Thanks for your reply. I didn't quite know how to send you the Kingsman screenshots so I made a tumblr post with them, I'll send you the link in a second. Btw, one thing one cannot see in the caps is that the heart rate is actually changing in the scene where he wakes up, which is sth I don't see often on TV.
(And thanks for your reminder! I know I haven’t done much on this blog recently… I have very little motivation for a lot of things as of late and this week in particular sucked pretty terribly, but I’m going to try to answer the best I can)
Disclaimer: I’m not an ICU nurse, nor have I seen (or read fanfic of) this movie. Everything is based on my critical care classes/clinicals in nursing school and my conjecture as to what happened based on what I’m seeing in these screen shots.
From what I’ve seen of ICU settings, this was pretty well done. They clearly did their research and/or hired a consultant when designing this set. Certain things I particularly appreciated were the presence of a central line (an IV that ends in a large, central vein- necessary for drugs that could injure smaller vessels, like many that would be used in an ICU setting), the not-overly-neat wires/tubes/hoses, and the changing vitals on the monitor screen.
(The following is mostly an explanation of what you’re seeing in the screenshots- nitpicks and a real-life pic for comparison at the end)
Here’s what’s present in a couple of those screenshots:
Monitor display: Showing two leads’ worth of ECG readings (green), heart rate (green), central venous pressure (the pressure in the vein that carries blood into the heart- yellow), oxygen saturation (blue), and non-invasive (cuff) blood pressure (purple).
- The blood pressure cuff: Hooks up to the monitor display and will cycle (take
a reading) at set intervals. While manual blood pressure is taken by
listening to a pulse as the cuff slowly deflates, automatic cuffs sense
vibration in the blood vessels as the cuff deflates, which can be
interpreted by the computer.
- Hardwire ECG leads: These are leads that go directly from the pt
and physically plug into the monitor. They measure the electrical activity of the heart and present a graph of that electrical activity. They are common in ICU settings
but mean the pt has to be physically disconnected if they ever want to
get out of bed.
- Pulse-Ox/SpO2: This is a device that optically or physically measures pulse (which can be different than heart rate as measured electrically) and optically measures oxygen saturation. In this case, it would be helping to determine whether the ventilator settings were correct.
Syringe pumps: syringe pumps are used when only teeny-tiny volumes of medication are needed. They’re a lot more common in pediatric settings, but are definitely used in adult ICUs for very high potency drugs (especially drugs to increase blood pressure, sedatives, and painkillers). Syringe pumps are usually not the only pumps in the scene though- likely there would be at least a few “line pumps” controlling delivery of larger volumes of fluid like IV hydration, antibiotics, and electrolyte replacement fluids that come in hanging bags. Line pumps look like this:
(EEEP EEEP ………… EEEP EEEP<— that’s the sound they make. A lot.)
Endotracheal (ET) tube and securement: This is a tube that goes from just outside the pt’s mouth to their lungs, maintaining the pt’s airway and allowing the ventilator to deliver breaths while the person is paralyzed/sedated and unable to breathe for themself. The securement device keeps it from accidentally coming out or moving out of place. Missing is an NG or OG tube to deliver tube feedings, which would be necessary in this situation.
Central Line: This is an IV with a very long catheter (tube) that is placed in a vein (inserted surgically into the arm or upper chest) and that ends near the heart. This allows for administration of drugs/fluids at high pressure/volume and administration of drugs that could harm smaller peripheral veins. Simple versions (PICCs) may just provide reliable IV access to people who don’t have great veins, but they can be very advanced and include monitoring devices built in.
Because the monitor display is reading central venous pressure (CVP) (something that can only be measured by a sensor very near the heart), this guy’s central line is one of the more advanced ones (I’m still not seeing the external component to the CVP monitor but maybe its just hiding).
Also I’m going to guess that his injury has something to do with his chest and they’re monitoring for tamponade/pneumothorax? Because he seems a little young and healthy to be stricken with heart failure.
Peripheral IV: In addition to the central line, he’s also got a
peripheral IV. These are much shorter catheters (about two inches at
most) that can take IV fluids and many IV medicines that don’t need to
go in a central line.
Miami-J collar: These are hard collars that do not allow movement of the neck (versus the soft foam ones that are for comfort only). Usually you see them in the field when injury is suspected, and they’re taken off once it’s ruled out in a hospital. The fact that he’s wearing one in this scene means that they’ve done the necessary imaging and determined that his neck was indeed injured in whatever happened to him. I’m guessing this guy was in a coma for a while (it would be arguably more important when he’s awake and moving around, so I’m guessing he had some time to heal and they took the collar off).
Ventilator: These devices breathe for pts who can’t breathe on their own, or assist for pts who find breathing prohibitively difficult. The screen shows a real-time graph of the breaths delivered and how much air was given with each breath.
There’s really not a whole lot that I’m downright “well that’s not realistic” about, but here are a couple nitpicks based mostly on ease of nursing care for him:
- How would you suction that ET tube? (I’m sure there’s a way to do it but I’ve only ever used in-line suction before and it seems strange that this setup doesn’t have that given this movie came out so recently)
- Why no line pumps? Why is EVERYTHING going through a syringe pump? That seems tedious…
- Why are no lines labeled? That seems dangerous and confusing…
- If they gave him a CVP monitor, why not also give him an arterial line? Especially since they’re probs going to need lots of arterial blood samples to make sure the vent settings are working right and it would be easier than sticking him that many times IN AN ARTERY…
- Feeding tube- if he’s out as long as I’m guessing he’s out for (via the collar) and there’s no problem with his digestive tract, I’m gonna guess he’ll need some food (but tube feeds are rather icky for the whump community, so I get why they omitted it aesthetically).
Compare the screenshots you took with a similar scene from an actual ICU:
NOTE: I got this pic from a google image search, if you recognize it and would like it removed, let me know!