1 / 188
Sep 2021

So, here’s the thing. I LOVE reading and I LOVE leaving positive comments on Tapas. I don’t really care if the English is broken, the plot is thin, or the pros are repetitive, I will always find something positive to say. I have very strong inhibitions against critiquing people, particularly when unsolicited. But the one time I feel really tempted to break my golden rule to only ever be positive in the comments section of someone’s work is when they make medical errors in the plots. Even then I usually won’t say anything, because, let’s be real, no one asked MY opinion and who really cares if it’s inaccurate?

Me. I care. So I decided to make a forum for it.

Here’s the gimmick: I’ll review your comics or novels for medical accuracy... and I promise to be nice about it. My qualifications are as follows: I am a doctoral prepared Family Nurse Practitioner who works in a outpatient family practice, diagnosing and prescribing acute and chronic conditions across the lifespan. Prior to working as a doctor, I was a intensive care unit nurse for six years. I practice holistic medicine, so if you have questions about natural or Eastern remedies I can help with that too. I don’t pretend know everything, but I know how to find out anything you ask, either through medical research databases or the six doctors in my immediate family. (Yeah, conversations at family dinners are interesting to say the least.)

So ask away! Post your questions or links to chapters in your novel with medically related plot points. I’ll tell you what’s inaccurate and how to fix it.

I’ll start out by posting just a couple famous examples that I see really frequently in books and TVs and then the space is all yours to ask questions!

  • created

    Sep '21
  • last reply

    Sep '22
  • 187

    replies

  • 11.1k

    views

  • 39

    users

  • 347

    likes

  • 50

    links

Frequent Posters

There are 187 replies with an estimated read time of 101 minutes.

CPR:
Ok writers: first point of order is to debunk some myths about CPR.
Most importantly, it doesn’t bring people back from the dead. When you pound on someone’s chest, you are literally manually pumping their heart with the goal of pushing blood to the brain. If you do not reverse whatever caused the heart to stop in the first place, a person will not spontaneously regain their heartbeat through CPR. If you have specific questions about what causes the heart to stop and how we treat those conditions: ask away!
The other thing I see quite frequently is people waking up immediately after CPR. The MC pumps on their best friend’s chest a couple times, maybe delivers an electric shock, and voila! They open their eyes. Doesn’t happen. Most people are comatose for at least an hour or two (if not several days) before they begin to wake up after cardiac arrest and even then they are extremely confused and lethargic.
The only exception I can think to these two rules is maybe a child who drowned/choked on something. CPR can act as a pseudo abdominal thrust for choking children, forcing the object or liquid that is obstructing the airway out. Kids (I’m talking young kids under the age of 12) are also more resilient than adults, so if they are under for less than one round of CPR (two minutes) they may wake up pretty quickly (but they still will be confused and tired).

Amnesia:
The second most egregious offender is the amnesia trope. Unless it’s magic, then do whatever you want. For everyone who wants to write semi-accurately about amnesia... maybe don’t? It’s sort of way more depressing than you think.
Basically there are two forms of amnesia: retrograde (the ability to retrieve memories) and anterograde (the ability to store new memories). When I see anterograde amnesia portrayed, it’s usually accurate. Everyone seems to get how to write a Dory character. Retrograde amnesia is usually wrong.
There are three types of retrograde memory: episodic, procedural, and semantic. When we are talking about a person’s ability to remember events in their own lives: that’s episodic memory.
Most of the time, episodic memory lose is temporally graded, meaning a person will forget more recent memories first. So, for example, a person with a traumatic brain injury (like falling down a flight of stairs or being tortured with electrical shocks in the lair of an evil villain) will have more trouble remembering events closer to the time of the injury than events from years prior. Think about it like someone with Alzheimer’s disease for a reference of what I’m talking about: they may recognize their children, but not their grandchildren.
Global episodic retrograde amnesia (forgetting everything about your life) is stupid rare and basically never happens expect in advanced stages of disease and is almost always accompanied by anterograde amnesia. Do I have people in the ICU who can’t remember their own name? Sure! But they also can’t hold meaningful conversation and forget everything I say.
Most important thing to remember is that if a character has any form of retrograde amnesia and they are not critically ill: that amnesia is permanent. Amnesia that is not associated with illness (i.e. low-oxygen states, increased intracranial pressure, infectious diseases, or encephalitis) is associated with brain damage and we don’t ever regain what we’ve lost in the brain.
Now, disclaimer, suppressed memories associated with emotional trauma are a whole different story. But, in general, all these stories where the MC forgets who they are and then goes on a journey of self discovery to remember their past life? Completely inaccurate.
Just don’t do it or call it magic. Or do it, I don’t know. It’s your story.

