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80-790: Vivien Theodore Thomas (August 29, 1910 – November 26, 1985) was an American laboratory supervisor who, in the 1940s, played a major role in developing a procedure now called the Blalock–Thomas–Taussig shunt used to treat blue baby syndrome (now known as cyanotic heart disease) along with surgeon Alfred Blalock and cardiologist Helen B. Taussig . He was the assistant to Blalock in Blalock's experimental animal laboratory at Vanderbilt University in Nashville, Tennessee , and later at Johns Hopkins University in Baltimore, Maryland . Thomas

160-612: A cardiac surgery pioneer and a teacher of operative techniques to many of the country's most prominent surgeons. A PBS documentary, Partners of the Heart , was broadcast in 2003 on PBS's American Experience . In the 2004 HBO movie Something the Lord Made , based on Katie McCabe's National Magazine Award –winning Washingtonian article of the same title, Vivien Thomas was portrayed by Mos Def . Vivien Thomas writes in his autobiography, published shortly after his death, that he

240-793: A dog . At the end of Thomas' first day, Blalock told Thomas they would do another experiment the next morning. Blalock told Thomas to "come in and put the animal to sleep and get it set up." Within a few weeks, Thomas was starting surgery on his own. Thomas was classified and paid as a janitor , despite the fact that by the mid-1930s, he was doing the work of a postdoctoral researcher in the lab. Thomas struggled with finances despite saving most of what he earned. The salaries that he received did not provide enough comfort for him to quit his laboratory research job and go back to school. Nashville's banks failed nine months after Thomas started his job with Blalock, and his savings were wiped out. He abandoned his plans for college and medical school, relieved to have even

320-449: A heart attack or cardiac contusion . Obstructive shock may be due to cardiac tamponade or a tension pneumothorax . Distributive shock may be due to sepsis , anaphylaxis , injury to the upper spinal cord , or certain overdoses . The diagnosis is generally based on a combination of symptoms, physical examination , and laboratory tests. A decreased pulse pressure ( systolic blood pressure minus diastolic blood pressure ) or

400-755: A systolic blood pressure of 70–90 mmHg, or until the patient has adequate mentation and peripheral pulses. Hypertonic fluid may also be an option in this group. Vasopressors may be used if blood pressure does not improve with fluids. Common vasopressors used in shock include: norepinephrine , phenylephrine , dopamine , and dobutamine . There is no evidence of substantial benefit of one vasopressor over another; however, using dopamine leads to an increased risk of arrhythmia when compared with norepinephrine. Vasopressors have not been found to improve outcomes when used for hemorrhagic shock from trauma but may be of use in neurogenic shock . Activated protein C (Xigris), while once aggressively promoted for

480-420: A 1–4 scale on the physical signs. The shock index (heart rate divided by systolic blood pressure) is a stronger predictor of the impact of blood loss than heart rate and blood pressure alone. This relationship has not been well established in pregnancy-related bleeding. Cardiogenic shock is caused by the failure of the heart to pump effectively. This can be due to damage to the heart muscle, most often from

560-417: A cellular level, shock is the process of oxygen demand becoming greater than oxygen supply. One of the key dangers of shock is that it progresses by a positive feedback loop. Poor blood supply leads to cellular damage, which results in an inflammatory response to increase blood flow to the affected area. Normally, this causes the blood supply level to match with tissue demand for nutrients. However, if there

640-538: A central line correlates well with SmvO2 and is easier to acquire. Tissue oxygenation is critically dependent on blood flow. When the oxygenation of tissues is compromised anaerobic metabolism will begin and lactic acid will be produced. Treatment of shock is based on the likely underlying cause. An open airway and sufficient breathing should be established. Any ongoing bleeding should be stopped, which may require surgery or embolization . Intravenous fluid , such as Ringer's lactate or packed red blood cells ,

720-454: A fast heart rate raises concerns. Shock is a medical emergency and requires urgent medical care. If shock is suspected, call for emergency help immediately. While waiting for medical care, if safe to do so, lay the person down (unless a head or back injury is suspected), elevate their legs if possible, and keep them warm. If the person is unresponsive, monitor their breathing and be ready to perform CPR if necessary. The presentation of shock

