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IVs

Item one! Because it's very visible and often misunderstood: our friend the IV. Shown below, a pretty bog-standard hand IV, a dressing with a clear window to show the insertion site, and technically-optional but very commonly-used J-loop tubing

(You can also just screw the long infusion tubing directly onto the IV itself, but it's a pain in the ass to do and often pinches the patient when you take it on or off.)

Common Misconception: If we are "taking you off the IV" we are not removing the IV! We're unhooking the tubing from that hub you can see at the end of the J-loop.

Common Misconception: The actual “IV” is the very thin plastic tube that goes into the vein itself, and the plastic hub that rests on the skin outside. The needle used to guide the IV is retracted once the catheter is into the vein.  There’s no needle in there. Irritation to the inside of the vein may feel sharp, but it's not because you're being literally stabbed.

Artists: Note that the IV is inserted pointed up the arm, toward the heart! I've seen it drawn the other way once or twice. Nope!

Artists: most likely areas to see an IV placed ^^^

Writers: IVs in the elbow-bend/antecubital vein/"AC" tend to kink when the arm bends, which causes the pump to beep. Perhaps to the annoyance of Blorbo, who would like to be able to use their arms for things.

Somebody more critical could be getting medications and fluids through several IVs at once, and will often have at least one that's not currently in use as well--the most IVs I've seen in one patient is five, with three of those all running infusions at once, but generally I'd expect one or two IVs in a routine surgical patient, and probably two to three in a trauma patient.

Patients who have had surgery or a traumatic injury, or who aren't able to eat/drink like normal, will often be getting a slow drip from a big bag of fluid (i.e. saline! laypeople know saline, I think right?)

Artists: these bigger hydration infusions are compatible with most other medications, so when someone gets an IV medication--an IV antibiotic, an electrolyte, etc--they'll often be hung "piggyback" or as a "secondary infusion" (see below). If blorbo has two bags hanging on connected tubing, one should be notably lower than the other.

If Blorbo has medications running, and/or is anywhere but the emergency room, the tubing will also run through an IV pump, to moderate how fast it goes. (reference: IV pump).

There are other types of venous access, and also arterial lines, but we don't have a million words to do a primer on access types unfortunately.

RE: IVs being dramatically yanked out so Blorbo can run off to do Drama: should stop bleeding with a minute or two of light pressure, and bleed in a dark, welling trickle, not a bright red gush or spurt. Unless Blorbo got an IV accidentally placed in their artery, which is *LOUD INCORRECT BUZZER*.

Dressings/Bandages

There are approximately eight billion types of dressing, but this is specifically a PSA that there are a lot of options that aren't the classic White Wrapped Bandage.

Dressings of the Wrapped Bandage genre are used, especially on things like a hand or foot wound, or to (try to) wrap a head wound. (Bandaging somebody's face/head, my beloathed. it does NOT stay on.)

BUT injuries not on a part of the body with fiddly surfaces like toes/fingers or facial orifices are often covered by what I'd broadly call an "island dressing"--essentially a big bandaid sealed on all sides, or gauze pads laid down and taped to fit the wound. Looking up "surgical dressing" has provided me with a lot of the ones I was thinking of, and minimal gore, so I recommend it! Things of this general species:

Those dressings ARE sometimes paired with essentially a wide ACE bandage--in my field, I often see a smaller dressing on the hip/knee/ankle surgery site, and then an elasticated wrap around a large part of the leg, to gently compress the limb.

Oxygen (reference:nasal cannula or hospital oxygen mask)

Writers: Oxygen flow is measured in "liters per minute" which is confusing but true. You'll hear medical people shorten it to "they're on two liters nasal cannula" or "they're on ten liters nonrebreather", etc--or if Blorbo isn't on oxygen at all, they're on "room air".

The nasal cannula is a tube to deliver extra oxygen through the patient’s nose; the tubing goes back over the top of the ears, loops forward and meets under the chin.  The other end is usually hooked to a wall port if the patient’s in bed.

