Polite Dissent

Ultimate Spider-Man #30 “Emergency”
Brian Michael Bendis, writer
Mark Bagley, penciler

Spider-Man has been shot in the shoulder by an overzealous police officer. With some help from Mary Jane, Peter Parker arrives at a nearby Emergency Room and collapses on the floor.

There’s clearly a little confusion in the scene, as the doctor is asking for the blood pressure just after the nurse tells him what it is, but you can chalk that up to the stress of the resuscitation, or maybe misplaced speech balloons.

Let’s take a look at what everyone is saying:
Number 8 ET tube — the doctor is considering intubating Peter and is ordering a 8.0 endotracheal tube, a normal size for an adult male. There’s no indication that Peter is having trouble breathing or protecting his airway, but the doctor is probably just being prepared. After all, “Airway” is the A in the ABCs of trauma.

Pulse Ox is Low, 82 — The Pulse Ox gives a quick approximation of the how oxygenated a patient’s arterial blood is. A normal reading is 99-100%. A reading of 82% is very low, and could be caused by a couple of things: First, it suggests that Peter may have lost much more blood than his other vitals show. Second, given the location of the wound, I’d be very suspicious that the bullet may have clipped the lung and given Peter a pneumothorax (collapsed lung), explaining the low oxygenation. Finally, a Pulse Ox machine fits over the finger and uses light shined through the nailbed to work, so anything that obscures light can cause bad readings — maybe Peter has web fluid or blood under his nails.

BP’s 132 over 82 — That’s a blood pressure in the normal range, or at most slightly elevated for a patient Peter’s age and size. A moderate blood loss should give a low diastolic reading (the second number), and a more severe blood loss would show up in the systolic (top number) as well. Certainly pain and stress can raise the blood pressure, but at this point he’s 1) passed out, and 2) has had the wound for quite some time so their effect should be minimized.

Pulse 110 — A slightly elevated heart rate, could be related to blood loss or stress.

A and O times four — Here’s the problem: this result is impossible. “A” stands for “Alert” and “O times four” means that Peter is oriented to person, place, time, and situation. It’s a quick neurological test. The difficulty is that peter is unconscious, and thus by definition in not alert, or able to talk to answer the nurse’s questions about orientation. Oops.