Polite Dissent

Batman: Legends of the Dark Knight #200 “Gotham Emergency”
Eddie Campbell and Daren White, writers
Bart Sears, artist

This comic’s a few years old, but it was just re-released as part of the Batman: Going Sane collection, so it’s fair game to discuss again. When it first came out — other than the unexplained use of a British medication name — I thought the medicine was good. However, on second review, while the authors do an excellent job conveying the feel of a hectic night in the ER, the medicine leaves a lot to be desired.

It’s a busy night in the Gotham General Hospital emergency room, and things get even worse when the Joker becomes involved. This story is told mostly through the eyes of Dr. Natalie Koslowski, an intern on the first day of her Emergency Room rotation.

Paramedic #1: Gunshot wound to the mid sternum, exit wound to back of the right shoulder. Blood pressure 100/50, Pulse 158, Respirations 36.
Paramedic #2: Unconscious upon our arrival.
Dr. Koslowski: Resuscitation. Establishment of airway and restoration of hemodynamics.

That’s a good start, Dr. K. But don’t forget the B of the ABCs of resuscitation (Airway, Breathing, and Circulation). Just getting an airway is not enough; you have to make sure the patient has good (or at least adequate) air exchange.

Dr. Koslowski: Symptoms suggest serious blood loss. Unless treated aggressively and in a timely manner it can lead to hypovolemic shock.

True, but take a look at those vitals. He’s already in hypovolemic shock.

Dr. Singh: OK. Let’s tube him, get blood gases, and 2 liters of O Neg.

Intubation is good — it establishes the airway mentioned by Dr. Koslowski (though frankly the paramedics probably should have intubated the patient before he got to the hospital).
Blood gases aren’t going to tell anything useful and are not going to improve the care of this patient one whit. Not to mention he’s being tubed, so his respiratory situation is changing (hopefully for better) and this will alter those blood gases.
Starting a blood transfusion is appropriate, but blood comes in units, not liters, in the United State. I suspect this is a second Britishism creeping into this American ER.

Finally, those paramedics didn’t do a good job at all. Looks like they wrapped the patient in a sheet, lashed him to a stretcher, and came to the ER. He should be intubated and have a couple of IV lines started already.

Cop #1: Help us. Look like Sam’s inhaled Smilex.
Dr. Singh: Rose, quickly get up to toxicology on the fourth floor. They have an antidote but it must be injected as soon as possible after inhalation.
Cop #2: Does this stuff work, man? Sam’s got kids.
Dr. Singh: It works if we can administer it quickly enough…If we get to the victim within the hour, we normally expect a coma for twenty four hours. Much beyond that it’s touch and go.

If time is of the essence, why is the antidote being stored in a closed department on another floor? Wouldn’t it make more sense to store it in the ER — at least at night, when the Toxicology department is closed?

This is only story I can recall where Joker venom is considered treatable, and one of the few where it’s called “Smilex.”