This is one of the biggest ones I see people draw funky. The versions people come up with are very funny but also that's probably not what you're going for so pls. Take this reference I am gently handing to you.

A CLOSED LOOP: two small tubes in the nose, then the tubing goes back over the ears, then down onto the chest where the loop joins back up into one length of tubing.

It’s not actually as common to wear an O2 mask--masks deliver a higher concentration of oxygen than the cannula does, and if someone is struggling enough on a regular nursing floor that they need a mask to get their oxygen up, that's something their nurse is most likely keeping a close eye on. The Intensive Care Unit/ICU, the Emergency Room after a trauma, or in the hour or two after surgery are the places I'd expect to see a lot of O2 masks.

Artists: If you're looking up reference for oxygen masks, note that the kind shown on the left, with the bag (a nonrebreather) is a further step past the simple face mask shown on the right and delivers a pretty hefty dose of oxygen. Things have gotten pretty serious breathing-wise if Blorbo needs a nonrebreather.

Many people in the hospital don't actually need oxygen. Some common reasons people DO: lung injuries/diseases, a sleepy/sedated/unconscious patient, or something like broken ribs, where breathing is painful/hard.  (looking at u, hurt/comfort writers).

We check oxygen on the finger the majority of the time (reference: pulse oximeter clip, pulse oximeter sticker)--if the patient’s unstable/sedated or has problems with their oxygen levels, the sticker is made to stay on continuously while the clip is easier to apply for occasional checks and then take off.

A little guy of this general variety, although you can honestly freestyle the shape. Note the norm is that the cord comes out on top. These can actually be used on any finger, or even the toes, although the fingers tend to read better.

Fun fact: the little finger doodad, whichever kind you choose, simultaneously reads oxygen and heart rate. If Blorbo has a little clip on their finger, their monitor should probably be showing both!

Drains  (Careful looking up ref of these--they’re usually used for wounds, and the image searches can sometimes be unexpectedly graphic)

Inserted into somewhere there’s going to be drainage (because of infection or after some kinds of surgery/injury)

There are a million kinds of these, but I most commonly see the JP/Jackson-Pratt. The little hand grenade guy. He shouldn't be round unless he's full and needs emptied; the suction comes from compressing the bulb and corking it that way.

On a non traumatic-injury-related topic: to my knowledge, this is commonly what you'll see placed after top surgery! Congratulations to Blorbo on the top surgery.

Another useful friend for more traumatic art/writing is the humble chest tube, inserted for injuries around the lungs; severely broken ribs, blunt or penetrating trauma, etc.

Injuries around the lungs can cause air or blood to pool in the space the lungs are supposed to take up, and a tube can be inserted so the lungs can do their thing again.  They drain into a weird flat tall little box that collects the drainage and can be hooked up to suction to help the drainage along.  (reference: chest tube dressing, pleur evac)

There are a million pieces and parts to a pleur-evac and I could explain them all but to be frank you do not need to know. Face it away from the illustration and I will still be applauding, impressed that someone drew a chest tube.

Heart monitors

Most people who are hospitalized for a run-of-the-mill fanfic-style traumatic injury (and who don’t have heart problems/symptoms) don’t necessarily need their heart monitored, but if they’re critical/have heart issues, a telemetry box is a common piece of hospital equipment.

It’s hooked up by five wires to five stickers that go on the patient’s chest--if you want to get the placement right and make a nurse quietly impressed, look up five-lead telemetry

Incredible. A whole eight pixels of telemetry setup. >:Ic To simplify it down: one on either side a little below the collarbones, one on either side of the ribs, and one about in the middle. That's close enough for horseshoes or hand grenades, at least!

