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View Full Version : Poor attention to medical details in 'Penance'.



Flyboy
December 22nd, 2009, 02:46 PM
SPOILERS



Fantastic episode, no doubt about that.

But fcol, I wish some writers would actually pay attention to modern conventions. Often with SG1 it's military protocols, however in Penance it was Jimmy's CPR that really bugged me. Jimmy's version of CPR was simply to repeatedly provide ventilations. Correct procedure is 30 compressions and 2 ventilations on a continuous cycle, with the compressions being the key element. It's a minor detail, but I really wish it would be taken into account.

majorsal
December 22nd, 2009, 03:29 PM
SPOILERS



Fantastic episode, no doubt about that.

But fcol, I wish some writers would actually pay attention to modern conventions. Often with SG1 it's military protocols, however in Penance it was Jimmy's CPR that really bugged me. Jimmy's version of CPR was simply to repeatedly provide ventilations. Correct procedure is 30 compressions and 2 ventilations on a continuous cycle, with the compressions being the key element. It's a minor detail, but I really wish it would be taken into account.

i agree with you in parts, but i guess i don't care enough to fuss on it.

sorry, fob. :p

jelgate
December 22nd, 2009, 04:35 PM
Actually last time I checked the American Red Cross said they were now only advocating chest compressions and did away rescue breaths. But that was a year ago so it may have changed.

Anyway yes Jimmy did give poor CPR in addition how poorly he dug out the bullet and wrapped Kate's bandage. But I've just learn to forget about since Stargate and a lot of other shows medical practices are poor and false. I think it has something to do with protecting the actors

Flyboy
December 22nd, 2009, 06:08 PM
Actually last time I checked the American Red Cross said they were now only advocating chest compressions and did away rescue breaths. But that was a year ago so it may have changed.

Anyway yes Jimmy did give poor CPR in addition how poorly he dug out the bullet and wrapped Kate's bandage. But I've just learn to forget about since Stargate and a lot of other shows medical practices are poor and false. I think it has something to do with protecting the actors
I can provide you with some fairly recent research that counters that information if you're interested.

The public are advised that if they feel unsafe performing ventilations, say for infection reasons, just to do compressions, as that in itself is better than nothing, but health professionals are required to perform full CPR with ventilations as they should have the appropriate protective equipment such as face masks or face shields.

The addition of two ventilations every thirty compressions can be essential to prevent cerebral deterioration. The caveat however is that within the first few minutes after a non-asphyxial cardiac arrest, compression only CPR in adults can be as effective as CPR with ventilations, but that's obviously time dependent, and is the reason why compressions are commenced before any attempts at ventilations.


Anyway, point is - it's highly unlikely Jimmy would have gotten her beathing again simply through rescue breaths, that generally only occurs with drowning victims or children.

jelgate
December 22nd, 2009, 08:31 PM
I can provide you with some fairly recent research that counters that information if you're interested.

The public are advised that if they feel unsafe performing ventilations, say for infection reasons, just to do compressions, as that in itself is better than nothing, but health professionals are required to perform full CPR with ventilations as they should have the appropriate protective equipment such as face masks or face shields.

The addition of two ventilations every thirty compressions can be essential to prevent cerebral deterioration. The caveat however is that within the first few minutes after a non-asphyxial cardiac arrest, compression only CPR in adults can be as effective as CPR with ventilations, but that's obviously time dependent, and is the reason why compressions are commenced before any attempts at ventilations.


Anyway, point is - it's highly unlikely Jimmy would have gotten her beathing again simply through rescue breaths, that generally only occurs with drowning victims or children.


No need too. I believe you. I know better then anyone that medical science is always changing thier position on issues

Amalthea
December 23rd, 2009, 09:40 AM
Actually last time I checked the American Red Cross said they were now only advocating chest compressions and did away rescue breaths. But that was a year ago so it may have changed.

Anyway yes Jimmy did give poor CPR in addition how poorly he dug out the bullet and wrapped Kate's bandage. But I've just learn to forget about since Stargate and a lot of other shows medical practices are poor and false. I think it has something to do with protecting the actors

I saw the chest compression thing on The Doctors (or maybe it was Dr. Oz?) less than a month ago. They still do advocate no more breaths, just compressions.