800-635: A hard time working with Blalock. However, Thomas found Blalock to be pleasant, relaxed, and informal during his interview, which provided excitement and comfort. Thomas soon learned that Blalock moved quickly and expected his technicians to be just as efficient. As Blalock performed experiments daily, Thomas observed thoroughly so that he would be able to recreate the steps when Blalock had other responsibilities to attend to. However, there were times when Blalock would lose his temper and use profanity; this often bothered Thomas and threatened their stable working relationship. During Thomas' time working at Vanderbilt in

880-469: A large myocardial infarction . Other causes of cardiogenic shock include dysrhythmias , cardiomyopathy / myocarditis , congestive heart failure (CHF), myocardial contusion , or valvular heart disease problems. Symptoms of cardiogenic shock include: Obstructive shock is a form of shock associated with physical obstruction of the great vessels of the systemic or pulmonary circulation. Several conditions can result in this form of shock. Many of

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960-522: A low-paying job as the Great Depression deepened. Thomas continued working with Blalock and saving his earnings, so that he could provide for his daughters and wife the best he could. Thomas and Blalock did groundbreaking research into the causes of hemorrhagic and traumatic shock . This work later evolved into research on crush syndrome and saved the lives of thousands of soldiers on the battlefields of World War II. In hundreds of experiments,

1040-413: A procedure they had perfected for a different purpose in their Vanderbilt work, involving the anastomosis (joining) of the subclavian artery to the pulmonary artery , which had the effect of increasing blood flow to the lungs. Thomas was charged with the task of first creating a blue-baby–like condition in a dog, and then correcting the condition by means of the pulmonary-to-subclavian anastomosis. Among

1120-469: A rate of about 2% of the cell's total need per hour, even restoring oxygen is futile at this point because there is no adenosine to phosphorylate into ATP. The diagnosis of shock is commonly based on a combination of symptoms, physical examination , and laboratory tests. Many signs and symptoms are not sensitive or specific for shock, thus many clinical decision-making tools have been developed to identify shock at an early stage. A high degree of suspicion

1200-449: A reaction to the sudden impact of a missile. However, the first English writer to use the word shock in its modern-day connotation was James Latta, in 1795. Prior to World War I , there were several competing hypotheses behind the pathophysiology of shock. Of the various theories, the most well regarded was a theory penned by George W. Crile who suggested in his 1899 monograph, " An Experimental Research into Surgical Shock" , that shock

1280-493: A stable, self-correcting trajectory. Otherwise the condition can become increasingly difficult to correct, surprisingly quickly, and then progress to a fatal outcome. In the particular case of anaphylactic shock, progression to death might take just a few minutes. During the Initial stage (Stage 1), the state of hypoperfusion causes hypoxia . Due to the lack of oxygen, the cells perform lactic acid fermentation . Since oxygen,

1360-403: A subcategory of shock, many endocrinological disturbances in their severe form can result in shock. Shock is a common end point of many medical conditions. Shock triggered by a serious allergic reaction is known as anaphylactic shock , shock triggered by severe dehydration or blood loss is known as hypovolemic shock , shock caused by sepsis is known as septic shock , etc. Shock itself

1440-407: Is a life-threatening condition as a result of compromised body circulation . It can be divided into four main types based on the underlying cause: hypovolemic, distributive, cardiogenic, and obstructive. A few additional classifications are occasionally used, such as endocrinologic shock. Shock is a complex and continuous condition, and there is no sudden transition from one stage to the next. At

1520-407: Is delayed or the antimicrobial drugs are ineffective, however has a mortality rate between 30% and 80%; cardiogenic shock has a mortality rate of up to 70% to 90%, though quick treatment with vasopressors and inotropic drugs, cardiac surgery, and the use of assistive devices can lower the mortality. There is no evidence of the word shock being used in its modern-day form prior to 1743. However, there

