Polite Dissent

In the excitement of having an actual day off work last Friday, I neglected to post the last review of JSA Week.

JSA #18 “Injustice Be Done, part 4: Into the Labyrinth”
Geoff Johns and David Goyer, writers
Stephen Sadowski, penciler

This issue pretty much picks up where issue #17 left off (the intervening issue #18 was a flashback issue). Mr. Terrific decides against performing surgery himself on the wounded Sentinel (thank goodness) and rushed him to the hospital:

Mr. Terrific: Start an I.V. Two liters of Lactated Ringer’s over the next twenty minutes and type and cross for six units of whole blood

Lactated Ringer’s (abbreviation LR) is a commonly used intravenous fluid. It contains sodium, chloride, lactate, potassium, and calcium. Other common intravenous fluids include Normal Saline (abbreviated NS), a 0.9% w/v sodium chloride solution, and Half-Normal Saline (½NS), a 0.45% w/v sodium chloride solution. Different physicians will go to great lengths to tell you which fluid is better for which situation, but I have always found the debate more academic than practical.

As a nitpick, most clinicians would have phrased it “2 liters Lactated Ringer’s wide open.”

When practical, it is always best to transfuse blood that matches the recipient’s blood. To check this, a type and cross is performed. The donor blood is matched to the recipient’s blood type (the “type”) and an antibody screen is checked (the “cross”). Cross-matched blood minimizes the risk of transfusion reactions. A type and cross takes time though, up to forty-five minutes. In emergencies, non-cross-matched type O blood can be given.

Sentinel has been bleeding heavily for quite some time. I think he’d benefit from some type O blood initially, followed by cross-matched blood when it becomes available. Speaking of blood transfusion, whole blood hasn’t been used for years; instead, PRBCs (packed red blood cells) are given.

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Meanwhile, Dr. Mid-Nite has seen the true face of Johnny Sorrow and collapsed. Black Canary cannot find a pulse and begins CPR.

Black Canary: Mid-Nite! Oh Thank God! I thought you were –
Dr. Mid-Nite: Damn Close. Definite myocardial infarction. You give good C.P.R. Canary.

A myocardial infarction is fancy doctor-speak for a heart attack. Dr. Mid-Nite is saying that the sight of Johnny Sorrow’s true face caused him to have a heart attack. And not just a minor heart attack either, but one that actually caused his heart to stop and required CPR from Black Canary.

Heart attacks, even small ones, are serious. Part of the heart has died, and will not grow back. This can lead to all sorts of problems from arrhythmias to heart failure. It is not a good idea for Dr. Mid-Nite to get up and resume fighting crime immediately after the heart attack. Doctors have several names for patient’s like that: a charitable one would be “non-compliant,” a better one would be “idiot.” I’m not saying that patients with heart attacks are doomed to the life of an invalid — far from it — but they need to take it easy immediately after the attack because this is when the risk of complications is the highest.

Other issues: How exactly did Dr. Mid-Nite diagnose his heart attack? Does he have an EKG wired in his suit (OK, he probably does). What about treating the heart attack? I know he carries bottles of controlled substances in his costume, but what about drugs commonly used to treat heart attacks such as clot-busters, blood thinners, or nitroglycerin (the medication, not the explosive)? Don’t tell me he doesn’t at least have an aspirin in there. (Admittedly, Mid-Nite’s heart attack was caused by “fear” — whatever that entails — so clot-busters and blood thinners may not be appropriate. Aspirin and Nitroglycerin would still be a good idea though).

Tags: comics medicine jsa dr. mid-nite mr. terrific transfusion myocardial infarction