Doing realistic CPR on a live, non-critical condition person isn't a good plan. As long as it looks like conventional knowledge of what CPR looks like, what's the difference to the viewing masses?

Skydiver
December 28th, 2009, 04:55 AM
actually, if you're an actor doing cpr on a healthy person, you must do it wrong..or you'll kill them

doing 'good cpr' usually means that you'll break their ribs, mess up their heart rhythm and eventually kill them

CPR on tv is ALWAYS done wrong.

now, how convincingly wrong it is varies from show to show. on some, it looks real, on others, it's just laughable

Flyboy
December 28th, 2009, 05:51 AM
actually, if you're an actor doing cpr on a healthy person, you must do it wrong..or you'll kill them

doing 'good cpr' usually means that you'll break their ribs, mess up their heart rhythm and eventually kill them

CPR on tv is ALWAYS done wrong.

now, how convincingly wrong it is varies from show to show. on some, it looks real, on others, it's just laughable
Very good point.

But despite not being able to real CPR, you can at least simulate it correctly, as has been done in SG1, notably following Teal'c wound in Orpheous. Ignoring compressions completely is ridiculous imo.

Skydiver
December 28th, 2009, 06:47 AM
thing is, if Kate had a pulse and just wasn't breathing, compressions would have messed that up

honestly, i'm not sure if her stopping breathing from the pain is likely, she should have just passed out (and i won't go into the silliness of compounding the itty little hole, the lack of blood and the 'gotta get the bullet out or you'll bleed to death'

Jimmy did everything wrong until he simply put pressure on it (although, with a foreign object in a wound, the last thing you wanna do is apply pressure)

that whole thing was just all together wrong

Flyboy
December 29th, 2009, 12:09 AM
thing is, if Kate had a pulse and just wasn't breathing, compressions would have messed that up

honestly, i'm not sure if her stopping breathing from the pain is likely, she should have just passed out (and i won't go into the silliness of compounding the itty little hole, the lack of blood and the 'gotta get the bullet out or you'll bleed to death'

Jimmy did everything wrong until he simply put pressure on it (although, with a foreign object in a wound, the last thing you wanna do is apply pressure)

that whole thing was just all together wrong
Actually, we're taught to never both checking for a pulse, if they're not breathing and their airway isn't blocked or closed, then whatever happens they NEED CPR.

But yeah, otherwise you're right. The risk with the bullet was imo more likely infection, as opposed to bleeding to death, she wasn't demonstrating any signs of shock, so little liklihood of internal bleeding, and as you said, not much external bleeding...

siles
December 29th, 2009, 04:43 AM
SPOILERS



Fantastic episode, no doubt about that.

But fcol, I wish some writers would actually pay attention to modern conventions. Often with SG1 it's military protocols, however in Penance it was Jimmy's CPR that really bugged me. Jimmy's version of CPR was simply to repeatedly provide ventilations. Correct procedure is 30 compressions and 2 ventilations on a continuous cycle, with the compressions being the key element. It's a minor detail, but I really wish it would be taken into account.

Why should it bother you? jimmy wasn't a medical professional so it is reasonable he might not know how to perform CPR correctly

Flyboy
December 29th, 2009, 05:10 AM
Why should it bother you? jimmy wasn't a medical professional so it is reasonable he might not know how to perform CPR correctly
Ok.

It's also highly unlikely that ventilations would work as they did in the episode. Basically the episode made it look like all you need to do in order to get a casualty breathing again is provide ventilations - that generally only works in children and drowning victims.

The problem is I know how many people's opinions of how to do CPR are based on TV shows. If people repeat what they saw on Sanctuary, they won't do any good at all.

jelgate
December 29th, 2009, 06:41 AM
Actually, we're taught to never both checking for a pulse, if they're not breathing and their airway isn't blocked or closed, then whatever happens they NEED CPR.

But yeah, otherwise you're right. The risk with the bullet was imo more likely infection, as opposed to bleeding to death, she wasn't demonstrating any signs of shock, so little liklihood of internal bleeding, and as you said, not much external bleeding...

I was always taught you check for both breathing and a pulse before performing CPR.