1600-447: Is enough increased demand in some areas, it can deprive other areas of sufficient supply, which then start demanding more. This then leads to an ever escalating cascade. As such, shock is a runaway condition of homeostatic failure, where the usual corrective mechanisms relating to oxygenation of the body no longer function in a stable way. When it occurs, immediate treatment is critical in order to return an individual's metabolism into

1680-461: Is evidence that Hippocrates used the word exemia to signify a state of being "drained of blood". Shock or "choc" was first described in a trauma victim in the English translation of Henri-François LeDran 's 1740 text, Traité ou Reflexions Tire'es de la Pratique sur les Playes d'armes à feu (A treatise, or reflections, drawn from practice on gun-shot wounds .) In this text he describes "choc" as

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1760-433: Is necessary for the proper diagnosis of shock. Shock is, hemodynamically speaking, inadequate blood flow or cardiac output , Unfortunately, the measurement of cardiac output requires an invasive catheter, such as a pulmonary artery catheter. Mixed venous oxygen saturation (SmvO2) is one of the methods of calculating cardiac output with a pulmonary artery catheter. Central venous oxygen saturation (ScvO2) as measured via

1840-477: Is often given. Efforts to maintain a normal body temperature are also important. Vasopressors may be useful in certain cases. Shock is both common and has a high risk of death. In the United States about 1.2 million people present to the emergency room each year with shock and their risk of death is between 20 and 50%. The best evidence exists for the treatment of septic shock in adults. However,

1920-414: Is released to conserve fluid by reducing its excretion via the renal system. These hormones cause the vasoconstriction of the kidneys , gastrointestinal tract , and other organs to divert blood to the heart, lungs and brain . The lack of blood to the renal system causes the characteristic low urine production. However, the effects of the renin–angiotensin axis take time and are of little importance to

2000-482: Is reversible if it's recognized and treated early in time. Aggressive intravenous fluids are recommended in most types of shock (e.g. 1–2 liter normal saline bolus over 10 minutes or 20 mL/kg in a child) which is usually instituted as the person is being further evaluated. Colloids and crystalloids appear to be equally effective with respect to outcomes., Balanced crystalloids and normal saline also appear to be equally effective in critically ill patients. If

2080-412: Is severe. In select cases, compression devices like non-pneumatic anti-shock garments (or the deprecated military anti-shock trousers ) can be used to prevent further blood loss and concentrate fluid in the body's head and core. It is important to keep the person warm to avoid hypothermia as well as adequately manage pain and anxiety as these can increase oxygen consumption. Negative impact by shock

2160-459: Is the most common type of shock and is caused by insufficient circulating volume . The most common cause of hypovolemic shock is hemorrhage (internal or external); however, vomiting and diarrhea are more common causes in children. Other causes include burns, as well as excess urine loss due to diabetic ketoacidosis and diabetes insipidus . Signs and symptoms of hypovolemic shock include: The severity of hemorrhagic shock can be graded on

2240-523: Is to achieve a urine output of greater than 0.5 mL/kg/h, a central venous pressure of 8–12 mmHg and a mean arterial pressure of 65–95 mmHg. In trauma the goal is to stop the bleeding which in many cases requires surgical interventions. A good urine output indicates that the kidneys are getting enough blood flow. Septic shock (a form of distributive shock) is the most common form of shock. Shock from blood loss occurs in about 1–2% of trauma cases. Overall, up to one-third of people admitted to

2320-668: Is variable, with some people having only minimal symptoms such as confusion and weakness. While the general signs for all types of shock are low blood pressure , decreased urine output , and confusion, these may not always be present. While a fast heart rate is common, in those on β-blockers , those who are athletic, and in 30% of cases of those with shock due to intra abdominal bleeding, heart rate may be normal or slow. Specific subtypes of shock may have additional symptoms. Dry mucous membrane , reduced skin turgor , prolonged capillary refill time , weak peripheral pulses, and cold extremities can be early signs of shock. Hypovolemic shock

