Polite Dissent

More than once, I’ve pointed out when a penciler takes a little artistic license and draws extraneous IV lines, tubes, and wires in hospital scenes.

This cover, however, takes to a new ridiculous extreme. Exactly how many tubes and wires does John Lynch need?

cover from Team 7 #2, art by Aron Wiesenfeld

Looney Tunes and Merrie Melodies #21 (Dell, 1943)

And what would Independence Day be without a clip from the musical 1776? Here’s one of the songs, “But, Mr. Adams,” concerning who gets to has to write the Declaration of Independence.

Just a few days past Independence Day, so I thought America — and in particular, democracy — would be a good theme for this week’s public service ad. Luckily, Peter Porkchops and his friends were able to oblige with this PSA from August 1951.

Peter seems a little unclear on the differences between a democracy and a republic, and he manages to work checks and balances into his confusion, too. At least his heart’s in the right place — rather than some other pigs I know.

This PSA can be found in various DC comics from August of 1951. It was written by Jack Schiff, with art — I believe — by Otto Feuer.

More PSAs

Tags: comics psa peter porkchops wolfie democracy jack schiff otto feuer

Black Lightning Year One #4
Jen Van Meter, writer
Cully Hamner, penciler

Black Lightning (Jeff Pierce) comes home and finds his friend Peter shot and dying on his front steps. When he cannot detect a pulse, Jeff gives him a large shock.

For once, I’m not going to lecture about “don’t shock a flatline” because that’s precisely the problem — we don’t know what the heart rhythm is. Jeff checked the pulse, but Peter’s lost an awful lot of blood (check the comic for yourself to see, I can’t reprint every panel) — there’s probably not enough left to give any sort of pulse, even if the heart were beating normally. Jeff may be shocking a heart beating normally, or one in ventricular fibrillation, or a flatline — the point is he doesn’t know, and so it’s not a good idea to blindly shock.

Peter’s problems are his massive blood loss and his gunshot wounds. Any heart issues are secondary to these. It’s fine to treat the heart, but it’s not going to do any good if the hemorrhage isn’t dealt with quickly — or if one of the bullets wounded the heart.

Other Thoughts:
1. Now in real life, a situation like this isn’t going to happen: if you have access to a modern defibrillator or an AED, you have access to a basic heart monitor because they are built into the machine. Sure, the monitor’s not usually fancy, but it’s enough get the job done.

2. The reason two paddles are used in defibrillation is to make an electrical circuit with the heart in the middle. Is that what’s happening here? Is current flowing from one of Jeff’s hands into the other? (His hand position’s a little off too, unless he meant to defibrillate the sternum.)

3. Admittedly, Black Lightning’s reaction here is more emotional than medical, and I can’t really fault him for that — but I can use him as a teaching point.

4. Kudos to Jeff for remembering to open up Peter’s shirt before shocking him.

5. If it were me in this scenario? While the electrical powers may look cool, they don’t really change the treatment: I’d keep the airway open, stop the bleeding as much as possible, and provide CPR until properly equipped help arrived.

6. As cliché would have it, despite being found down and pulseless, Peter is able to revive enough to whisper his last words to Jeff.

Looney Tunes and Merrie Melodies Comics #72

This cover represents the perfect intersection of two common comic book medical clichés: the head mirror and the x-ray cover gag. (And if I start to see a bunch of comics with doctors who don’t wear pants, then this comic cover has a third cliché covered as well.)

In Las Vegas the next few days for a couple of conferences. First, the Science-Based Medicine Conference, then a couple of days at The Amaz!ing Meeting.

Then, we’ll squeeze a few days of vacation before heading back home.

Here’s a head mirror scene that’s almost right. The doctor is wearing the mirror over one eye, instead of in the middle, but the hole in the center of the mirror should be over his eye, not his forehead.

He also appears to be an ENT (Ears, Nose, Throat) doctor as vocal cords fall under their specialty, and ENTs are the doctors who use head mirrors the most.

Of course, while he appears to be looking in her mouth, there’s no way he’d be able to see her vocal cords like that. The cords are found in the neck-portion of the throat and you need special equipment (like the laryngeal mirror, below left) to be able to see them.

Still, a good try.

From Action Comics #159, where the plot centers on the fact that Superman has to do whatever Lois tells him to do — but then she gets laryngitis, so she can’t tell him anything.

The boyfriend of high schooler Dinah Lance (eventually to become Black Canary) is a wannabe rocker and convinces her to sing a little for him.