Wow, have you been reading my series? Thank you! Please leave a like and comment. (joking)

Actually I'd like a review on some of "medical-related" scenes which isn't entirely meant to be accurate due to the fantasy nature of it (I love giving myself a loophole), but I think it needs to be grounded in reality.

How many chapters are you willing to read? Or should I only give you the relevant excerpts? Are you willing to be contacted via DM? Thank you very much in advance.

Oh, I'm just writing a chapter about someone giving naloxone injection and doing CPR. It's not yet published but would be great if you can have a look at it. Let me know and I'll give you the link

Yes! I’ll check out the first little bit of it and if it’s my jam, I’ll read everything. If not I’ll just read the scenes you need some advice on. I’m open to reading as much as you need given enough time. I can absolutely DM you. Send me a link to your series!

Absolutely! This is exactly why I made this forum! Send me the link and tell me where you would prefer the advice to be sent to you!

Wow, well tickle me pink and color me intrigued! There is a lot to unpack here.
At first, when you primed me with a mental health issue, I thought we were going with binge-eating disorder, then it took a sharp left turn when you mentioned the color of his blood!
Ok, so, first off, obviously, only magic (or sci-fi equivalent) would cause someone’s blood to be blue or purple. The notion that deoxygenated blood is blue is not true. It’s really dark red, nearly black. But, I’m assuming this is a magical thing, so let’s side-step that for right now.

Let’s talk about headaches! That’s actually my specialty! (So I apologize in advance for the long-winded response in advance.) There are over 100 types of primary headaches and not all of them are migraines. There are actually super specific diagnostic criteria for migraines that most people who say they “have a migraine” don’t meet. When we are talking about headaches caused by stress, that is a tension-type headache. It is not associated with any other symptoms specifically, like dizziness or fainting and never causes people to become unconscious. Migraines, on the other hand, are not caused by stress, although stress can trigger or worsen a migraine.

Funny enough, Leo, actually does meet the criteria (kinda) for migraine. I would classify his headache as specifically vestibular migraine. Vestibular migraine is accompanied by an aura (or warning sign of impending headache) of dizziness. Like you describe, the dizziness can actually come without headache, but usually occurs 5-30 minutes before the onset of pain (so what you’d describe happening is a bit fast and puts the pain coming first before the dizziness which is out of order). Feeling unbalanced is not uncommon, and indicates vertigo. People report feeling like they are walking on a boat or on clouds or even marshmallows.

Vision changes are also pretty common auras. Again, this would happen 5-30 minutes before the headache and can persist for the duration of the headache or go away after the pain starts. Leo describes his vision getting “hazy”. You could be more specific here. While visual auras vary, the most common types are tunnel vision (blackening of the peripheries), double vision, visual snow (think TV static), and light spots. I would personally go with double vision or tunnel vision for Leo’s condition, just because it is more closely associated with vestibular migraine than the other two.

Here’s the most important inaccuracy I caught: no primary headaches (neither tension type or migraine) cause lose of consciousness. Not even hitting your head causes lose of consciousness longer than a few seconds and any lose of consciousness for any length of time is a sign of serious concussion or brain damage. I see characters knocked out by a blow to the head (either falling or in a fight) in novels or TV frequently, but this doesn’t happen normally and if it does you won’t be “waking up normal” in a few hours. That’s a one way ticket to the ICU and permanent mental deficits for life.

Good news is, I don’t really think it would disrupt the flow of the novel to just axe this bit. Migraines are plenty freaky and disabling without needing to fall unconscious. Associated symptoms which may make Leo “out for the count” include fatigue, mild confusion, difficulty concentrating, sensitivity to light and noise, difficulty speaking, forgetfulness, allodynia (finding non-painful stimuli painful), nausea, and even vomiting. Just think about being incredibly sick and how you can’t to be around anyone or do anything. Then multiply that feeling by a thousand and that’s what a migraine is like.