2400-705: The Erik Barnouw Award for Best History Documentary in 2004 from the Organization of American Historians . McCabe's article, brought to Hollywood by Washington, D.C., dentist Irving Sorkin, formed the basis for the Emmy - and Peabody Award –winning 2004 HBO film Something the Lord Made . Thomas' legacy as an educator and scientist continued with the institution of the Vivien Thomas Young Investigator Awards, given by

2480-448: The intensive care unit (ICU) are in circulatory shock. Of these, cardiogenic shock accounts for approximately 20%, hypovolemic about 20%, and septic shock about 60% of cases. The prognosis of shock depends on the underlying cause and the nature and extent of concurrent problems. Low volume, anaphylactic, and neurogenic shock are readily treatable and respond well to medical therapy. Septic shock , especially septic shock where treatment

Vivien Thomas - Misplaced Pages Continue

2560-970: The Council on Cardiovascular Surgery and Anesthesiology beginning in 1996. In 1993, the Congressional Black Caucus Foundation instituted the Vivien Thomas Scholarship for Medical Science and Research, sponsored by GlaxoSmithKline . In fall 2004, the Baltimore City Public School System opened the Vivien T. Thomas Medical Arts Academy . In the halls of the school hangs a replica of Thomas' portrait commissioned by his surgeon-trainees in 1969. The Journal of Surgical Case Reports announced in January 2010 that its annual prizes for

2640-470: The Heart , was published just days later. Having learned about Thomas on the day of his death, Washingtonian writer Katie McCabe brought his story to public attention in a 1989 article entitled "Like Something the Lord Made", which won the 1990 National Magazine Award for Feature Writing and inspired the PBS documentary Partners of the Heart , which was broadcast in 2003 on PBS's American Experience and won

2720-445: The arteriolar smooth muscle and precapillary sphincters relax such that blood remains in the capillaries . Due to this, the hydrostatic pressure will increase and, combined with histamine release, will lead to leakage of fluid and protein into the surrounding tissues. As this fluid is lost, the blood concentration and viscosity increase, causing sludging of the micro-circulation. The prolonged vasoconstriction will also cause

2800-650: The best case report written by a doctor and best case report written by a medical student would be named after Thomas. Vanderbilt University Medical Center created the Vivien T. Thomas Award for Excellence in Clinical Research, recognizing excellence in conducting clinical research. Blalock%E2%80%93Thomas%E2%80%93Taussig shunt Too Many Requests If you report this error to the Wikimedia System Administrators, please include

2880-426: The condition. As a result of the acidosis , the person will begin to hyperventilate in order to rid the body of carbon dioxide (CO 2 ) since it indirectly acts to acidify the blood; the body attempts to return to acid–base homeostasis by removing that acidifying agent. The baroreceptors in the arteries detect the hypotension resulting from large amounts of blood being redirected to distant tissues, and cause

2960-490: The details below. Request from 172.68.168.226 via cp1108 cp1108, Varnish XID 225133361 Upstream caches: cp1108 int Error: 429, Too Many Requests at Thu, 28 Nov 2024 08:44:02 GMT Shock (circulatory) Shock is divided into four main types based on the underlying cause: hypovolemic , cardiogenic , obstructive , and distributive shock . Hypovolemic shock, also known as low volume shock, may be from bleeding, diarrhea , or vomiting. Cardiogenic shock may be due to

3040-435: The dogs on whom Thomas operated was one named Anna, who became the first long-term survivor of the operation and the only animal to have her portrait hung on the walls of Johns Hopkins. In nearly two years of laboratory work involving 200 dogs, Thomas was able to replicate two of the four cardiac anomalies involved in tetralogy of Fallot. He did demonstrate that the corrective procedure was not lethal, thus persuading Blalock that

3120-491: The immediate homeostatic mediation of shock. The Progressive stage (stage 3) results if the underlying cause of the shock is not successfully treated. During this stage, compensatory mechanisms begin to fail. Due to the decreased perfusion of the cells in the body, sodium ions build up within the intracellular space while potassium ions leak out. Due to lack of oxygen, cellular respiration diminishes and anaerobic metabolism predominates. As anaerobic metabolism continues,

