morphine iv

The night starts with a big, spicy Philly cheese steak. It’s about 6pm. I’ve been wanting to try the cheese steak from this corny, 50’s retro place for a long time. I gobble down the big greasy bowl of meat, hot sauce, and cheese, then head to the coffee shop for my weekly draw group. A little after I get home, about 10pm, a stomach ache comes on. “Damn, guess spicy foods are out.” I’ve been getting stomach aches every time I have spicy Thai or hot wings. I google search about spice pain- possible stomach ulcer? “I guess I have been stressed lately, but no more than usual I don’t think…” File under “Will investigate further later.“ According to the comments on this health website, a glass of milk will help. Gulp one down, go to bed.

Wrestle to sleep for about an hour. Realize the ache is just over the required pain threshold to keep you from sleeping. Do some work on my comic, more tired, but stomach worse. Will play batman until I fall asleep. I feel like I’m just running in circles… How many times have I failed this mission? Batman, batman, stomach now hurts too bad to enjoy an active task like video games. Deliriously tired. Would be great to sleep through the rest of this abdominal temper tantrum. Try the old “hot shower will make you sleep” trick. Take some Pepto-Bismol, and some generic acetaminophen. Out of the shower, hurts to walk around now, and to lie down. Guess I’ll have to wait it out with my eyes open. Call and leave my Doc a message, maybe will get a spot in there tomorrow. Need to get that ulcer discovered… Time to enjoy a passive task like watching TV. Breaking Bad feels like the right mixture of funny and painful, just like me and my burning spice belly. Damn, I can’t even enjoy that part where during Hank’s interrogation of that meth head, Wendy, she accuses Hank of trying to buy sexual services from her on behalf of an underage “football player” (a misunderstanding involving Walter Jr. from a few episodes before). Oh hell. Time to look up what time emergency medical clinics open. Guess I’ll have to pay out of pocket since I can’t wait for my Doc tomorrow.  It’s about 4am now. Earliest clinic opens at 8. Now hungry again, but can’t eat what with all the pain. One hour down. Man, this is really starting to hurt. Can I really wait 3 more hours? Sitting is starting to hurt as much as lying and standing. And I’m still not enjoying TV. Okay, I’ve come to a decision…. 

“Hey, Kayla, my stomach still hurts, I’m thinking about driving to the ER, do you wanna come?” “Oh! Ya, sure. What time is it?” “It’s 5:30”. I  call the hospital “Hey, I’ve had a pretty bad stomach ache all night, I’m thinking of coming by.” Operator: *long pause* “Haha, well, okay! We’re open all night, so just come on in.” 

Driving with a stomach ache is not so bad, because you’re already hunched over. Wish Kayla could drive, but she doesn’t really know how, probably would have a panic attack and would definitely crash. Interesting that they have ER parking, I wonder how many ER patients drive themselves here… All bodily positions hurt my insides now, signing in to this place sucks. Give Kayla half the paperwork to fill out, glad she’s here, or this would be really boring. Man, they sure take a long time for someone trying to get into an empty emergency room… Signing in with a nurse, she ask me my height and I say “ ‘5’’8”, but I notice she puts down “ ‘5’’7”… They want to look at my pee, they always want to see my pee. I pee, no blood, so whatever that tells them means I’m getting an ultrasound first. Then a young nurse named Ken, a cool Asian dude with screws through both ears, squirts so much morphine into my IV that I lean back and audibly say “oh my god.” I feel it ripple like a shock wave from my arm down to the ends of my body. My belly is feeling alright now. 

The ultrasound technician tells me that babies are the least common thing she uses ultrasounds for. My joke has fallen flat. Back in the room, the doctor and his manila folder tell me “Good news! No gallstones, there are kidney stones inside your kidneys, but since they are inside, you shouldn’t be feeling the pain from those.” “Wait, does that mean I have to pee those stones out at some poin–” It is not discussed again. Seeing that neither organ has the appropriate stones, Doc would “rather not expose me to more radiation than necessary” and is working on discharging me. But, “I won’t leave here without a diagnosis.” 

