Dr. Strange Should Know Better

If you haven’t seen the movie Dr. Strange, you have been warned that this blog post will contain spoilers to the movie.

Dr. Strange, released in 2016 as part of the Marvel Universe, features a stereotypical, obnoxious, arrogant, and rich neurosurgeon. He is greatly skilled, but is known to turn down patients in order to keep his perfect surgical record. Unfortunately for the character, he is in a terrible car accident and both his hands sustain multiple fractures that cause permanent nerve damage and therefore lead to the end of his promising career.

Dr. Strange is like many patients when the medical establishment can’t offer complete healing. He begins to investigate alternative/investigative medicine for treatments. He hears from a physical therapist that a patient with a complete spinal fracture is up and walking around. Dr. Strange responds to this by saying, “Show me his file.”

I’ve said all along in this blog that medical people in films, television, and novels can do bad things. Your job as the writer is to let the reader know that you know that the character is misbehaving in his role. This allows the reader to know you’ve done your research and they can trust you as an author.

Dr. Strange asking for this patient’s chart if flat out a HIPAA violation. He never cared for the patient and he has no right to know what’s in his medical record. There are consequences for HIPAA violations and having the character suffer these is a great way to add tension and conflict to the story.

A second medical violation in the movie is the treatment of Dr. Strange’s chest wound. He suffers a blade wound to the chest and transports himself back to his old hospital to be treated by a colleague. There are a few problems with this scene.

Problem #1: That there is a sterile operating room in the ER. No, this isn’t standard. Can sterile procedures be done in the ER? Yes, but not a sterile operation as in the OR.

Problem #2: Wrong ECG rhythm. Dr. Strange has diagnosed himself with a pericardial tamponade. A cardiac tamponade is where fluid is collecting in the sack around the heart thereby impinging on the heart’s ability to pump blood.

The rescue procedure for this is a pericardiocentisis— or removal of the fluid from around the heart. His love interest confirms the diagnosis by percussing his chest. This is probably the least reliable way of diagnosing this problem. Any well equipped ER should have some sort of bedside ultrasound to aid in the diagnosis. The ECG monitor first shows a rhythm of bradycardia— the heart beating too slowly. This again is one of the least likely rhythms related to this condition.

Problem #3: Wrong placement of the needle. In the movie, the doctor is shown placing the need straight into the chest. It should be at an angle pointed to the left shoulder which this nifty video on You Tube shows.

Problem #4: Shocking asystole: I’ve blogged a lot on this. You cannot shock asystole. It won’t improve the outcome for the patient and is contraindicated. First treatment is high quality CPR and a dose of epinephrine or adrenaline. Also, this is not the correct paddle placement for defibrillation. It should be just to the right of the patient’s sternum and over the apex of the heart or more to the left side. They also cannot be placed over clothing.

Problem #5: OR is next. Most likely a patient like this with penetrating trauma to the chest would likely go to the OR, or at least some follow-up radiology studies. Not just stitched up and sent on his way.

Medical Review of the Movie Flatliners 2/2

I’m continuing my review of the movie Flatliners that released last year which is a reimagined redux of the original 1990 movie.

In the movie, a group of medical students intentionally put one another into cardiac arrest so they can have a near death experience (NDE). Let’s examine medically whether or not their method would work.

The plan is to anesthetize the inductee with Propofol (which is a short term anesthetic), cool their core body temperature, and then defribillate them with electricity causing them to flatline. Keep in mind, asystole means there is no electrical activity happening in the heart. You can read a post I did here on how electricity or defibrillation really works.  Amazingly, in this medical center’s basement in another fully functional hospital with a very expensive MRI to be used during a disaster.

Issue #1: A medical center has a fully functional part of the hospital with an expensive MRI that is doesn’t use. Any empty, unused space in the hospital is a drain on the budget. Especially an expensive piece of radiology equipment. No sane hospital anywhere would be leaving that piece of equipment unused in a basement.

Issue #2: What they show is not an MRI. MRI scans take a long time and can never be done in 60 seconds.

Issue #3: Trusting a fellow medical student to resusciate you. Need I say more?

Issue #4: Knowing that they are going to put someone in cardiac arrest, no one really bothers to hook up a resuscitation bag.

Issue #5: During one code that begins to run several minutes, one of the students orders another to put the cooling blanket back on because “she’s too warm”. This flies in the face of every resusciation protocol there is. There is a somewhat well used phrase that you must be “warm and dead”. Suboptimal body temperature makes resuscitation more difficult. They are only making their job harder.

Issue #6: Endotracheal tubes have a balloon on the end that must be inflated to stay in place and deflated to take out. No one seems very concerned about this.

Issue #7: You cannot deliver electricity over clothing. Bare skin only. Also, paddles are really not used any more for a variety of reasons. Most hospitals have transitioned to patches. The paddles are used as a back-up.

Issue #8: Propofol is a distinctive milky white substance. Seems easy enough to draw up some milk in your syringe for the movie to simulate this.

Issue #9: You cannot shock a heart that is in asystole into a normal rhythm. You can see my post above for that. Can you shock someone into asystole? There is a rare possibility that you can shock someone and stop their heart. However, the common rhythms a person would go into because of this is V-tach and V-fib and not asystole. The movie depending on this rare event for every flatline is unrealistic.

Issue #10: You can tell when a shock is delivered to a patient because generally they have quite a few muscles contract. Patients never come up off the bed as dramatically as on film or television. In fact, I’ve never seen a patient come up off the bed at all.

Have you seen Flatliners? What did you think of the medical aspects?