3200-469: The institution's rolls. Although Thomas never wrote or spoke publicly about his ongoing desire to return to college and obtain a medical degree, his widow, the late Clara Flanders Thomas, revealed in a 1987 interview with Washingtonian writer Katie McCabe that her husband had clung to the possibility of further education throughout the blue baby period, and had abandoned the idea only with great reluctance. Mrs. Thomas stated that in 1947 Thomas had investigated

3280-418: The lab, he struggled with his salary because he needed to be able to provide for himself, but he also was saving up to go back to school. After many encounters with Blalock about a pay raise and no results, Thomas was going to return to his old job as a carpenter. However, Blalock saw Thomas as a valuable asset and did everything he could to keep Thomas from leaving. Blalock's approach to the issue of Thomas' race

Vivien Thomas - Misplaced Pages Continue

3360-666: The management of septic shock , has been found not to improve survival and is associated with a number of complications. Activated protein C was withdrawn from the market in 2011, and clinical trials were discontinued. The use of sodium bicarbonate is controversial as it has not been shown to improve outcomes. If used at all it should only be considered if the blood pH is less than 7.0. People with anaphylactic shock are commonly treated with epinephrine . Antihistamines , such as Benadryl ( diphenhydramine ) or ranitidine are also commonly administered. Albuterol , normal saline, and steroids are also commonly given. The goal of treatment

3440-432: The many Black lab assistants he trained at Hopkins, he was not well paid. He sometimes resorted to working as a bartender , often at Blalock's parties. This led to the peculiar circumstance of his serving drinks to people he had been teaching earlier in the day. Eventually, after negotiations on his behalf by Blalock, he became the highest-paid assistant at Johns Hopkins by 1946, and by far the highest-paid African American on

3520-430: The medical community by the mid-1930s. At this same time, Blalock and Thomas began experimental work in vascular and cardiac surgery , defying medical taboos against operating on the heart. It was this work that laid the foundation for the revolutionary life-saving surgery they were to perform at Johns Hopkins a decade later. Vivien Thomas spent 11 years at Vanderbilt with Blalock before moving to Johns Hopkins. By 1940,

3600-399: The medical institution. Thomas spoke humbly to the full-capacity auditorium. He stated that he lived in humble satisfaction that he was able to help solve some of the world's numerous health problems. He was overjoyed that he was finally getting recognition for his significant role in the research leading to developmental skills that many surgeons had begun to practice. On July 1, 1976, Thomas

3680-401: The newlywed couple moved to Nashville, Tennessee. The couple had two daughters. Olga Fay, the oldest, was born in 1934, and Theodosia Patricia was born 4 years later in 1938. In 1941, Thomas and his family moved to Baltimore so that he could continue working with Blalock. In 1971, Thomas was recognized for all his work "behind the scenes" with a ceremony and the presentation of his portrait to

3760-431: The operating room during the first series of tetralogy operations. On the other hand, there were limits to his tolerance, especially when it came to issues of pay, academic acknowledgment, and his social interaction outside of work. Tension with Blalock continued to build when he failed to recognize the contributions that Thomas had made in the world-famous blue baby procedure, which led to a rift in their relationship. Thomas

3840-450: The operation could be safely attempted on a human patient. Blalock was impressed with Thomas' work; when he inspected the procedure performed on Anna, he reportedly said, "This looks like something the Lord made." Even though Thomas knew he was not allowed to operate on patients at that time, he still followed Blalock's rules and assisted him during surgery. On November 29, 1944, the procedure

3920-531: The painting of his portrait (by Bob Gee, oil on canvas, 1969, The Johns Hopkins Alan Mason Chesney Medical Archives) and arranged to have it hung next to Blalock's in the lobby of the Alfred Blalock Clinical Sciences Building. In 1976, Johns Hopkins University presented Thomas with an honorary doctorate. Due to certain restrictions, he received an honorary Doctor of Laws , rather than a medical doctorate , but it did allow

4000-442: The pathophysiology of shock in children appears to be similar so treatment methodologies have been extrapolated to children. Management may include securing the airway via intubation if necessary to decrease the work of breathing and for guarding against respiratory arrest. Oxygen supplementation , intravenous fluids , passive leg raising (not Trendelenburg position ) should be started and blood transfusions added if blood loss