In I go to the CT scan tube. That hot squish of contrast dye spreading through my veins. “Okay, we’re moving you into a room upstairs.” Says a hippy technician. Upstairs in my sweet and swanky single with couch, a person I’m pretty sure is just a businessman disguised in medical scrubs types on a computer. He takes down my answers to what seem like pre-surgery questions. “Do you have anybody specific on file in the event you are medically unable to yield consent  for yourself?” This, combined fact that they won’t feed me, makes me wonder what it is I’m going into surgery for. I saw this same thing about a year and a half ago with the whole brain debacle, but that’s a story for another time. Several medical people dip in, sprinkle breadcrumbs of information; it’s like a game show challenge that combines a scavenger hunt with a jigsaw puzzle. You have to gather the pieces of information from their hiding places, then assemble them in the correct order to reveal an answer. A tech comes in and spoils the game, “You seem to have a lot of questions, so I just want to make sure, you know you have appendicitis right? We’re about to take it out.” “Thank god,” I think. “It’s not the spicy foods. Spicy foods are still in.” Downstairs, in pre-op, I complain to my plain-clothes surgeon about how analog tests like pressing on my stomach are remarkably inaccurate, since a doctor’s subjective interpretation of my poor description of say, “the pain is slightly higher” can rule out appendicitis, the same appendicitis that a machine might spot an hour later. I tell him that I almost got sent home. My surgeon tells me he’s been doing analogue tests for 30 years, and not to worry about it. I start to tell him how “my deadpan reaction to pain also causes a lot of people to misdiagnose me, that a lot of people laugh when I describe how I’m in pai–”, but he walks away in the middle to get dressed for surgery. The operating room has big TVs and lights, it looks like a set, and I consider the possibility of fake hospitals as the anesthesia takes the wheel.

In the recovery area, the nurse tells me how big, inflamed appendixes can be agitated by spicy foods, foods high in fat, and dense foods like heavy cheese. I see an image of a spotlit cheese steak appear in a black void. Nurse feeds me ice chips and tells me she craves ice chips when she’s dehydrated. I suggest that she only craves ice chips because she works in a hospital, that ice chips are too unsatisfying a thing to crave at random, and that most people would just crave water. She agrees. Back upstairs in my room, it is now 8pm, and it has been 26 hours since I’ve eaten. I’ve been hydrated only through IV’s. The driest mouth and the clearest pee. Because the lingering anesthetic can cause nausea and vomiting, they will only give me jello. I go nuts on the jello. They continue to give me every jello I ask for, one at a time, like a test. Way past where I though the cutoff point would be, the nurse tells me “That’s it! There’s no more jello! You ate all the jello on this floor.” You’re damn right I did, you’re damn right….

anonymous asked:

hi scripty! so my main character was kidnapped + before she escaped, she was choked, punched in the face, pushed down a flight of stairs + shot in the stomach. right now i have her in ICU bc of hypovolemic shock but to make things really interesting + emotional, i need her to be unconscious/otherwise unresponsive for like 1.5 days. i liked the idea of sedation w propofol, espec bc at one point her bp/heart rate drop suddenly and they fear she wont make it + i believe i read somewhere (1)

(2) propofol can do that? i probably sound really dumb but i just want to make this is as realistic as possible so i wanted to ask you. she didn’t hit her head when she fell so no concussion. i know this is fiction but i just want to know if this is reasonable/logical/possible, i guess. also i know she won’t be wide awake and coherent when she wakes up but would she be completely out of it/loopy or just groggy? thanks and sorry if this doesn’t make any sense would she be able to breathe on her own for the most part or would she have to be placed on a ventilator? thanks and sorry again!!  😭

Hey there nonny! ER & ICU medicine is one of my wheelhouses, so let’s take a look at all of this! 

So first things first: you seem to have bypassed a super important part of this character’s medical journey. 

This gunshot. In the belly. This is an Un-Goodness. Hypovolemic shock is going to be from internal bleeding, which means something in there got hit. The liver and the spleen both bleed like hell from puncture wounds. 

She’s going to need surgery.

So here’s the thing: your character is going to have abdominal surgery once she gets to the ER. She’ll be evaluated, she’ll probably have a blood transfusion begun in the ER, and she’ll be sent into surgery to control the bleeding, repair the damage, and generally find out what happened. (Even with great imaging it can be impossible to tell what exactly was damaged internally; generally speaking, penetrating  abdominal trauma requires surgery to check on things.) 