Now, the headache pain itself is usually one sided, behind the eye or side of the head, throbbing (like you said), and lasts 4-72 hours. Interestingly enough, migraines are genetic, so if his dizziness is related to this blood thing that might be a cool point for accuracy! However, migraine is not a mental health condition, but a primary neurological disorder, meaning their is no known cause.

So in conclusion, it would not be unreasonable to have Leo feeling irritable, dizzy, room spinning, double vision, sensitive to noise and light for about 5-15 minutes prior to when he starts to feel pain. The pain when gradually worsen over the course of 15-60 minutes and his condition would rapidly decline from there. He would most definitely say he needed to lie down, maybe fall on the way there, pick himself back up with the help of Savannah, and then fall asleep on the coach. If she tries to wake him, he will open his eyes or shake his head, moan and groan saying she is hurting him just by touching him, complain about some nausea and the room spinning, maybe vomit, and proceed to make zero sense if he tries to speak at all. (Like pretend someone is drunk.) Then she goes to get Oliver who maybe has a friend or a relative who gets migraine headaches (super common, very likely) and assures Savannah he will be ok and won’t need to go to the hospital. She can put a cold pack on his forehead or behind the neck for pain relief, turn off the lights, tell her he needs quiet, and maybe try to get him to swallow an ibuprofen or ginger (for nausea). Maybe she even has some Excedrin Migraine or Zofran (really common antinausea med, needs a prescription, but it’s used for so many reasons it’s not unheard of to have some lying around) in her meds cabinet for him to take. He wakes up a few hours later with a lingering headache and without any memory of much after he hit the coach. He wouldn’t rub his eyes though, because that is sure to be very painful due to lingering allodynia. Trust me when I say people who have migraines would never say it can’t get worse, cause anything to “take the edge off” is vital to them.

Can we ask questions if we're working on comics?? :flushed:

..or will that get us flagged for going off-topic? :sob:

I don't have anything to link btw lol it's all a script for now

So one of the two big injuries I wanna showcase requires a bit of context, it's two people fighting a big monster in a city, and it's snowing heavily (basically blizzard conditions).

He gets swung at and he's not able to dodge it in time. So he gets flung into a car, more specifically, his back hits one of the side mirrors and he's out of the fight for a good while. He lies in the snow for a few minutes. A nurse comes on to the scene to check up on him and come to find: he's not capable of answering any of her questions, his breathing is uneven and labored, and he's bled from the mouth and has already stopped. He's then able to limp and talk on his own for a few steps, several minutes after. He feels the intense pain from the injuries during that time, but is able to just barely put up with it. (That is.. before he heals himself magically, which has its own consequences, blah blah blah)

What I'm aiming for: Broken ribs, punctured lung, shock from the sudden injury. Said injury is severe, but it won't kill him immediately. I tried not to let the weather conditions make the injury that much worse, but considering the quick amount of time this happens in.. I figured it wouldn't make too much of a difference. I realize an injury like that would probably have him out of it for a few hours instead of minutes, but um it's influenced by anime and that doesn't always follow rules lol

So like, am I good or- like, what's up? What you got for me?

Content warning for both links in this post: Graphic depiction of injuries which maybe disturbing for some viewers. First link has no blood, but depiction of real patient with abnormal anatomy. Second link, minimal fake "TV" blood and depiction of surgery.