Jumble
December 29th, 2009, 10:56 AM
thing is, if Kate had a pulse and just wasn't breathing, compressions would have messed that up

honestly, i'm not sure if her stopping breathing from the pain is likely, she should have just passed out (and i won't go into the silliness of compounding the itty little hole, the lack of blood and the 'gotta get the bullet out or you'll bleed to death'

Jimmy did everything wrong until he simply put pressure on it (although, with a foreign object in a wound, the last thing you wanna do is apply pressure)

that whole thing was just all together wrong

The thing that bothered me most was the fact that he was giving her alcohol (I assume that's what was in the flask), which is a definite nono for someone who has a bleeding wound. Alcohol thins the blood and prevents it from clotting, thereby increasing blood loss.

Flyboy
December 29th, 2009, 11:28 AM
I was always taught you check for both breathing and a pulse before performing CPR.
When?

First aid regs change all the time as they learn more about medical science, the current regs don't include taking a pulse as part of primary survey (http://www.sja.org.uk/sja/first-aid-advice/life-saving-procedures/primary-survey.aspx) if the casualty isn't breathing.

Skydiver
December 29th, 2009, 12:31 PM
A
B
C

Airway
Breathing
Circulation

when you find an unconscious person you check that the airway is clear, that they're breathing and that they have circulation/pulse

http://en.wikipedia.org/wiki/ABC_(medicine)

and yeah, for a lay person, they ignore the 'check the pulse' step. I know that cpr will futz with a normal heart rhythm, but maybe they consider getting them breathing first - since anoxia will kill you in a matter of minutes - and worry about a futzed up heart rate later

so Jimmy's cpr wasn't that far off, although i still have issues with him digging for that bullet, especially given the artery in the area. he should have just packed the wound and let it be

Flyboy
December 31st, 2009, 06:54 AM
A
B
C

Airway
Breathing
Circulation

when you find an unconscious person you check that the airway is clear, that they're breathing and that they have circulation/pulse

http://en.wikipedia.org/wiki/ABC_(medicine)

and yeah, for a lay person, they ignore the 'check the pulse' step. I know that cpr will futz with a normal heart rhythm, but maybe they consider getting them breathing first - since anoxia will kill you in a matter of minutes - and worry about a futzed up heart rate later

so Jimmy's cpr wasn't that far off, although i still have issues with him digging for that bullet, especially given the artery in the area. he should have just packed the wound and let it be
Interetingly the C was actually dropped from standard practice for several years, it has since returned, but in the Primary Survey only really refers to managing any major bleeding. The reason being is the Primary Survey is to deal with issues that could kill very quickly.

If the casualty isn't breathing, whether they have a pulse or not i largely irrelevant. Your efforts are to get them breathing again.

Once they're beathing, you can deal with any major bleeding they have, which has now taken the place of pulse under 'Circulation'.

Pulse monitoring is part of the secondary survey once you've ensured that the airway is clear, the casualty is breathing, and there's no major bleeding.

Jimmy's CPR was VERY off, because there was no evidence of ANY compressions, which considering the casualty wasn't breathing and opening the airway alone didn't help, was required.

Skydiver
December 31st, 2009, 07:13 AM
I had a CPR instructor once tell me 'look, if they need cpr, there ain't much you can do to hurt them'

the meaning being, if they need cpr, they're clinically dead - or well on their way - so anything you try, even doing CPR wrong, is better than doing nothing.

There is one fallacy involved in TV CPR...it's rarely successful. even trained medical professionals have a low success rate bringing people back with CPR alone. (drowning/choking victims are the one big exception i think since once you remove any impediment in the airway, food, water, etc, the autonomic need to breathe reasserts itself and you start to breathe again.)

Most often, if you're doing CPR on a person, the most you can hope for is to minimize brain damage until someone with advanced life support gets there. and if they're not there within a very few minutes, you might as well stop, because the person is gone.

the only exception to that are hypothermic victims. because, as the saying goes, 'you ain't dead until you're warm and dead'. the cold can preserve teh brain and limit damage.

Flyboy
December 31st, 2009, 07:46 AM
I had a CPR instructor once tell me 'look, if they need cpr, there ain't much you can do to hurt them'

the meaning being, if they need cpr, they're clinically dead - or well on their way - so anything you try, even doing CPR wrong, is better than doing nothing.