After surgery she’ll be admitted to the ICU, where they’ll monitor her heart rate, blood pressure, blood oxygen levels, and more. 

Now, she should be pretty zonked, from the head injury, from the surgery, from the pain meds. So her not really being awake for the first day and a half or so after all of this is mostly believable, especially if she’s got a good nurse defending her from others who want to wake her up. 

Whether or not she’d be sedated is a whole other story, and honestly…

I don’t think she’d be sedated during her hospital stay, much less put on propofol (outside the OR, anyway). 

She’s got no head injury and no reason to go on a ventilator. She’ll be in pain from her wound, for sure, and from the surgery. But this will be managed by IV pain medication, such as IV morphine, hydromorphone/Dilaudid, or fentanyl (most likely in a trauma patient). This can make her super groggy without “sedating” her. 

(There is a special place in hell for ICUs that consider pain meds like fentanyl to be sedatives and to use them as such, but that’s another rant entirely.) 

During the surgery she would be anesthetized, and it might be with propofol (though for bleeding and serious trauma, I would think something that uses less propofol, such as propofol/ketamine AKA ketafol), or no propofol at all, such as a combination of fentanyl and midazolam and/or ketamine, would be more likely. 

But the point is, outside the OR, she likely won’t be sedated, unless she needs to stay on the ventilator. 

You want her blood pressure to drop and for her to nearly die again? 

Very simple: have an internal stitch rip when she shifts. She starts bleeding again internally and gets taken back into the OR for more surgery to repair the bleeding. (This also gives you lovely hours of your supporting characters waiting to find out whether she lives or dies.) This adds the drama of MOAR SURGERY, a longer period of uncertainty, and physical separation of the other characters. 

Now: As To Your Propofol Question

Let’s throw reality out the window, or change the situation to one where she needs a ventilator. Why? Because we can. (We could even make her need a ventilator in your scenario, with a complication from multiple transfusions known as Transfusion Related Acute Lung Injury, or TRALI, which is essentially the lungs reacting badly to Way Too Much Foreign Blood and causing a lot of edema, i.e. fluid, i.e. drowning. This results in a longer ICU stay, though.)

So let’s assume she’s on the vent, and to keep her on the vent, she’s been sedated. 

Yes, propofol causes hypotension. It is legendary for causing hypotension. But intensivists and anesthetists are well aware that it has that property, and there are a few workarounds they would tend to use to counterbalance that tendency.

1) Use a different sedative. Propofol and Versed/midazolam are both great sedatives, but if pressure is a concern, they may opt for another kind of sedation. They might use something like Precedex/dexmedetomidine, which doesn’t depress blood pressure. (In some cases, they might be put on a drip of – you knew this was coming! – ketamine. I’ve seen a switch from propofol to ketamine bump a patient’s blood pressure by 30 points.) 

1a: Switch her off of propofol when her pressure drops. Either let her wake up a bit or put her on a different medication. 

2) Compensate with pressors. Pressors are medications that raise blood pressure, such as Levophed / norepinehprine, which squeezes the blood vessels. 

Critically ill patients are often in a delicate balance between propofol and Levophed. They need the propofol to stay down and they need the Levophed to keep their pressure up. Again, this is a very common practice in the ICU. 

3) Add More Fluids. Fluids, such as normal saline or Ringer’s Lactate, will help… a bit. Temporarily. It’s a short-term fix, for a lot of reasons. But mostly because they don’t stay in the bloodstream for a long time (1/3 of the volume is lost into the interstitium in the first 3 hours), and they can cause electrolyte imbalances. 

4) Add More Blood Products. There are two products in particular I’m thinking of. Red blood cells (PRBCs) improve oxygen carrying capacity of the blood – making the character less “shocky” – and also improve blood pressure. And albumin helps raise pressures by essentially making the blood a bit thicker and thus pulling in fluid from the surrounding tissues, because the physics of fluids are kind of neat. 

