Author Beware: Inaccurate Ultrasound Scenes Part 2/2

Today, we’re concluding Shannon’s series on how to write medically accurate ultrasound scenes. You can find Part I here. Today, Shannon is covering tips #3-#5.

Welcome back, Shannon!

Tip #3: Sonographers scan in the ultrasound department most of the time.

Most scans are performed in the designated ultrasound department for their exams, unless they are in active labor, in the ICU or for some astronomical reason, cannot leave their room. Even in the emergency department, if the patient can be transported to the department, then they will be.

Portable ultrasounds are performed on serious cases when the physician does not want the patient moved for some pertinent reason.

 For Writers: If your character needs an ultrasound exam, is conscious, can move well, or sit in a wheelchair, send them to the ultrasound department.

Tip #4:  Sonographers like top of the line equipment.

One television scene at a top-rated hospital showed a tiny little ultrasound machine from the 1990’s being used for the exam. Seriously?

Get rid of the outdated equipment. The machines in top-rated healthcare systems are the best of the best, large and full-sized pieces of equipment.

Modern portable systems look like laptops, are smaller, and are taken to the inpatient rooms or ICU.

Some facilities provide their ER and L&D doctors with tiny devices the size of a cell phone to carry in their pocket for quick peeks, not full anatomy exams.

For Writers: When describing the machine look at top of the line equipment with GE, Philips, Samsung or other manufacturers. This will give you a good idea of what is being used in the real medical world.

Tip #5:  Sonographers know where to place the probe.

Make sure the anatomy showing on the screen matches the location of the probe and the anatomy being discussed is displayed.

One television scene I witnessed had the actor place the probe in the middle of the abdomen, but a kidney presented on the screen. Sonographers know the kidneys are located on the sides of the abdomen, not in the top middle.

If you’re listening to the baby’s heart on a second or third trimester baby, then the heart will display on the screen. Not the brain, fingers, and toes.

If investigating the liver, then the probe needs to be placed on the right side of the abdomen. With the spleen, move the probe to the left side.

If it is a first trimester scan, then a vaginal exam will be performed. If the baby is in the second or third trimester, then the probe is placed on top of the abdomen.

For writers:  Research anatomy and physiology on the internet or in books before writing the ultrasound scene. Make sure the location is correct and the disease process is represented accurately. If unsure, then find a nurse, physician or medical professional to ask or connect with Jordyn and me.

When researching a specific topic, perform a google search, but select a credible source. Choose sites that end with .edu, .org, or .gov. Those tend to be most accurate. Sometimes I will use others, but always back it up with a healthcare system education site like Mayo Clinic, Cleveland Clinic, or the government site (ncbi.nlm.nih.gov).

Don’t be like one famous author, whose patient’s venous blood clot, located in the leg, traveled to the brain and caused a stroke. However, in real life, strokes most often come from the carotid arteries and heart. Venous blood clots in the legs kill when they break off and travel to the lungs.

Shannon, thank you so much for this valuable insight. I know I learned a lot.

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Shannon Moore Redmon writes Romance Suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

 

Author Beware: Inaccurate Ultrasound Scenes Part 1/2

Redwood’s Medical Edge is pleased to host Shannon Moore Redmon, an ultrasound sonographer, and she’s offering her insights on how to write ultrasound scenes accurately. I know I’ve learned a few things for sure. Today, we’ll cover tips #1 and #2.

Welcome, Shannon!

Americans love to watch medical television shows, like Grey’s Anatomy, ER, or House. We buy up the latest medical thriller and discover the scientific world of healthcare.

What many fail to recognize are the glaring inaccuracies associated with the ultrasound profession and the exams being performed on the television screen. Such scenes contain incorrect anatomy, probes placed in wrong positions, or actors who need more camera face time and scan patients backwards.

Doesn’t Hollywood consult experts when they use ultrasound to determine an abnormality of a baby or find cancer in a patient’s liver?

As a registered diagnostic medical sonographer for over twenty years and an instructor who teaches others to utilize this amazing modality, here are five tips to make those ultrasound scenes more accurate.