First off! Love it! It actually is pretty good and fairly accurate in that he actually would not pass out from this injury.
What you are describing is a hemopneumothorax caused by compound rib fracture puncturing the pleural sac. This is a medical emergency, but is actually really easy to treat. While extremely painful, very uncomfortable, and most certainly will affect a person's ability to communicate, it is not something that would immediately affect his mental status. So that's great for you! He could totally be alert enough to walk (if he had the pain tolerance of a titan) and heal himself through magic. Cold has zero affect upon the seriousness of this condition, so point for accuracy there too!
So let's break down what exactly a hemopneumothorax would look like when the nurse finds him:
1. He would be actively bleeding internally which wouldn't appear as blood in the mouth as much as blood in his cough. He would have a dry, hacking cough with a bit of bright red blood mixed in, which might stain his mouth, but probably not. Blood is not very viscous as is usually dissolved by the spit fairly quickly.
2. He would have severe chest pain which would make it difficult for him to move around (but not impossible) and difficult to concentrate.
3. His heart would be racing and the oxygen content in his blood would be dangerous low. While he probably would be conscious for several minutes to maybe up to an hour, the effort to breathe would eventually tire him out and he would lose consciousness resulting in serious brain injury or death if left untreated.
4. Talking would be extremely uncomfortable. While technically possible, he probably wouldn't even try, because it would require too much airflow and effort. People with lung injuries generally are gasping so much they don't have time between breaths to speak. They tire very easily from mundane tasks.
5. Breathing is where it gets fun. There is this really weird thing that happens when you have a destabilized pneumothorax called fail chest. It's difficult to explain what it looks like, so I've just linked a video here3. Basically what is happening is every time he takes a breath in, his chest cavity caves inwards at the point where the ribs are broken. (So if they are broken on his back and to the right, that's where you would see it.) This is super distinct sign of pneumothorax with broken ribs and something the nurse would pick up on immediately.
6. Now lets talk about magic healing and medical management of pneumothorax. To understand the treatment, we must first understand what is going on inside a little better first. The pleural sac is made up of two layers: the visceral which lines the lungs and the parietal which touches all the other organs and structures in the chest cavity (including the ribs). The potential space between these two layers is called the "pleural cavity" or "sac". Normally there is nothing between the two layers and the pressure is actually measured in negative mmHg, that is why it is a "potential space". When a rib punctures through the pleural sac, the pleural cavity becomes exposed to the inside of the lungs which is connected to the outside air. Suddenly that space can be filled and because the pressure is so much lower in the pleural sac than anywhere else, it is filled... immediately. The lung collapses very quickly like a deflated balloon with a hole in it as seen in this picture.
So, what happens when you "magically close" the hole in the lungs? Well, unfortunately, all that gas and blood (the hemo part of hemothorax) stays inside the pleural sac. It doesn't have anywhere to go, so the lung can't re-expand. In real life, we allow the body to naturally heal the lungs over the course of several days to weeks while simultaneously draining gas and blood through an incision in the chest. Placing a chest tube to drain gas and liquid in the pleural sac is the first and most important treatment for a pneumothorax and should be done as soon as possible to prevent respiratory failure (basically where you stop breathing). If you want to see a really cool makeshift and accurate example of a homemade chest tube done "in the field" check out this clip2 from The Good Doctor. I would totally do something like this to save someone's life if proper medical equipment was not immediately available. Good Samaritan Laws protect medical professionals from being sued when they give lifesaving treatment outside of the hospital, so I could totally see this nurse stabbing your MC with a knife, inserting a straw into the opening, and then allowing him to heal his interior while blood leaked out of the makeshift hole she made. Gross and a neat limitation on healing magic. :smiley:

currrently i don't have any questions, but will bookmark this topic in case i get a medical question :grin:

Ooh, ooh! I have a general set of questions. Since it's a persistent thing, there is no singular chapter or section to point to.
But in my story, the protagonist suffered from a severe burn to her scalp as an infant. I'm thinking third degree since it has left a lasting scar on her scalp now in her mid-twenties. It hurts her sometimes when it's been agitated or been in the sun. I read that burn scars can be more sensitive, even after they've healed, as sometimes the nerves are totally damaged or healed incorrectly.

Her scarred skin is also uneven in texture and pigment as well. I would rate her as a III or IV on the Fitzpatrick scale and I describe her burn as slightly redder than the rest of her skin.

And since she got it when she was super young, I'm pondering how it would grow with her body, like if stretch marks would affect the area and essentially make the uneven skin grow in proportion with her as she aged through puberty.

I'm just wondering how well I got this down, if I'm missing any details, or if I need to explain some of the lingering effects (appearance or otherwise) with magic since that exists in the story.

And thank you for doing this! This is super helpful! (Wish you were around before I was a novel deep into this story :joy:)

OMG THIS IS THE TOPIC I REALLY NEEDED!!
I'll share what I've found on the internet and I might need your help about motorcycle accidents, and the paralysis (Paraplegia specifically) that would caused by spinal cord injury, how would the process when the injured person first gets to the hospital works..

Thank you so much for the positive feedback! Honestly, I wasn't sure if anyone would be interested in this, so am very happy to see responses. :blush:

Burn scars will vary in appearance based upon what caused the burn (fire, hot liquid, or steam). Most will fade from red to white (or paler than the surrounding skin) over years. Uneven skin texture is mostly closely associated with fire burns, with water burns having a splash pattern and steam burns appearing circular or linear.