But really, the number one reason for your character to have their blood pressure drop is to have their bleeding start again, and have them go back into the operating room

One Other Reason Her Blood Pressure Could Fall 

Sepsis. Sepsis is one of the Big Fears in abdominal trauma because the GI tract is full of bacteria, and bacteremia (bacteria in the blood) can trigger sepsis. Check out [the sepsis tag] for more! 

Phew! I hope this has helped! 

This is kind of a long and rambly post, so let me know if anything needs clarified. 

Thanks for your ask and I hope this helped! 

xoxo, Aunt Scripty


[Maim Your Characters: How Injuries Work in Fiction is out and can be yours! If you like books on writing and books about medicine (without all the jargon), check it out!] 

Rumours// Rich Goranski

Warnings:Hospitals ? F a k e people 

Summary: Rich is in the hospital and everyone wants the popularity that comes in a crisis

Words: 1064

Requested: @consumed-by-musicals

The bright lights, stench of cleaning products, white walls, the beep of machines. Everything about hospitals made you uncomfortable, and the burned body of your boyfriend laying unconscious against the white bedding did not help anything. You scanned his form, noting scars from surprisingly quickly healed burns. A tear runs down your cheek as you run a shaky hand through his faded hair. His heart monitor beeped steadily and a morphine drip and IV ran in rhythm, but other than that the room was eerily quiet. Where was his “friends”? You phone has been notifying you that people have been non-stop tweeting about the party and Rich, yet they haven’t even asked about him- much less came to visit him. You knew about the SQUIP, but you were there before he took it. You have been through it seems like everything together, and you hadn’t left his side in days. The clock ticked to the 10 and a nurse knocked on the door, telling you visiting hours were over. You take one last glance before kissing the top of his head, grabbing your bag, and leaving.

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A New Chapter (Ch. 6): Home Again

Characters: Dean Winchester x Reader, Sam Winchester x Platonic!Reader

Length: 1355+ words

TW: Descriptions of Injuries

A/N: I decided to split this Chapter into two parts! It was too long, and I felt like this new split is way better. Feedback is encouraged, but not necessary. Let me know if you want to be tagged, or removed from the Tag List!

Catch up on the Hell on Earth Series HERE

Sam waited for hours in the hospital. The sun finally appearing brightly through the windows of the waiting room. He had checked in Y/N, telling the police a story about perhaps an abusive boyfriend in the picture or a robbery, and how they were long distance friends who had planned to meet up, but she never showed up, leading for him to go to her home to check on her.

“Y/N L/N?” the doctor called.

Sam ran to the doctor. She was in her mid-30s, her fiery red hair a stark contrast against white coat. “Is she okay?”

“Hello, I’m Dr. Carter. Y/N had a lot of injuries ranging from shallow to severe injuries, but thankfully it wasn’t life threatening. Aside from the superficial wounds, she has five broken ribs, two hairline fractures on her collarbone, both her wrists are twisted, the bones in left ankle was crushed- it looks like he shattered it with a blunt object, and her right knee is twisted- perhaps from trying to escape against her binds, and her trachea is badly bruised from being strangled and also her screaming probably. Her state was only worsened because of the lack of nutrients given to her in the past few days. We have her hooked up to an IV, and morphine, so she will continue to be unconscious until perhaps tomorrow.”

“Can we see her?”

“Of course.” The doctor led them to a few rooms down the hallway, opening the door for the two boys. “I will give you some time alone. If you have any more questions, feel free to find me.”

Sam slowly walked up to her bed, seeing her face covered with cuts, and black and blue bruises. There didn’t seem to be a part of her that was not covered with bandages and gauze. The younger Winchester choked back a sob, his hand reaching out to touch her face, but stopping himself midway. “I don’t want her to wake up alone,” Sam softly said, sitting by the foot of her bed as Dean sat on the chair, silently agreeing with his brother.

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I’m All Yours - Version 1

Summary: Reposted request from @ amrita31199 that i posted before, but Tumblr deleted. Shoutout to @katykyll for letting me know!

Request: I wish you’d write a fic where the reader is high due to some medication and she shamelessly flirts with Bucky (not knowing he is her bf). 