4080-630: The patient was able to leave the hospital three weeks after the surgery. Next, they operated on a six-year-old boy, who dramatically regained his color at the end of the surgery. The three cases formed the basis for the article that was published in the May 1945 issue of the Journal of the American Medical Association , giving credit to Blalock and Taussig for the procedure. Thomas received no mention. News of this groundbreaking story

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4160-433: The person remains in shock after initial resuscitation, packed red blood cells should be administered to keep the hemoglobin greater than 100 g/L. For those with hemorrhagic shock, the current evidence supports limiting the use of fluids for penetrating thorax and abdominal injuries allowing mild hypotension to persist (known as permissive hypotension ). Targets include a mean arterial pressure of 60 mmHg,

4240-565: The possibility of enrolling in college and pursuing his dream of becoming a doctor, but had been deterred by the inflexibility of Morgan State University , which refused to grant him credit for life experience and insisted that he fulfill the standard freshman requirements. Realizing that he would be 50 years old by the time he completed college and medical school, Thomas decided to give up the idea of further education. Vivien Thomas felt nervous when he first met Dr. Alfred Blalock because his friend Charles Manlove made it apparent that many people had

4320-428: The practice of splitting incoming first-year students into four colleges, each named for famous Hopkins faculty members who had had a major impact on the history of medicine. Thomas was chosen as one of the four, along with Helen Taussig , Florence Sabin , and Daniel Nathans . In the summer of 1933, Thomas met Clara Beatrice Flanders. Thomas was so fond of Flanders that he married her that same year on December 22, and

4400-447: The primary reasons that shock is irreversible at this point is that much of the cellular ATP (the basic energy source for cells) has been degraded into adenosine in the absence of oxygen as an electron receptor in the mitochondrial matrix . Adenosine easily perfuses out of cellular membranes into extracellular fluid, furthering capillary vasodilation , and then is transformed into uric acid . Because cells can only produce adenosine at

4480-526: The pulmonary artery) were transposed. A complex operation called an atrial septectomy, the procedure was executed so flawlessly by Thomas that Blalock, upon examining the nearly undetectable suture line, was prompted to remark, "Vivien, this looks like something the Lord made." To the host of young surgeons Thomas trained during the 1940s, he became a figure of legend, the model of a dexterous and efficient cutting surgeon. "Even if you'd never seen surgery before, you could do it because Vivien made it look so simple,"

4560-416: The release of epinephrine and norepinephrine . Norepinephrine causes predominately vasoconstriction with a mild increase in heart rate , whereas epinephrine predominately causes an increase in heart rate with a small effect on the vascular tone; the combined effect results in an increase in blood pressure . The renin–angiotensin axis is activated, and arginine vasopressin (anti-diuretic hormone)

4640-429: The renowned surgeon Denton Cooley told Washingtonian magazine in 1989. "There wasn't a false move, not a wasted motion, when he operated." Surgeons like Cooley, along with Alex Haller, Frank Spencer, Rowena Spencer , and others credited Thomas with teaching them the surgical technique that placed them at the forefront of medicine in the United States. Despite the deep respect Thomas was accorded by these surgeons and by

4720-477: The rest of Baltimore, was rigidly segregated, and the only Black employees at the institution were janitors. When Thomas walked the halls in his white lab coat, many heads turned, and he began wearing city clothes when he walked from the laboratory to Blalock's office because he received so much attention. During this time, he lived in the 1200 block of Caroline Street in the community now known as Oliver, Baltimore . In 1943, while pursuing his shock research, Blalock

4800-422: The signs of obstructive shock are similar to cardiogenic shock, although treatments differ. Symptoms of obstructive shock include: Distributive shock is low blood pressure due to a dilation of blood vessels within the body. This can be caused by systemic infection ( septic shock ), a severe allergic reaction ( anaphylaxis ), or spinal cord injury ( neurogenic shock ). Although not officially classified as