There is one fallacy involved in TV CPR...it's rarely successful. even trained medical professionals have a low success rate bringing people back with CPR alone. (drowning/choking victims are the one big exception i think since once you remove any impediment in the airway, food, water, etc, the autonomic need to breathe reasserts itself and you start to breathe again.)

Most often, if you're doing CPR on a person, the most you can hope for is to minimize brain damage until someone with advanced life support gets there. and if they're not there within a very few minutes, you might as well stop, because the person is gone.

the only exception to that are hypothermic victims. because, as the saying goes, 'you ain't dead until you're warm and dead'. the cold can preserve teh brain and limit damage.
You're definitely right with the results of CPR.

The exception being with children in which the success rate of CPR is around 90%. Drowning victims as you said are another exception.

You shouldn't stop after a few minutes though - you should keep going, because it IS possible even after extended time for a casualty to be revived once an AED has been used. When I did my instructor's assessement one of the things I was marked up for was the fact that I highlighted the fallacy presented by television in that so many people abandon efforts to continue CPR because they didn't get any result after 5 minutes.

CPR is averagly possible for 20 minutes with no emotional connection to the casualty and 40 if it's someone you know, and really should be done for as long as possible.

Skydiver
December 31st, 2009, 09:28 AM
true, the guideline is 'do it as long as you can or until someone else comes'

There is one thing to consider, however, even medical professionals quit after about 20 minutes or so, because either the person won't come back or they are so brain damaged that...it's just not nice. They're often just postponing the inevitable or giving the family the heart breaking decision of turning off the machines.

but you're right, it doesn't happen fast, and tv rarely portrays the broken ribs and bruising and pain that recipients - if they come back - deal with.

I know in SG1 Sam has been 'cpr'd' at least twice, and they never talk about the fact, even after surviving, she'd be incapacitated for quite a while with broken ribs and severe bruising

Inquisitor
December 31st, 2009, 09:50 AM
true, the guideline is 'do it as long as you can or until someone else comes'

There is one thing to consider, however, even medical professionals quit after about 20 minutes or so, because either the person won't come back or they are so brain damaged that...it's just not nice. They're often just postponing the inevitable or giving the family the heart breaking decision of turning off the machines.

but you're right, it doesn't happen fast, and tv rarely portrays the broken ribs and bruising and pain that recipients - if they come back - deal with.

I know in SG1 Sam has been 'cpr'd' at least twice, and they never talk about the fact, even after surviving, she'd be incapacitated for quite a while with broken ribs and severe bruising


There is a little difference, though. In a hospital, you know the exact state of the patient; whereas 'on the battlefield', you don't really know.

iamdragonrider
January 2nd, 2010, 03:48 PM
The whole scenario bugged me, and it wasn't so much the CPR...

But she apparantly had a fairly shallow chest wound (hence why Jimmy was able to dig out the bullet with his knife to prevent her bleeding to death?? Gah! let's not even go there first of all...) all he did for anesthetic was give her a slug of liquour. If the wound had been deeper, it would have penetrated her lung, and nothing Jimmy had done in the primitive conditions he had could have saved her from a sucking chest wound. So that means it had to be superficial, probably lodged against a rib.

Why the heck did she arrest?

Anyway, my only thought was perhaps it was really strong liquour, and Kate is a really cheap date, and that the would bled much more than they showed on TV... and this caused respiratory depression... (which can be induced by narcotics and alcohol) essentially she stopped breathing or was breathing very very poorly. But perhaps had not gone into cardiac arrest. (but cardiac arrest would be imminent)

Also, she might have vomited on the nasty liquour (it's not really a good idea to feed alcohol to someone that's bleeding or risk of bleeding to death...) and choked, and obstructed, and again... not breathing or breathing poorly, but still had a pulse.

Basically they didn't establish if she was pulseless as well as not breathing. And while it's true that adults usually have cardiac arrest first, in this case i think it MIGHT have been feasiable that Kate suffered respiratory arrest first.

In this case, rescue breathing without chest compressions would have been completely appropriate.

I still think her suffering either respiratory or cardiac arrest from a little wound like that to be a bit far fetched.

(And removing the bullet actually to me seems like a worse idea than leaving it in, it might have been plugging something after all, then going in there and digging around with a knife!)