The Good Doctor is Bad Medicine Part 1/3

The Good Doctor is a medical drama that’s first season just started airing on ABC. Of course, anytime a new medical drama hits the airwaves I get messages from people curious about my opinion.

The drama focuses on first year surgical resident Shaun Murphy who has autism. I’ve watched the first two episodes and though the premise of the drama is mildly intriguing— I don’t find the medical aspects or interactions between the medical staff worthy enough to keep watching. Unless, I keep analyzing episodes for this blog. We’ll see.

Episode 1 features the fight of a hospital administrator to get him accepted into the program. On Murphy’s way to the hospital for seemingly his first day, of course, he saves a life at an airport.

A teen is showered with glass and suffers life-threatening injuries to the neck and chest. An older male, who identifies himself as a doctor, begins to render aid by putting pressure on the wound. The doctor says, “His jugular vein has been cut.”

Issue #1: Placement of direct pressure. Murphy chastises the older doctor for holding direct pressure improperly (for a pediatric patient) and for occluding the patient’s airway because of it. The doctor adjusts and the patient begins to breathe again. Truthfully, there are differences between the adult and pediatric airway, but I’ve never heard of adjusting pressure d/t anatomy. You have to put pressure on what’s bleeding. If that causes problems with the airway, then the patient requires intubation to protect the airway.

Issue #2: Doctors having sex in the call room. Can we please just get rid of this stereotype? Please, just please. There is never as much rampant sex as portrayed on TV in hospitals. In my almost 25 years of nursing, I’ve heard ONE rumor.

Issue #3: Airport Security. I cannot believe in this day and age that, regardless of what someone says, hospital security would allow anyone to grab a knife and run wildly through the airport without being arrested— even if a patient’s life is in danger.

Issue #4: EMS response. Considering this is an airport, the EMS response time is laughingly long.

Issue #5: Chest tube. Of course, Dr. Murphy places a chest tube in the patient as well as makes, MacGyver style, a chest tube drainage system. Once this is done, he triumphantly raises it above the patient and the patient dramatically improves. Just, no. Drainage systems should always be level or below the patient to drain. Never above. Like never. You can check out this nifty nursing video that explains just that.

Issue #6: Direct OR admission from the ambulance. The now stable patient is met by a surgical resident and goes straight from the ambulance to the OR. No, just no. First of all, why does a stable patient need to go to the OR? Secondly, everything first to the ER. The ER attending will make a decision to consult surgery and a plan will be made to take the patient to the OR.

Honestly, there’s more in this episode. Can we talk about the language the doctor uses to get consent? I’ll spare you until next post where I examine episode 2.

 

Don’t Miss Out!

Hello Redwood’s Fans!

I promise I’ll be getting back to my normal medical mayhem next week with an examination of the new ABC show The Good Doctor. Do I give it a thumbs up or thumbs down? Tune in next week to find out.

What I want to make sure you don’t miss out on is one amazing box set and two awesome giveaways.

The Kill Zone: Ten Deadly Thrillers box set (featuring myself and authors such as Robert Liparulo—one of my personal favorites— Christy Barritt and Patricia Bradley) price is going up to $5.99 in just four days. Right now, you can get it for $0.99! Please, please— don’t miss this amazing collection of brand new novellas. These will only be boxed together for a short time.

Also, there are TWO amazing Rafflecopter giveaways happening right now. The prizes are shown below. You can find BOTH of them by clicking this link and also this link. Both contests end October 7th, 2017 at midnight MST time.

Pediatric CPR: When to Stop?

Nothing probably tugs at the heartstrings more than thinking about a child dying. It’s not the way things are supposed to happen. We expect life to follow the natural order of things— the old die first. Parents should never bury their children.

Sadly, we know this reality is not true. The pediatric nurse understands and confronts this reality more often than most. Particularly nurses who work critical care, ER, oncology, and hospice.

A reader of this blog posed this question to me: How long will a nurse or doctor perform chest compressions on a pediatric patient? Is forty-five minutes too long or would they try longer?

This is a tough question and not so easily answered. There are really no hard and fast rules as to when CPR should be stopped and it depends a lot on the reason for the code (if known) and what types of signs the patient is giving us. For instance, just because a patient doesn’t have a pulse, doesn’t mean they don’t have electrical activity in the heart muscle. Some causes of a code are reversible, but it takes time to do so. Hypothermia might be a good example of this.

I’ve worked in both adult and pediatric critical care. What I’ve found generally is providers will run pediatric codes longer than adult codes even when chances are small to get a pulse back. No one wants to see a kid die— health care providers are no different. Plus, culturally, we resist death at every turn even though it is the course each of us will journey to.

However, I did come across this article that begins to address this concern. If we can teach how to resuscitate patients— should we also not teach providers when it is reasonable and ethical to stop such efforts?