On one hand, I’m pleased to see the writers stick with the previously established value of 300 decibels for the Canary Cry (though at that point she was using an artificial cry). On the other hand, the doctor/scientist in me remains concerned — and somewhat amused — by the misunderstanding of the unit “decibel.”

A decibel is a unit used to measure the strength of sound waves. Decibels are measured on a logarithmic scale, meaning that each integer value is geometrically larger than the one before it.

After a certain point, it is better to think of a high decibel sound as a shock wave rather than simply a sound wave. For example, a sound of 200 decibels would be equal to the shockwave produced at the epicenter of a Richter 1.0 earthquake, and this is also the level at which most humans would die of exposure to the sound.

The power of Dinah Lance’s 300 decibel scream is substantially greater than the force wave produced by the atomic bombs dropped on Nagasaki and Hiroshima…combined. Her scream would have:
1. Killed, if not entirely pulverized, her boyfriend.
2. Destroyed the football field and stadium, and likely most of the town as well.

For more on Black Canary and decibels, check out my look at her role in JSA #6

Tags: comics medicine decibel black canary

Buzzy — who seems to be DC comics resident stick-his-nose-in-other-people’s-business do-gooder — takes a moment to remind us all to be kind to our elders.

This is not the first time a comic book public service ad has addressed this issue.

This PSA is found in DC comics from September 1951. It was written by Jack Schiff — of course — with art by Win Mortimer.

More PSAs

Tags: comics psa buzzy old folks jack schiff win mortimer

Storm’s CPR technique starts off looking quite good. Her rescue breathing appears fine, and her hand position — and correctly interlocked fingers — are impeccable.

However, when the traditional CPR doesn’t work, she reaches back and gives Cyclops a hard thump on his chest.

And that’s the problem.

The precordial thump is an actual medical technique — but it is only used in very limited circumstances. Consider how the precordial thump works: it doesn’t restart the heart or help circulate blood through the body, but instead works by interrupting dangerous heart rhythms such as ventricular fibrillation. The thump is only supposed to be used if the patient had a witnessed cardiac arrest (the rescuer actually saw the arrest occur), and only at the very beginning of resuscitation. Only one blow should be tried. The precordial thump has a small, but real, success rate (it depends on your source, but positive results are — at best — 25%). If it fails, the rescuer then proceeds with normal CPR.

By the time Storm gets around to performing the thump on Cyclops, it is too late for it to have any effect. She’s also being overly aggressive in her technique, and is likely to injure Cyclops along the way.

Both the attending and the medication took their sweet time to arrive and by the time they showed up in the room, we’d had to thump him two more times. Luckily, the magnesium sulfate worked and his torsades never recurred.

Blackest Night #1
by Geoff Johns and Ivan Reis

I know it’s just a typo, but still, it’s funny.

As far as I can tell, Damage either means:

It can be challenging enough to diagnose a patient’s problem in the real world — just imagine how difficult how much more difficult it would be in a comic book world where magic, psychic powers, aliens, advanced technology, and Grant Morrison all exist. Here are a handful of actual comic book medical cases — are your diagnostic skills up to the task?

If these case studies are new to you, start here for a more in depth look at differential diagnosis in a comic book world, as well as Case Studies #1 and 2
Case studies #3-5 can be found here.

I know this is supposed to be an uplifting public service ad, along the lines of “You didn’t make the team, but you can still contribute!” — but the cynic in me sees it as advice to youngsters to give up their dreams and settle if they don’t succeed at first. Or if you want to be really, really cynical, the ad is basically saying, “Sorry the girl of your dreams is going to marry someone else, but you can still be the photographer at the wedding!”

When Fred grows to become a bitter disillusioned sportswriter, with a divorce and an ulcer by the age of 35, we’ll all know why.

Other thoughts:
It would have been nice for the coach to tell Fred that he didn’t make the team before he went out and bought the uniform, including those spiffy striped undershirts.
Of course, Fred should have actually practiced during the off season, instead of just reading about baseball.

This PSA was written by “King of the PSAs” Jack Schiff, with art by Bernard Baily. It can be found in DC comics from June 1959. This particular copy was scanned from Adventure Comics #261 (which has a couple of good stories in it, including Lois Lane first meeting Superboy, and Aquaman winning the day by telepathically commanding a water buffalo — get it: a water buffalo.)

More PSAs

Tags: comics psa baseball jack schiff bernard baily

From the medical point of view, Rags Morales has traditionally been one of the most accurate comic book artists. So it pains me to see that he has fallen victim to the “more is better” approach to hospital wires and tubing in this scene from Superman/Batman #55.