Tip #1:  Sonographers perform the majority of scans.

Whether in a hospital setting, an outpatient center, most OB/Gyn offices, vascular offices, and general imaging facilities, registered sonographers are the ones who perform the majority of ultrasounds on patients . . . not doctors.

In my experience, sonographers scan the patient first and sometimes are the only one who take the images. If a patient is high-risk OB, a sonographer will scan her first, then a maternal fetal medicine doctor will scan after to confirm the diagnosis.

When abdominal or vascular ultrasounds are performed, sonographers scan these patients and the reading physician or surgeon may come into the room to discuss with the patient. More than likely, they will read the images from a digital archiving system located in their office down the hall, then attach a report to the patient’s medical record.

Most episodes on television have a doctor performing the exam. Where have all the sonographers gone? Having lunch together down by the river?

For writers: When writing your ultrasound scenes, let the sonographer take the images and discuss the case with the reading physician. If you want to ratchet up the drama, then let them have a heated discussion over what the sonographer believes she sees versus what the physician thinks he knows.

Great radiologists and reading physicians will critique a sonographer’s images and call them out on sloppy pictures. Sonographers will defend their opinions and their patients when a doctor minimizes the seriousness of the findings with a list of differential diagnoses or refuses to discuss the diagnosis with the patient. This happens in real life.

Tip #2:  Sonographers turn off the sound of the heartbeat.

In the famous Doritos commercial, granted the scene is a comedic parody, but if you listen close during the entire exam, the heartbeat is playing in the background and there is no Doppler technology activated. This is also the case in many television scenes, depicting actual exams.

In real life, the heartrate sound does not play during the entire exam. Sonographers know the heart rate plays only when we turn on the Doppler technology, drop the gate into position and hit the update key. We listen for a few seconds, acquire a heartrate strip along the bottom and then turn the sound off.

For writers: If there is background noise, it comes from the cooling fan on the machine.

Next post: Tips #3-#5.

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Shannon Moore Redmon writes romance suspense stories to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

Author Beware: Movie Patriots Day and Narcotic Distribution

Recently, I took in the movie Patriots Day starring Mark Wahlberg that follows the events surrounding the Boston Marathon bombing that took place on Monday, April 15, 2013.

The movie is insightful and entertaining and I don’t think I’ll be spoiling anything by discussing it here. Plus, the issue I’m highlighting really has nothing to do with the events of the actual bombing.

Mark Wahlberg plays Sergeant Tommy Saunders. In the movie, he is suffering from some sort of chronic knee injury. He walks with a limp and is looking to get off patrol for this very reason.

In the aftermath of the bombing, he goes to one of the local hospitals to interview witnesses. He approaches the nurses’ desk and asks a nurse for something for pain. The nurse offers Lortab, a scheduled narcotic, but he declines and asks for Tylenol or ibuprofen instead.

Yea— just no.

Even in a disaster, a nurse is not going to be handing out scheduled medication for several reasons that I’ll highlight below.

First, what are scheduled medications? The FDA schedules medications that have the potential to be addictive. Schedule I medications are highly addictive and have no currently accepted medical use— drugs like heroin and LSD. Lortab is a Schedule II medication– which means it’s highly addictive, but does have a medical use. All scheduled drugs in the hospital have a process where they are counted to ensure no one is diverting (not using the medication for its intended purpose) the medication.

Narcotics counts where there is less drug there than should be are taken VERY seriously. Even in a disaster situation, these would be watched closely. The nurse would not be handed a bottle of Lortab to dispense as she wishes.

Why would a nurse not be able to simply give this police officer Lortab in a critical incident where there is a large influx of patients and things are generally crazy?

1. The police officer is not a patient. Any medical treatment rendered by the hospital should be documented. Now, I could see the nurse tossing him a few Ibuprofen considering these circumstances. In all likelihood, this would be frowned upon but understood. Not so with a narcotic.