1. Are there clinical features present prior to the code that are predictive of poor survival? For instance, in the adult patient some of these from the article included pneumonia, metastatic cancer, and low blood pressure. For pediatric patients, kidney failure and use of a continuous infusion of epinephrine are mentioned.

In the emergency department setting, we want to know what the patient’s initial heart rhythm was. If there was no electrical activity in the heart (terms such as asystole, flat-line, ventricular standstill) then chances of getting back organized electrical activity AND contraction of the heart muscle are low.

2. Is the patient receiving high quality CPR? This might seem like a no brainer. Of course, if the patient codes in the hospital, they must be receiving excellent CPR. What research shows is that this is not true and it is a big drive of many institutions to simply improve the quality of CPR. If I can ease your mind, many hospitals are improving CPR basics through high fidelity code labs, more frequent CPR check-offs, mock codes, and computer based CPR training that measures effectiveness of CPR and coaches the participant on how to improve .

What are some CPR pitfalls? Initiating CPR in a timely manner. Compressing deep enough and at the right rate. Not over or under ventilating the patient (both can actually cause problems). CPR is what we call a high risk, low yield procedure— meaning we don’t do it very often, but when we do we have to do it right. What you don’t practice frequently you don’t become adept at. CPR is no different.

Considering this, we look at how long the patient’s down time was. This refers to the time when the patient’s heart stopped beating to the time they got CPR. Trouble is, this might be relatively hard to determine. When was the patient last seen? Is the patient cold to the touch? Are their pupils fixed and dilated?

The good news for the writer is there is a lot of leeway in this area as far as how long a medical team might “work” on a patient. Factors can be given for both short and long resuscitation times.

The most important part is getting those factors medically correct.

What about you? Have you written a resuscitation scene into a work of fiction?

 

FIVE Amazing Book Contests

You might be thinking to yourself– just where has Jordyn been? It’s been close to three weeks since she’s posted anything! Well, I’ve been planning some amazing giveaways for you.

My latest novel, Taken Hostage, released earlier this month. The novel was inspired by two pioneering medical works. The first is the work that Duke Medical Center is doing using modified polio virus to treat very aggressive brain tumors. When I first saw this news story a few years back, I felt like this was unlike any other medical advancement I’d seen in my lifetime.

The second inspiration was based on the work of Italian physician Dr. Paolo Macchiarini who specializes in building tracheas (or windpipes) for patients. His work, and large inspiration for this book, was featured in a documentary by Meredith Vieira call A Leap of Faith.  Since the airing of the special, Dr. Paolo’s work has come under scientific scrutiny.  At the time of this special, he was literally the only hope for some people.

I thought to myself . . . what if the one doctor who can save your life goes missing? What would you do to save your family member? This is the question for bounty hunter, Colby Waterson, in Taken Hostage when maverick doctor, Regan Lockhart, pops up missing the day of his sister’s lifesaving surgery.

To celebrate the release of Taken Hostage— I’m participating in no less than FIVE contests to award prizes to readers. If you’re a book lover– you don’t want to miss out on these contests!

The first is a BookSweeps contest featuring two box sets geared toward lovers of inspirational suspense. The Grand Prize winner gets a Kindle Fire! Click this link to enter. There are some amazing authors in these sets including Robert Liparulo and Christy Barritt.

If you’ve followed my fiction novels, my entry into Kill Zone is titled Malicious Intent and features the first case detectives Nathan Long and Brett Sawyer ever worked together. I’ve been told by a few trusted readers that it’s my best work yet!

Kill Zone is currently on sale at the rock bottom price of $0.99! This price is going up October 8th to $5.99 and this box set will also only be available for a limited time so definitely act now. This contest ends today— Sept 25th!

The next two contests end Sept 30th. I’m part of a four book giveaway over on Susan Sleeman’s excellent website for thriller lovers called The Suspense Zone. Click here to enter that contest.  Also, I’m honored to be on Shannon Vannatter’s inspirational romance blog. Stop by and leave a comment on this blog post for your chance to win one print copy of Taken Hostage.

Now, for some uber amazing prizes. To further celebrate the release of Taken Hostage, I put together this Rafflecopter Giveaway that features, as the prize, this hand embroidered autumn bouquet (stitched by yours truly.)

To celebrate Kill Zone’s release on October 3rd— myself and the nine other awesome authors put together this Thriller Fest Giveaway. This, you definitely don’t want to miss out on. Five different prizes that total over $450.00! I kid you not. The bottom of this post has photos of all the prizes in this amazing contest.

Both of the Rafflecopter Giveaways end October 7th.  Don’t miss out!

 

Author Question: Motorcycle Injuries

Tory Asks:

I’m currently writing a fan fiction and the two main characters get in a motorcycle crash. The female just found out she was pregnant. I have three (very unrelated) questions. Could the crash send her into cardiac arrest? Would the male (who was driving) be able to survive with just a broken arm and a sprained ankle? And would the baby survive?