Growth will certainly stretch a scar, but not during puberty in this case. By the time we are one years old, our head has almost reached our maximum size (which is why babies have adorably oversized heads compared to their bodies). When we are born our average head circumference is 36 cm. By the time we are one, it increases 14 cm to a total of 50 cm. Over the next eight years we only grow half that much to 57 cm. Fully grown adult head circumference averages 59 cm.
So, your protagonist's scar would not have changed significantly during her teenage years, only getting less red and paler with time.

Burn wounds are extremely sensitive, even years later, so kudos to you! She probably would feel discomfort brushing her hair, using a blow dryer, or showering. This is a condition called allodynia in which non-painful stimuli becomes painful. Topical lidocaine and gabapentin can help treat this type of pain. For a more medieval (or natural) remedy topical creams made from cayenne peppers relieve nerve pain.

Finally, I will just briefly touch on concept of Total Body Surface Area (TBSA). When you sustain a burn of second degree or higher, you break the skin barrier which keeps water inside of the body. We actually lose evaporated water through burns proportional to the surface area of the burn. This can lead to severe dehydration, particularly in children who have much less water to spare. Any "healing", real or magical, for a burn must replace water lost during the injury. How much fluid a healer needs to give depends upon the percentage of TBSA affected. Typically we give 3 mL/kg body weight/% of TBSA of fluid repletion.
Burn wounds are extremely deadly for infants, because their surface area compared to their weight is so much higher than in adults. Burns to the head in infants are even more deadly because the head comprises 21% of babies TBSA. So, let's assume your MC was 5 kg as an infant and burned half of her head (10% of her TBSA). She would need to receive 150 mL of water shortly after sustaining the burn in order to not die. So, when you are writing magical healing, think how water incorporated back into the body through magical means. :blush:

Glad I'm here to help!
Just to recap topics you want me to cover are:
1. Motorcycle Accidents
2. Paraplegia
3. Triage in the Hospital Setting

I'll make a separate post for each topic so other people can more easily sort through useful information. Please send me any more specifics or links to your works that might help me narrow these topics down, otherwise you will just get nurse Breezy's long winded explanations which may or may not help you. Haha. :joy:

Ahhh, ok. Gotcha. Listen, that flail chest video is gnarly :grimacing: I'd have never imagined that could happen to the human body, but I mean, with you explaining it.. That's just plain logic lol it's a price my boy is willing to pay :smiling_imp:

So, here's my main takeaways and changes I'd be making with your super helpful comments..

  • Should probably change the blood situation, it's more like coughing it up instead. Blood stains unlikely, but not impossible.. Which works for me! I was gonna stain his mouth regardless.
  • I gotta have the nurse untuck his shirt and lift it to see what's going on with his chest. He's wearing a full suit and tie. It'd be safe to assume it probably won't be visible enough through his clothes in that situation, right?
  • Everything you said about talking! I should've mentioned how much he says, but lucky for me, he only says 4 words before healing himself. He musters up enough strength to say "Please take me back", so he can finish the fight. It works out for me!
  • You brought up time. So the battle itself is roughly 20 minutes, but 7 of those have my guy kinda dealing with this. I had the nurse decide to take him indoors with the help of a couple guys to prevent adding on hypothermia to the injury. (Again, blizzard conditions, there's no way she'd know how long the fight would last.) Definitely wouldn't pass out with the pace I have going. That works for me!
  • As far as the draining of liquid and gas goes.. There's definitely enough materials to make a chest tube. They intend to drag him into a.. totally not Starbucks. While a makeshift chest tube would be cool, there's also an oppurtunity there to let the magic to also do the same job..? Hear me out, the healing process could involves his own flesh essentially ripping itself apart enough to where the incision has to be made, and the magic forces his body to air the contents out from that area kinda like this, but from his back. Like I said, healing has consequences.. What's one more? :imp:
  • Based on what I looked up, there's specific ways to carry injured people so their wounds don't get worse and I used one. He's carried by two guys at his sides, his arms over their shoulders. After his little "take me back", he stands on his own and walks a few steps forward before healing up. I forgot to bring it up, but does affect his insides in any significant way?

Ty for answering us, I hope you have a wonderful day