2. It is outside the nurse’s scope of practice. Scope of practice deals with what a provider can and cannot do. It is generally determined by the state licensing board where the individual practices. Scope of practice issues tend to be a big pitfall for writers everywhere and I’ve blogged about it previously here and here.  A nurse cannot order medication for a patient without a standing protocol in place— this is a provider function. A nurse also cannot dispense medication— this is the function of a pharmacist. Even with automated medication dispensing systems, there is usually a pharmacy double check before the medication can be pulled from the machine. In an emergency this function can be overridden, but that is highly frowned upon.

Overall, Patriots Day was an entertaining film and most probably won’t even realize this error. However, in writing please keep in mind scope of practice issues. Not every medical provider can do every medical function— even during a disaster.

Author Beware: Taking out Perfectly Good IVs

If you’re a frequent reader of this blog then you know I have kind of a love/hate relationship with James Patterson. Love his books (most of them), but I frequently take him to task for medial inaccuracies. I rarely call out an author in person or name their book because I like to mostly teach on medical topics, but I think James could use a medical consultant and I also think he has enough money to afford one– though I think these posts are not increasing my chances of working for him.

Anyway . . .

In one of his recent titles, Woman of God, the first part of the book highlights the main character serving as a physician in a war torn region.

Early in the novel, a young boy comes to their primitive hospital suffering from a bullet wound to the chest. During the surgery, which involved opening up the side of his chest, it is noted that the patient stops breathing and so the surgeon, a mentor of the main character, just gives up.

First of all, a patient receiving major surgery like this should be intubated and anesthetized. They do offer surgery, so must provide this to most of their patients. Earlier in the chapter, it is noted that the patient is being bagged and anesthetized patients can’t breathe on their own anyway— so why is a decision made to let him die when he stops breathing when, if properly cared for, he shouldn’t be breathing anyway?

However, this situation does not deter the main character and she continues his operation.

“The heart wasn’t beating, but I wasn’t letting that stop me. I sutured the tear in the lung, opened the pericardium, and began direct cardiac massage. And then, I felt it— the flutter of Nuru’s heart as it started to catch. Oh, God, thank you.

But what can a pump do when there’s no fuel in the tank? 

I had an idea, a desperate one. 

The IV drip was still in Nuru’s arm. I took the needle and inserted it directly into his ventricle. Blood was now filling his empty heart, priming the pump.”

Where to start, where to start.

First, it’s never noted that this patient is receiving blood. I think this is an add on by the author for effect. Secondly, remember IVs are not needles, but very small plastic catheters, that would not be able to puncture through the tough muscle of the heart.

Thirdly, and by far the most egregious, the physician takes out a perfectly good IV for a nonsensical reason! It is hard, really hard, to get IVs into sick kids— particularly those suffering from hemorrhagic shock like this boy is from a gunshot wound to the chest. That one, lonely IV you took out to puncture his heart (not a good idea either), you’re going to need back because this kid will still be sick. You’ll close his chest and then have to find more IV access. Giving fluids via a vein can rapidly fill the heart and it is insanity to take out a good IV to do what the text suggests.

Call me, James. Really. I’m not as expensive as you might think.

Medical Review of The Shack

There’s nothing like a Christian movie to create a firestorm of controversy. I am a Christian and saw the film and I thought the biggest failure of the film was actually medical in nature.

That’s right . . . medical.

There have been plenty of articles written on The Shack’s theology, but I doubt anyone has touched on the medical inaccuracies which I’ll do here. If you haven’t seen the movie and don’t want any spoiler alerts then stop reading . . . like right now.

The story revolves around a man named Mack who early in the film narrowly misses a major collision with a semi. At the end of the movie, it’s revealed that he’s been in a coma (he’s been unresponsive) for approximately 2-3 days. Our first glimpses of Mack post accident are in a regular patient room. He has an IV, IV fluids and is on a monitor.

Problem One: If you’re broadsided by a semi, you should actually look injured. Mack is relatively uninjured as a result of this accident. He has but a few scrapes (not even stitches) on his face and none of his bones are broken.

Problem Two: The IV pump is not running. If you watch the film, the IV pump is off. If it were on, you’d see numbers lit up on the screen.