Jordyn Says:

Hi, Tory. Thanks for sending me your questions.

1. Yes, a motorcycle crash could send someone into cardiac arrest.

2. Could the male survive with just a broken arm and a sprained ankle? Sure, this is possible, but I don’t know if it’s probable. When looking at accidents, medical people always look at the injuries of the other people involved to determine how serious everyone’s injuries might be.

If the female in the accident suffers a cardiac arrest, it would be surprising that the male walks away with just, essentially, a broken arm. You could make it more believable in the description of how the accident happens. For instance, the female is thrown from the bike, but the male is trapped underneath it. You could also have them differ in the type of protective equipment they’re wearing (helmet, jackets, etc.)

3. Would the baby survive? Again, it depends on a lot of factors. How far along is she in the pregnancy? Cardiac arrest— how long is she pulseless? What other injuries does she get in the accident? The sicker she is from her injuries, the more likely she will miscarry the pregnancy. The body will defer energy and resources to the mother over the pregnancy. Then again, some women have maintained a pregnancy through terrible injuries so you would have some leeway as an author here.

If the mother is far along in the pregnancy (at least 22-24 weeks along) and in cardiac arrest the providers might consider C-section to save the infant. So, without more details as to the nature of the accident, her injures and the state of her pregnancy, it would be hard to say if the baby would likely live or die.

Good luck with your story!

5 Tips for a Character’s Stroke

Even some famous authors get medical details wrong.

In a New York Times bestselling novel, the author presented his main character’s mother with a stroke. Almost all the details were accurate, except for the origin of the blood clot in the mother’s leg. This is where the author needed more research and clarification.

For example:

If the blood clot broke loose from the arteries of the leg, it travels to the toes and become lodged in the tiny capillary vessels, never reaching the brain.

If the blood clot broke loose from the veins of the leg, it travels to the heart, out to the lungs and becomes lodged. This obstruction can be fatal and is called a pulmonary embolism, not a stroke.

Therefore, when giving your characters a stroke, let’s get the details right by asking the following questions:

What kind of stroke does the character have?

There are two types:

Ischemic Stroke occurs when blood vessels in the brain become blocked by a moving obstruction that has traveled to the brain and lodged within the vessels, cutting off oxygen supply. These moving obstructions or emboli and most often come from the heart or carotid arteries.

Hemorrhagic Stroke occurs when excessive bleeding in the brain, either from a ruptured blood vessel or from trauma, places pressure on the brain tissue. This cuts off the oxygen supply in that area.

There are two types of hemorrhagic stroke:

Intracerebral – located inside the brain
Subarachnoid – located outside the brain

What are the characters risk factors for a stroke?

Characters need to exhibit a pre-existing condition that contributes to a stroke. Such as:

High blood pressure
High cholesterol
Smoking
Heart Disease
Head Trauma
Drug Abuse

What are the characters symptoms?

Think FAST:

Facial drooping
Arm weakness
Speech Difficulty
Time to call 911

Strokes on the left side of the brain will contribute to symptoms on the right side of the body and vice versa. If the stroke affects the cerebellum or brain stem, then symptoms can affect both sides of the body.

What is the characters treatment?

Ischemic Stroke: t-PA therapy is provided by licensed medical professionals and needs to be administered within three hours of onset symptoms.

Hemorrhagic Stroke: Blood thinner meds are halted and blood pressure meds are administered to decrease bleeding.

What types of medical procedures are provided for a character experiencing a stroke?

Ultrasound of the carotid arteries may be performed to determine blockage in the arteries carrying blood to the brain.

CT or MRI scan of the brain to identify the cause and location of the stroke

For an Ischemic stroke, an angioplasty or endarterectomy is performed to open the narrowed channel and provide blood flow to the brain again.

For Hemorrhagic stroke, a procedure may be performed to place a coil, clip or glue in the affected area to try and stop the bleeding.

Follow these tips and you’ll be thinking FAST in no time!
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Shannon Moore Redmon writes romantic 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.

 

Forensic Question: Testing a Blood Sample for Pregnancy

Jordyn Asks:

Can you test a blood sample to see if the person who left the blood behind is pregnant?

Amryn Says:

For most traditional tests, it would require a fair amount of blood be left behind in order for perform a pregnancy test. The blood would also need to still be in liquid form rather than dried.

It’s not something that would be done for a variety of reasons, not the least of which is that samples are usually conserved as much as possible for forensic testing. So while it’s possible with the right set of circumstances, it likely wouldn’t be done since the blood would be used for DNA testing rather than diagnostic testing.

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Amryn Cross is a full-time forensic scientist and author of romantic suspense and mystery novels. Her first novel, Learning to Die, is available on Amazon. The first book in her latest series, loosely based on an updated Sherlock Holmes, is available for pre-order on Amazon. Look for Warzone in January 2015. You can connect with Amryn via her websiteTwitter and Facebook.