Polite Dissent

Medical errors show up commonly in hospital scenes. Tubes and wires running to and from the patient look impressive, but most are drawn incorrectly and probably not needed at all. Patients are commonly shown receiving oxygen, either by a face masks or nasal tubes known as nasal canulas.

This first lesson is going to focus on supplemental oxygen delivered by nasal canula because it is seen commonly in comics, and almost always wrong.

First, does the patient need to be on oxygen at all?
1. Do they have a lung condition (asthma, emphysema, pneumonia)
2. Do they have a heart condition (angina, heart attack, congestive heart failure)
3. Did they just undergo extensive surgery (especially if they were weak or sick to begin with)?
4. Is the patient a pregnant trauma patient?
If then answer to all these questions is “no”, then the patient probably does not need extra oxygen.
As a side note, a nasal canula can only provide up to 45% oxygen. Anyone who needs more oxygen then that will need a special face mask. Nasal canulas will not help someone who cannot breathe on their own; those people need to be intubated and placed on a mechanical ventilator.

Second, is the nasal canula shown correctly?
It needs to provide oxygen to both nostrils. It should be looped behind the ears (like a pair of glasses), then down the neck. The main reasons for this are comfort and mobility. Nasal canulas are already uncomfortable; they shouldn’t be pinching the nose or requiring tape to be held in place. It’s also important for the cannula to stay in place as the patient moves around in bed, or walks around.

Examples:
1. District X #1 – Officer Kucharsky suffered a grazing head wound. His lungs and heart are fine. He does not need to be on oxygen. Additionally, his nasal canula is drawn wrong as well, only providing oxygen to one nostril.

2. Daredevil #58, 59 (current series)– Daredevil was beaten up, but probably does not need oxygen (unless he suffered a pulmonary contusion or broken ribs and is not breathing deeply enough). The canula, while it goes in both nostrils, would not be comfortable and would fall off if he moved.

3. X-Treme X-Men #31 – The patient has a dual pronged nasal canula, but it is not looped around correctly and is taped in place. (And why is there a thick tube going to the eye socket? Ewww!)

4. The Dreaming #9 – Bridget is in a coma, and is hooked up to oxygen (but by very uncomfortable looking dual nasal canulas taped in place). I doubt she even needs oxygen: sShe’s not pregnant, and has no heart or lung problems.

5. Gen 13 (second series) #2 – Kudos to Chris Claremont and Ale Garza here (though I’ve picked on both of them before). Hamza is in a coma, but is correctly shown to not need supplemental oxygen.