Problem Three: If a patient is unresponsive, you have to provide a way for things to come out. Think about it, do you ever go three days without peeing? Neither does a comatose patient. Plus, we need to ensure kidneys are functioning properly which means we need to monitor urine output. This is the type of patient where the phrase “a tube in every orifice” means exactly what it means. Also, there is a significant amount of literature that patients should be nourished with tube feedings much earlier. In real life, Mack would likely be in the ICU, perhaps even on a ventilator, until he woke up. His only medical support would not just be IV fluids.

Next time Shack, call me.

Can You Commit Suicide With an AED?

Recently, my husband and I have been binge watching through all five seasons of breaking-bad-s5-400x600-compressedv1Breaking Bad. In the last season, a gentleman decided to kill himself using an AED.

AED stands for Automatic External Defibrillator. It is a quick rescue device used mostly by non-medical people for cardiac arrest. It is designed to recognize lethal heart arrhythmias and deliver a shock (electricity) if the patient is in one. The AED will not always fire. In fact, there are really only two arrhythmias it is designed to treat.

The question becomes, can you use an AED to commit suicide? An AED has two large, white patches connected to the device. In the show, the gentleman places one patch on his chest, pulls off the other patch and places the exposed wires in his mouth. After this, he turns on the device and discharges it, thereby killing himself.

aedThis scenario is highly improbable and here’s why:

1. Both patches must be in place for the defibrillator to analyze the patient’s rhythm. If they’re not, the machine will not progress any further.

2. Let’s say the AED would read the rhythm (one patch on the chest and exposed wire in the mouth)— it won’t deliver electricity for a normal rhythm (which this gentleman likely has because he’s alert and conscious.)

3. Let’s say the AED did fire for his normal heart rhythm— would he die? There is a slight chance that he might die, but only if the AED fired during a very sensitive time in the electrical cycle of his heart which has a very low probability.

All in all, I don’t find this method of suicide possible. Sorry, Breaking Bad, though I did love the series.

Author Beware: Don’t Make Medical People Look Like Uncaring Idiots 3/3

Today is the last post on my displeasure with a particular, bestselling novel. Click on the links to find Part 1 and Part 2.

In short, a fourteen-year-old girl has come to Planned Parenthood for the Morning-after Pill.

What follows in italics is an excerpt from the book where the nurse giving the patient her discharge instructions. I’m keeping the identity of the author and the name of the book anonymous.

 girl-1149933_1920Several more minutes ticked by before the nurse, her peppiness especially noticeable in the wake of her cool, serene, superior returned.  A brown paper lunch bag full of brightly colored condoms bunched underneath her arm, a prescription bottle in one hand, and a glass of water in the other.

“Take six right now.” She shook six pills into my clammy palm and watched me chase them down with water. “And six twelve hours from now.” She looked at her watch. “So set your alarm  for four am.” She shook the paper bag at me teasingly. “And being careful can be fun. Some of these even glow in the dark! ”

Wow! Just yikes. Trust me, nurses are usually not so peppy. How does the patient know the “brown paper bag” is full of “brightly colored condoms”? Can she see through brown paper? I digress.

Problem: What’s really wrong with this passage is the patient instructions. The author makes it clear in the novel that the patient is taking the Morning-after pill. There are two such pills. One by the same name and the other is Ella. Neither pill has such a dosing regime. Both are one pill only. That’s it.

I honestly don’t get the point of writing something so ridiculous that is so easily researched.

More seriously, this nurse’s teaching is cringe worthy. I don’t know a nurse on the earth who would talk about condoms glowing in the dark. How about having a serious talk about contraception? How about having a serious talk with a fourteen-year-old girl who is having sex and how she feels about that?

So much more should have been done for this girl in this book by these medical professionals that it was truly disheartening to read. Why? Because this is not the impression I want any woman of any age to expect when they interact with a medical professional about something as important as this.

Writers and authors everywhere— please, do better. Your words educate those we interact with as patients and this is not the impression we want them to have. I’m only asking for one, redeemable, medical person. Make all the rest awful— you have my permission.