Let’s look at the good and the bad:
Clark is intubated (has a breathing tube down his throat).
…but also has a nasal cannula delivering oxygen.
Clark is receiving blood in an appropriate IV location.
There is a cardiac lead on the left-side of the chest
…but there is also one on the right-side of the chest, the right arm, and the forehead.

Looked at as the product of its times, Superboy’s method is not an entirely unreasonable attempt at resuscitation. It may seem obvious that Superboy should have gone straight to mouth-to-mouth resuscitation instead of building his contraption¹, but we have to remember that the current mouth-to-mouth² style of artificial respiration hadn’t been invented when this comic was published³. During Superboy’s era, two of the most commonly taught techniques of resuscitation — the Schafer method and the Holger-Nielsen method — had the patient positioned on their stomach the same way Lois is.

Still, there’s no way Superboy’s plan is going to work, and it comes down to A. Remember the ABCs of resuscitation are Airway, Breathing, and Circulation. Superboy’s skipped ahead to the B (breathing), but hasn’t done anything to make sure Lois’s airway is open. Until he takes care of that, he won’t be able to get any air into, or out of, Lois’s lungs.

The human airway has a tendency to close in on itself. To prevent this from happening during resuscitation, special breathing tubes are placed down the throat (intubation), positive airway pressure is used (bag mask ventilation), or special positioning is used. Superboy has done none of this for Lois. The way she is slumped forward, her airway is definitely closed and there’s no way Superboy will be able to force air into her lungs, no matter how much pressure he uses⁴.

Sorry Lois, Superboy should have skipped his super-resuscitation and just used the normal technique — you would have had a better chance of survival.

Notes:
1. That’s really more of a pressure chamber than an iron lung
2. or Mouth-to-mask-to-mouth
3. Adventure Comics #261: 1959. Mouth-to-Mouth rescue breathing 1972.
4. He’ll bust her eardrums long before he gets any air moving in her lungs.

Power Girl #3 “Gorilla Warfare”
Justin Gray and Jimmy Palmiotti, writers
Amanda Conner, pencils

I’m not going to say that Clozapine is the wrong medication to use on the Ultra-Humanite, but there seem to be a bunch of superior alternatives.

Background Information:
For starters, Clozapine is a type of drug known as an atypical antipsychotic.
The first generation of medications designed to treat psychoses such as schizophrenia were developed in the 1950s and are referred to as “typical antipsychotics.” Common typical antipsychotics include haldoperidol (Haldol) and chlorpromazine (Thorazine). They were effective, but tended to be extremely sedating and side effects were very common.
To address these concerns, a second (and now third) generation of antipsychotics were developed, and these are referred to as “atypical antipsychotics.” Common drugs of this class include onlazapine (Zyprexa) and aripiprazole (Abilify).

Clozapine was the first atypical antipsychotic.
Pro: It worked very well to treat schizophrenia and was not as sedating as the first generation antipsychotics.
Con: Unfortunately, a nasty and potentially fatal side effect known as agranulocytosis occurred all too often and because of this, Clozapine was withdrawn from the market by its manufacturer. When later research showed it to be good at treating otherwise untreatable schizophrenia, the medication was returned to the market, though only under very strict supervision.

The Question:
What is the goal of treating the Ultra-Humanite with an antipsychotic?

If the goal is to control his schizophrenia, then Clozapine is a reasonable choice. But is he really schizophrenic? There is no doubt that he is an extremely evil and amoral man/ape, but I see no evidence that he has schizophrenia — thus Clozapine is not the best choice. (not to mention that Clozapine is only available in pill form, there is no injectable version).

If the goal of treatment is to keep the Ultra-Humanite constantly sedated (so called “chemical restraints”) so he can’t escape, then one the first generation traditional antipsychotics would be a better choice. They are much more sedating, they are injectable, and while side effects are more common than Clozapine, they don’t tend to be as dangerous.

From 1944, this is an untitled wartime public service ad starring Batman and Robin…but mostly Alfred.

Like most PSAs from this era, this ad deals with recycling paper for the war effort.

If you’re not clear why, Alfred explains it well in the ad.

This PSA was found in Adventure Comics #91, published in April 1944.

More PSAs

Tags: comics psa buzzy old folks jack schiff win mortimer

The days of yore, when comic book publishers would put out a letter explaining the reasons for a price increase.

Instead of trying to do it sneakily and hoping no one would notice or care.

Time for another Comic Book Medicine Case Study. There’s a fair amount of discussion after the case study — not about the actual diagnosis — but about what the patient thinks it is.

Read more…