Polite Dissent

Manhunter #3 “Dark Shadows”
Marc Andreyko, writer
Jesus Saiz, artist

At the end of the previous issue, Kate Spencer’s son Ramsey injured himself while playing around with her crime fighting equipment. In the beginning of this issue, he’s rushed to the hospital by ambulance.

Paramedic #1: What’s his status?
Paramedic #2: Boy, age 6, suffered severe force trauma in an explosion. B.P. is 60 over 80 and falling. Possible internal bleeding and…

This is an impossible blood pressure. The top number in the blood pressure is the systolic blood pressure. This is the blood pressure when the heart is beating. It is the maximum arterial pressure. The bottom number is the diastolic blood pressure –the blood pressure when the heart is relaxed. It is the minimum arterial pressure. An average blood pressure is 120/80. For an adult, anything over 140 systolic or 90 diastolic is considered high blood pressure (though we call it hypertension because it sounds cooler). Looking at the scene from Manhunter, Ramsey’s blood pressure is 60/80. In other words, his maximum blood pressure is lower than his minimum blood pressure. The paramedics probably just switched the numbers around, but it’s an impossible blood pressure as it’s written.

Doctor: Ramsey has suffered a severe concussion.
Kate: Meaning what exactly?
Doctor: Meaning that he is experiencing some severe brain swelling. The drugs we’re giving him did not slow it down, so we had to perform brain surgery to relieve the pressure in his skull.

A concussion is also known as a mild traumatic brain injury. There are a variety of definitions for concussion, but the simplest is a post-traumatic alteration of mental status, with or without the loss of consciousness. Over the past several years, the medical field has realized that concussions are not as minor as originally thought and can have lasting effects. The most dangerous situation is when a person suffers a second concussion while still recovering from their first. This is known as Second Injury Syndrome and can be fatal.

That being said, as injured as Ramsey is, he clearly suffered something more than a mere concussion. It sounds like he most likely suffered a brain contusion (a bruise of the brain itself) in addition to a concussion. Brain swelling is common with such contusions. Despite what the doctor implies, neurosurgical intervention is commonly used as an early treatment in such brain injuries before stronger (and riskier) medications are used. The doctor probably just called Ramsey’s injury a concussion to make it easier for the parents to understand. He still shouldn’t have made “brain surgery” sound as dramatic as he did.

Doctor: I can’t say for certain, but his age is a plus. Children tend to bounce back from serious injuries more quickly than adults. These first 24 hours will be the barometer for his recovery.

The doctor is absolutely right here. Children have a tremendous recuperative ability. The first twenty-four hours after a severe injury — especially a brain injury — are very important and are a good indicator of how recovery will proceed.

I need to add that Siaz’s art was excellent, including his depiction of the ambulance, hospital and all the assorted medical paraphernalia.

As a final thought, the nurse who called the reporter is not only due to be fired for violating patient confidentiality, but is also due for a hefty federal fine and jail time for violating HIPAA. I wouldn’t be so smug and open about accepting money from that reporter if I were her.

More Information:
1. Medical Dictionary definition of systolic and diastolic.
2. My comments about Manhunter #1 (legal concerns, not medical this time).
3. More on comic book head injuries (from my post on the Justice League)
4. The full text of the Health Inurance Portability and Accountability Act of 1996 (for those of you with insomnia or lots of time to kill)