4880-461: The staff and students of Johns Hopkins Hospital and Johns Hopkins School of Medicine to call him "Doctor". After working there for 37 years, Thomas was also finally appointed to the faculty of the School of Medicine as Instructor of Surgery, although due to his lack of an official medical degree, he was never allowed to operate on a living patient. In July 2005, Johns Hopkins School of Medicine began

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4960-468: The surgery itself, at Blalock's request, Thomas stood on a step stool at Blalock's shoulder and coached him step by step through the procedure. Thomas had performed the operation hundreds of times on a dog, whereas Blalock had done so only once as Thomas' assistant. The surgery was not completely successful, though it did prolong the infant's life for several months. Blalock and his team operated again, on an 11-year-old girl, this time with complete success, and

5040-551: The terminal electron acceptor in the electron transport chain , is not abundant, this slows down entry of pyruvate into the Krebs cycle , resulting in its accumulation. The accumulating pyruvate is converted to lactate (lactic acid) by lactate dehydrogenase . The accumulating lactate causes lactic acidosis . The Compensatory stage (Stage 2) is characterised by the body employing physiological mechanisms, including neural, hormonal, and bio-chemical mechanisms, in an attempt to reverse

5120-453: The two disproved traditional theories which held that shock was caused by toxins in the blood. Blalock, a highly original scientific thinker and something of an iconoclast, had theorized that shock resulted from fluid loss outside the vascular bed and that the condition could be effectively treated by fluid replacement. Assisted by Thomas, he was able to provide incontrovertible proof of this theory, and in so doing, he gained wide recognition in

5200-545: The use of the automatic implantable defibrillator . Thomas' nephew, Koco Eaton, graduated from the Johns Hopkins School of Medicine, trained by many of the physicians his uncle had trained. Eaton trained in orthopedics and as of 2024 is the team doctor for the Tampa Bay Rays . In 1968, the surgeons Thomas trained — who had then become chiefs of surgical departments throughout America — commissioned

5280-400: The vital organs to be compromised due to reduced perfusion . If the bowel becomes sufficiently ischemic , bacteria may enter the blood stream, resulting in the increased complication of endotoxic shock . At Refractory stage (stage 4), the vital organs have failed and the shock can no longer be reversed. Brain damage and cell death are occurring, and death will occur imminently. One of

5360-581: The work Blalock had done with Thomas placed Blalock at the forefront of American surgery, and when he was offered the position of Chief of Surgery at his alma mater Johns Hopkins in 1941, he requested that Thomas accompany him. Thomas arrived in Baltimore with his family in June of that year, confronting a severe housing shortage and a level of racism worse than they had endured in Nashville. Johns Hopkins, like

5440-488: Was able to secure a carpentry job at Fisk University repairing facility damages after graduating from high school. Thomas had hoped to attend college and become a doctor, but the Great Depression derailed his plans. Thomas intended to work hard, save money, and gain a higher education as soon as he could afford it. Determined to broaden his skill set, in 1930 he reached out to childhood friend Charles Manlove (who

5520-490: Was absent in official articles about the procedure, as well as in team pictures that included all of the doctors involved in the procedure. After Blalock's death from cancer in 1964 at the age of 65, Thomas stayed at Johns Hopkins for 15 more years. In his role as director of Surgical Research Laboratories, he mentored a number of African American lab assistants as well as Hopkins' first Black cardiac resident, Levi Watkins Jr., whom Thomas assisted with his groundbreaking work in

5600-765: Was appointed to the faculty as Instructor of Surgery; Thomas served in that capacity for three years and retired in 1979. A member of the Sharp Street Memorial United Methodist Church , he was named Man of the Year in 1980 by the Madison Avenue Presbyterian Church. Following his retirement, Thomas began work on an autobiography. He died of pancreatic cancer on November 26, 1985. He was survived by his wife, Clara née Flanders, their two daughters, and three granddaughters. His autobiography, Partners of

