X-Men — Manifest Destiny #2: A Medical Review

October 8th, 2008

Filed under: Comics, Medicine

X-Men: Manifest Destiny #2 “Kill or Cure, part 2″
Mike Carey, writer
Michael Ryan, Penciler

Bobby Drake (Iceman) has been pushed out of an airplane by Mystique. He lands in a small mountain lake and drags himself to shore. A local sheriff finds him and brings him to the Emergency Room suffering from hypothermia.

ER Doctor: Nurse, prep me an IV drip and a hemodialysis filter. And bring some blankets and glucose gel.

ER Doctor: Okay, we’ve got to get that core temperature up, slow and steady. Wrap him up warm abd plug into the dialysis machine for an hour. Then we’ll see.
Nurse: Not looking good. Blood pressure’s way down. Brain activity close to coma levels.
Bobby Drake: Cold! Got to — cold –

scene from X-Men: Manifest Destiny #21. First, let me start with the nurse’s comments. What the heck is she talking about in terms of “brain activity”? She’s not running any tests or an EEG to determine brain activity; she’s just checking his vital signs. Look at the scene: Bobby’s eyes are open, he’s gesturing, and he’s talking more or less appropriately, if hesitantly. That’s a Glasgow Coma Score of at least 11, nowhere near coma levels (which is 8 or lower).

Plus, if Bobby’s mental status is that bad, why is the doctor giving him glucose gel which he wouldn’t be able to swallow?

2. The doctor’s hypothermia treatment is appropriate, though I think he’s being overly aggressive. He is also overlooking a significant problem (see #3).

He is absolutely correct that the key to treating hypothermia is to rewarm the core temperature of the patient back to normal. How fast the patient should be rewarmed is still an area of some debate.

He seems to be treating Bobby as if he were a severely hypothermic patient, but the presentation doesn’t really support this. I’m sure that thanks to his Iceman powers, Bobby’s temperature is incredibly low and that’s throwing the doctor off, but he should also notice that Bobby is not demonstrating any of the other symptoms of severe hypothermia. For starters, he’s awake, breathing, and talking — all good signs. As my medical school instructors used to say, “Treat the patient, not the numbers.”

Blankets will help raise the temperature slightly (and so would putting some clothes on him), but warm packs would work even better. Heated IV fluids and warmed inhaled oxygen are other easy treatments. These will often be enough for the conscious, mildly hypothermic patients.

Patients with more severe hypothermia will likely require active core rewarming. Dialyisis (both hemodialysis and peritoneal dialysis) is one method of active rewarming and is a very effective method of raising a patient’s body temperature. Hemodialysis is a particularly good choice in cases where there is also kidney failure or electrolyte abnormalities. Neither of which seem to apply here, but there are times when you just have to go with whatever equipment is available. (On the other hand, it would be a very good idea to run some stat labs on Bobby.)

3. One last caution: hypothermic patients — particularly those who have been immersed in water (like Bobby) — the heart is very irritable and fatal heart rhythms are common. These patients should only be moved very cautiously and gingerly, and continuous heart monitoring is a must.

Tags:

11 Responses to “ X-Men — Manifest Destiny #2: A Medical Review ”

  1. Sable Hope
    October 9th, 2008 at 12:27 am

    they prolly had the nurse saying something helpful then deleted it for that angsty coment about comas. because angst is the new cool.:P

  2. Mike Blake
    October 9th, 2008 at 1:09 am

    By the way, shouldn’t his skin color be somewhat pale? He’s colored in exactly the same skin tones as the doctor and nurse.

  3. GAZZA
    October 9th, 2008 at 5:45 am

    Admittedly haven’t been reading the comics lately, but can Iceman really get hypothermia? If he wasn’t immune to the effects of cold, surely he’d be pretty much ALWAYS hypothermic?

  4. Carl
    October 9th, 2008 at 6:39 am

    Gazza, I bet what Bobby is trying to say is that he needs to be colder in order to recover. By treating him as if he were an unmodified human, the doctor is inadvertently harming him.

  5. Keith
    October 9th, 2008 at 6:56 am

    She knows his brain activity is low because she’s been reading the X-Men for years. It’s always been low.

  6. GAZZA
    October 9th, 2008 at 7:48 am

    Carl – you’re probably right, and I’m an idiot. :)

  7. Seth Finkelstein
    October 9th, 2008 at 4:25 pm

    I was under the impression that when Iceman wasn’t using his power, his body temperature was normal, though I can’t think of anything for or against that. It could be that when he activates his Iceman power he can’t get hypothermia, but if he can’t activate it for some reason (like he’s just been thrown out of a plane and has a concussion), then maybe he can indeed get hypothermia. It could be, like Carl says, that he’s trying to use his power in that scene but can’t concentrate enough to make it work.

  8. Mike
    October 10th, 2008 at 6:19 am

    If he’s received a concusion he would probably have at least one blown out pupil. Maybe the doctor should stop trying to mount Iceman and take a gander….

    And while he’s at it run a DCAP-BTLS

  9. Anonymous
    October 13th, 2008 at 11:59 pm

    isn’t he freaking iceman? how can he get hypothermia?

  10. Sean Duggan
    October 14th, 2008 at 11:33 am

    @Anonymous – *shrug* The same way that Colossus or Kitty could get hurt physical when not shifted? Or, for that matter, Husk, whose power was seemingly only skin deep. Marvel transformation seems to be an “all at once” thing where your normal physiology is replaced by whatever it is you turn into. And once you’re transformed, you are that material completely, so Frost can get shattered and survive and I want to say that Colossus has taken fairly deep damage and it’s metal all the way down. Therefore, pre-transformation, you only get the mutant ability to shrug off non-plot-related damage as “flesh wounds”.

    Admittedly, I don’t know if there’s any support for Bobby doing fine in the cold in his regular form. I know that initially, he stayed fleshy and was just surrounded by the cold (and in fact, looked more like a snow man) and it was only a later development that he turned fully into ice including the ability to melt (and reform!).

    By the by, did they ever do any development on the “he may be the most powerful mutant alive” bit they started on while Frost possessed him? Something along the lines of that his powers were actually temperature control and matter creation, and that mental blocks were all that kept him on this ice theme.

  11. JD Long
    October 14th, 2008 at 1:01 pm

    As a hemodialysis nurse I should comment here that “prepping a hemodialysis filter” won’t do you much good without the hemodialysis MACHINE. In fact, you can’t prep the filter without setting up and prepping a machine at the same time.

    Now what good hemodialysis would do is kind of a stretch. Using the onboard heater on a dialysis machine is a pretty radical way to warm the patient’s blood, but without a central line catheter or atrio-venous fistula to access the bloodstream

    it’s a waste of time. No access, no dialysis, no blood warming.

    Point of order: in an old issue of Marvel Team-Up from the 1980’s Iceman and the Human Torch were told my Mister Fantastic that they essentially had the same powers as “human heat pumps”, just externalized differently (Johnny externalizes the heat he absorbs from the environment, Bobby internalizes it.) That’s why Bobby never gets cold; he’s always toasty inside.

    Of course, that may not be canon anymore. Jim Shooter was EIC then. Your mileage may vary.

    ~~JD~~

Leave a Reply

« Top Five Robert E. Howard Characters Detective Comics #849: A Medical Review »