTS), Injury Severity Score (ISS), and pH were available. Phase 2 was a prospective comparison of a mathematical model of survival derived in phase 1 (pH-TRISS) with the TRISS method in 508 of 1325 subsequently admitted trauma patients. SETTING: Urban level 1 trauma center. PATIENTS: All patients admitted with blunt or penetrating trauma during the study period. MAIN OUTCOME MEASURES: Survival vs mortality. RESULTS: In phase 1, factors significantly associated with mortality by t test and chi 2 analysis included the RTS, ISS< Glasgow Coma Scale, corrected pH (CpH), and sum of the head, chest, and abdominal components of the Abbreviated Injury Scale-85 (AIS85) (HCAISS) (for all, P < .0001). The TRISS statistic was also a significant predictor of survival (P < .004). Age, sex, and the extremity and soft tissue components of the AIS85 were not associated with mortality. In a multivariate analysis of the RTS, HCAISS, and CpH, all were significant predictors of mortality. Even when controlling for RTS and HCAISS, CpH remained a significant predictor of mortality (P < .008). In phase 2, when pH-TRISS was tested prospectively against TRISS in a new group of patients, the new statistic appeared to provide a more accurate prediction of survival. CONCLUSIONS: The arterial pH measurement obtained on hospital arrival and corrected for PCO2 is a significant independent predictor of survival and adds to the predictive accuracy of the TRISS survival statistic. Age, sex, and the extremity and soft tissue components of the AIS85 did not contribute to the accuracy of the TRISS statistic in this patient population.

Abbreviated Injury Scale↗
PubMed1990

Emergency autotransfusion in hypovolemia.

Autotransfusion as a technique in managing hypovolemia has been enjoying renewed popularity. Autotransfusion from hemothorax is the most common application of the procedure; this consists of collection, anticoagulation, and retransfusion. The advantages include compatibility, no time delay required in laboratory type and crossmatch, and no transmission of disease. The use of autologous blood in managing hypovolemia in chest trauma has proven to be a practical and beneficial adjunct to traditional fluid and homologous blood therapy and should be considered by every emergency department.

Blood Transfusion, Autologous↗
PubMedDate not supplied

Development and implementation of clinical pathways for the management of four trauma diagnoses.

Clinical pathways are similar to the production algorithms developed by industry. They are being adapted for use in healthcare to reduce resource utilization, decrease variability, and control expenditures. At Boston Medical Center we identified four trauma diagnoses that we believed to be amenable to the design and implementation of clinical pathways: closed head injury, penetrating wound to the abdomen, penetrating wound to the chest, and penetrating wound to an extremity. Upon implementation of these pathways, appropriate nonoperative, single-system, short-stay trauma patients were enrolled in them. This article details the process by which the four diagnoses were identified and the pathways designed, implemented, and evaluated. Preliminary data demonstrate a significant decrease in resource utilization following implementation of the pathways, without an adverse impact on readmission rates, length of stay, or mortality.

Algorithms↗