5680-543: Was approached by pediatric cardiologist Helen Taussig , who was seeking a surgical solution to a complex and fatal four-part heart anomaly called tetralogy of Fallot (also known as blue baby syndrome , although other cardiac anomalies produce blueness, or cyanosis ). In infants born with this defect, blood is shunted past the lungs, creating oxygen deprivation and a blue pallor. Having treated many such patients in her work in Johns Hopkins' Harriet Lane Home, Taussig

5760-584: Was born in Lake Providence, Louisiana , in 1910. Thomas was born during the Jim Crow era, to Willard Maceo Thomas and the former Mary Alice Eaton. There are noted discrepancies in references to Thomas' birthplace due to his listing New Iberia as his birthplace on his World War II draft card, and when he died in 1985, his obituary in The Baltimore Sun also listed New Iberia. New Iberia

5840-779: Was circulated around the world by the Associated Press . Newsreels touted the event, greatly enhancing the status of Johns Hopkins and solidifying the reputation of Blalock, who had been regarded as a maverick up until that point by some in the Johns Hopkins old guard. Thomas' contribution remained unacknowledged, both by Blalock and by Johns Hopkins. Within a year, the operation known as the Blalock–Thomas–Taussig shunt had been performed on more than 200 patients at Johns Hopkins, with parents bringing their suffering children from thousands of miles away. Thomas' surgical techniques included one he developed in 1946 for improving circulation in patients whose great vessels (the aorta and

5920-409: Was complicated and contradictory throughout their 34-year partnership. Thomas, a laboratory technician, was paid only a janitorial salary. However, white men performing an equivalent of Thomas' job were paid an appreciable dollar more per hour. On the one hand, Blalock defended his choice of Thomas to his superiors at Vanderbilt and to Johns Hopkins colleagues, and he insisted that Thomas accompany him in

6000-457: Was desperate to find a surgical cure. According to the accounts in Thomas' 1985 autobiography and in a 1967 interview with medical historian Peter Olch, Taussig suggested only that it might be possible to "reconnect the pipes" in some way to increase the level of blood flow to the lungs, but did not suggest how this could be accomplished. Blalock and Thomas realized immediately that the answer lay in

6080-415: Was first tried on a fifteen-month-old infant named Eileen Saxon . The blue baby syndrome had made her lips and fingers turn blue, with the rest of her skin having a very faint blue tinge. She could take only a few steps before beginning to breathe heavily. Because no instruments for cardiac surgery then existed, Thomas adapted the needles and clamps for the procedure from those in use in the animal lab. During

6160-608: Was his mother's hometown, Lake Providence his father's. Either way, the family did not stay in Louisiana for long, moving to Nashville, Tennessee, when Thomas was about two years old. Thomas attended Pearl High School in Nashville in the 1920s, and graduated in 1929. Thomas' father was a carpenter, and took pleasure in passing down his expertise to his sons. Thomas worked with his father and brothers every day after school and on Saturdays, doing jobs such as measuring, sawing, and nailing. This experience proved beneficial to Thomas, as he

6240-533: Was quintessentially defined as a state of circulatory collapse ( vasodilation ) due to excessive nervous stimulation. Other competing theories around the turn of the century included one penned by Malcom in 1907, in which the assertion was that prolonged vasoconstriction led to the pathophysiological signs and symptoms of shock. In the following World War I, research concerning shock resulted in experiments by Walter B. Cannon of Harvard and William M. Bayliss of London in 1919 that showed that an increase in permeability of

6320-492: Was unique in that he did not have any professional education or experience in a research laboratory; however, he served as supervisor of the surgical laboratories at Johns Hopkins for 35 years. In 1976, Johns Hopkins awarded him an honorary doctorate and named him an Instructor of Surgery for the Johns Hopkins School of Medicine . Without any education past high school, Thomas rose above poverty and racism to become

6400-518: Was working at Vanderbilt University at the time) to ask if there were any jobs available. In the wake of the stock market crash in October 1929, Thomas put his educational plans on hold and, through a friend, secured a job in February 1930 as surgical research assistant with Dr. Alfred Blalock at Vanderbilt University. On his first day of work, Thomas assisted Blalock with a surgical experiment on

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