Wednesday, May 18, 2016
Personally, I loved the show Castle. Sadly, it's been cancelled and perhaps it's for the best-- especially if Season 8, Episode 21 entitled Hell to Pay is any indication of the attention to detail they were giving their medical/forensic scenarios.
"He bled to death from a wound in his left side. My guess is whatever he was stabbed with punctured his subclavian artery. After that he would have had about thirty minutes to an hour tops."
There are TWO major problems with the above assessment.
First, your right and left subclavian arteries are located just below your collar bones. So, if you're stabbed in the left side, it's really hard to hit that sucker. That got me thinking about what is on your left side that could cause brisk bleeding. Your spleen is located on your left side tucked pretty nicely under your lower left ribs. Perhaps they meant splenic artery which would have been appropriate for the scenario.
Second is the time frame. If you have a severed artery, the bleeding will be severe and deadly if not controlled in a matter of minutes. There is no way this character would have survived thirty to sixty minutes-- I'd give max time at ten minutes and that might be pretty generous.
So Castle, at least go out on a high note with a medically accurate death scenario.
Wednesday, April 27, 2016
Coming across inaccurate medical scenarios in books is common for me so to have one raise my ire enough to blog about it generally means a pretty big eye roll was involved when I read the passage.
Scenario: An elderly male dressed in sweats is found wandering the streets of New York in a confused state.
Well, yea, just--- no.
If police find an elderly male, let alone any confused individual, wandering the streets without any ID the first place that person is going is straight to the ER likely via ambulance.
The reason? One, is to make sure nothing medically is wrong. Chronic diseases such as dementia and Alzheimer's are not the only reason the elderly people become confused. Something as simple as an electrolyte imbalance could be the cause. In any new onset confused state, other minor and major medical conditions need to be ruled out first. What might some of those be? Electrolyte imbalance. Brain Tumor. Stroke. Head Injury. Brain Bleed.
Secondly, there is not a nursing home in the United States that will take in an elderly person unknown to them without a medical evaluation first. Plus, do you know all that's involved for nursing home admissions? A lot.
In this instance, if the patient is deemed to not have anything clearly medical (that could be fixed or treated) causing his confusion, then the hospital would involve the police and likely social services for placement.
But no drive by drop-offs at the nursing home.
Wednesday, April 20, 2016
Here I am, happily reading along one of my favorite mainstream suspense authors, when a glaring medical mistake takes me right out of the story. Bummer! Now I'm wondering how long it would have taken this well known author to make one phone call to determine if this situation was plausible or not.
Did you hear that? That was steam billowing out of my ears.
This is a very common mistake authors make-- issues that deal with scope of practice. I've blogged about it several times. This post has links to several others that just deal with scope of practice.
In simple terms, scope of practice is what a health care provider can and cannot do. EVERY licensed health care provider (a nursing assistant, a nurse, an EMT, a paramedic, a physician, a physical therapist, a pharmacist) has a scope of practice that is governed by their licensing board-- whoever that might be. These governing boards determine the rules of practice. If the licensee does something outside of these rules they can be brought up on disciplinary action and even potentially lose their license. Scope of practice rules can vary from state to state.
In short-- it's bad to operate outside your scope of practice.
For instance, this document gives a pretty detailed overview of the medical treatments different EMS professionals can do.
The first problem with the author's scenario is that EMS professionals do not carry oral narcotics to give to patients. Only IV and those that can be administered nasally.
The second problem is that EMS professionals not only operate under scope of practice laws but also medical protocols which outline the things they can do in the field and under what conditions. In fact, here's a whole document that lists the EMS protocols for one hospital in Colorado that would give a nice overview for what likely happens in the US. There will be differences state to state but you could reasonably generalize from this.
Essentially, a paramedic giving a patient (who is refusing medical treatment) three doses of an oral narcotic (which he doesn't carry) is a serious violation of his scope of practice. Only a few medical roles can prescribe oral narcotics and dispensing oral narcotics is the role of a pharmacist.
Authors should take scope of practice as seriously as medical professionals do because though your book might be fiction-- the public will take it as fact.
Wednesday, April 6, 2016
How fast a person can bleed to death is a very common question among authors and I've done several posts on the topic. About a month ago, I got a comment asking a variation of the question.
It's as follows:
It's hard in medicine to give actual time frames. The best demonstration I ever saw of how fast it took to bleed out was from a physician that drilled a hole into a two liter bottle of pop and then squeezed it mimicking a heartbeat. He said the size of the hole could be equated with an injury to the popliteal artery (which is behind your knee) and that bottle was empty in about two minutes.
Devastating injuries to larger arteries (your aorta for instance) can cause the patient to bleed out (hemorrhage or exsanguinate) in 1-2 minutes. It's fast. For instance, if you rupture your descending aorta in a hospital and they know exactly what is wrong with you, and even have a couple of IV's in place, your chances of survival are still not awesome.
Some general rules:
Arterial bleeding is faster than venous bleeding. This is because the pumping action of the heart causes more brisk blood loss. That being said, all bleeding can lead to death if not controlled. It's probably safe to assume that bleeding from an artery without any intervention could lead to unconsciousness in one to three minutes and death in under five minutes.
Uncontrolled venous bleeding might take upwards of twenty minutes or days. Again, if not controlled in any way. Again, this could be variable. The author has a lot of leeway.
Does a fast heart rate accelerate bleeding? Yes. The faster your heart beats, the more blood spills, particularly from an arterial bleed. This is a double edged sword because your body will compensate by increasing your heartbeat during blood loss to compensate for all those red blood cells on the pavement and not in your body carrying oxygen.
Here are other posts on the topic of blood loss:
Author Beware: Arteries vs. Veins.
Author Beware: Arterial Bleeding vs. Venous Bleeding.
Killing my Arteries: Truth or Die by James Patterson. Can IV drugs be given in an artery?
Pregnant Woman Bleeding to Death.
Pregnant Woman Bleeding after Delivery.
Bleeding to death from gunshot wound to the arm and back? What organs can be hit to bleed but not be lethal?
What other questions do you have about characters bleeding to death?