Characters: Bucky, Y/N (reader), and Natasha 

WC: About 800

TW: Explosion, language, injuries, legal medication

“Y/N!! LOOK OUT!!” A massive explosion rocked the empty lot where the battle was taking place. It was like a nightmare. Everything around me sped up, while my body slowed down. I stood and watched as her body was flung through air, landing hard on the pavement several seconds later.

I felt the heat from the blast, and my own body being wrenched from the ground from the force. I myself landing hard on my back, slamming my head on the ground. If it weren’t for the serum, I would’ve been knocked unconscious, maybe even killed.

But what about Y/N? Where was she? I had to get up. Had to find her. I sit up, looking around wildly only for another smaller explosion to force me back to the ground, knocking me out cold. 

When I wake up, I’m in the tower hospital. My body feels fine. No pain, not even in my head. They must have put me to sleep to heal. I look over and see Natasha sitting in a chair looking over files.

“How long?” I croak quietly. My throat is dry, and my vision is a bit blurry, but it clears soon after waking.

“Just the night. Got you back and in bed. Drugged you out to heal you faster.”

“Thanks. What happened?”

“Didn’t get to the bomb in time. It went off, and set off the smaller backup as well. Lucky for us, we were the only casualties.”

Suddenly I remember Y/N and I sit up in  the bed quickly, making my vision go black and my head hurt from the quick movement and loss of blood flow.

Natasha doesn’t have to look up to know that I’m freaking out. She keeps reading her files and says “Y/N made it. She’s out of surgery and is probably gonna be hopped up on morphine and a bunch of painkillers for a while. Last I heard, she was conscious but not exactly lucid. You can go see her after you shower.”

“Thanks Nat,” I smile over at her from the bed.

She finally glances up and smiles at me for a brief moment. “Get going Buck, before she passes out again.”

I gingerly get up, wobbling over to Nat. I plant a kiss on her head as I walk out.

I walk over to Y/N’s room, anxious to see her condition. She’s laying in bed, her face bruised and slightly swollen. She was the one we sent in to disarm the bomb, so she was closest, and got the most impact. Thank god she has serum too, otherwise she’d have been blown to bits. But even serum and her armor couldn’t protect her from that big of a blast that close.

She stirs a little, and I can hear her heart-rate increase. I can smell the IV dripping morphine into her body to help with the pain. She opens her eyes and I can see her trying to remember who I am and what happened.

“Who… de fak….. are youuu?” Her speech is slow and slurred, from a combination of drugs and a swollen mouth.

“It’s me, Bucky,” I whisper gently, sitting next to her bed.

“Okaaaayyyyyyyyy. Well, Booky…. if you know so mush….. den who de fook ammm Iiiiiiiiiiii?”

I can’t help chuckle slightly. And then glare under her furrowed eyebrows just makes me laugh even more. “Your name is Y/N, but the team calls you Y/N/N. And to me, you’re just my best girl.”

“I ain’t yur best nuthin, big guy,” she mutters. “At least not til yooouuurrr beefy ass buys me a shteak aaass biiiiig as your bicepppp.” She attempts a wink to follow her big pick up line but her eye is too swollen.

I can’t do anything but laugh. Huge guffaws that no one has heard since 1942. This is why I love my girl.

“What’re yooouuu laughin’ at you giant meatbaaallll?”

“Darlin’ we’re already a couple. I mean I’ll still take you out for a steak once you can chew food again, but you already snagged me honey. Ya ain’t got nothin to worry about. I’m all yours.”

She looks at me, still confused, “Waaaiiiiitttt….. so aaallllll this beefcake…. is mine? You’re aaallll mine?”

I laugh again and take her hand, kissing the back of it, “Yes doll face, I’m all yours.”

She eases back into the pillows, all stress gone from her face. I can see she’s dozing off again. Her last words are barely audible, even for me,

“All mine huh? Hah, I did damn good didn’t I?”

Yeah you did darlin. But I did better.

Tag List: @mar-gega @thatawkwardtinyperson @kit-kat-coffeeworld @softwintersoldier @papi-chulo-bucky @thejamesoldier @buckyappreciationsociety @sad-af1121@2boysandnewyork @scarlettsoldier @beebossinner@theoneandonlycarolg@katykyll