I've talked about this on the blog before, but the formula for a passable heart rhythm is a little rounded bump up from the base line, then a narrow spike up, down below baseline, and back to center, then another rounded bump. That makes one total heartbeat. Keep those clustered pretty close; if it’s a slower heartbeat, they space out slightly more but most of the space comes BETWEEN those clusters, not separating the parts themselves.

This is another one I see artists freehanding often, to often very humorous effect! Remember y'all, BUMP SPIKE BUMP.

Feeding Tubes

Unless the character’s going to need tubefeed long-term, hospital feeding tubes mostly go through the nose rather than in through the abdominal wall. They can be taped onto the nose (reference: NG tube tape) or we can loop something up one nostril and down the other to hold it in if it’s staying for a while/it keeps getting pulled out (reference: bridled corpak).

If your character had a gut injury/surgery, or is very malnourished from some form of illness and needs concentrated nutrition but can’t tolerate a lot of food, a hospital might give them tubefeed.

(we can also give nutrition through an IV!  Sometimes tubefeed and TPN or PPN (IV nutrition) are given at the same time, especially for very malnourished patients or ones we're weaning off of the IV nutrition)

Vital Signs

This one's mostly for the writers lol. A very simplified rundown:

Vital signs are usually taken at regular intervals, often every 4-8 hours on a regular nursing floor, or more frequently in ICU/ER, where they often leave the machine hooked to the patient and can set it to automatically cycle at an ordered frequency

TEMPERATURE:

often in celsius, yes even in America

PULSE:

Patients who have lost blood and are stressed and in pain--aka most trauma patients--will often run faster heart-rates. Some young traumas especially will sometimes just maintain 100s-120s even at rest.

BREATHS PER MINUTE:

Pretty self-explanatory. I often hear respirations shortened to "respers". Counting them is not often noticeable but might include glancing from the patient to the clock/a watch and/or having a hand on their shoulder or back.

Narcotic pain medications are a notorious reducer of respiratory rate/depth, especially when somebody has had enough to make them drowsy.

OXYGEN SATURATION:

(AKA "pulse ox"/"sats"/"O2")

100% is obviously the best

95-ish on a young person who's been sedentary or sleeping heavily wouldn't surprise me too greatly but I would expect it to come up with deep breaths and coughing.

If young previously-healthy Blorbo is needing oxygen to get above the 93-94% range or below, especially all of a sudden, I'm looking for why! Sometimes "why" is obvious--rib fractures, sedation from anesthesia or pain medication, pneumonia, etc--but if it's not, we might be getting a chest x-ray.

Older patients who smoke and/or have long-term respiratory diseases can sometimes just run around 88-90%, but it's sure the fuck not a sign of good health. :T

BLOOD PRESSURE:

Hoo boy there's a lot here. In case this is new information: "blood pressure" is TWO numbers, written as X/Y and usually spoken as "X over Y". "120 over 80" being the old textbook "normal" number.

The patient's BASELINE blood pressure and how it's TRENDING (is it going up, down, has it dropped or spiked suddenly) are very important parts of assessing a blood pressure, so trying to assign meaning to specific numbers gets tricky!

High blood pressures are not usually going to be the problem in Blorbo-torment situations, which tend toward blood loss etc, so to broadly cover the opposite:

100s/60s is what I'd generally call a "soft" blood pressure; on the low side but not necessarily concerning in isolation.

90s/50s is eyebrow-raising. We're looking closely at other vital signs, assessing the patient, seeing if they've had a lot of medication that can lower blood pressure (pain medication/narcotics a common suspect). We're likely calling doctors for blood work (to look for signs of bleeding) and/or asking for a "bolus" (a half or whole liter bag of fluid run very quickly). Some people just exist in the 90s/50s! But if Blorbo doesn't, or if they're having other symptoms (dizzy, sleepy, lethargic, pale, heart-rate rising from their baseline rate). CONCERNING.

80s/40s is "if a doctor doesn't come up here ASAP and/or order some stuff right now, I'm activating my hospital's rapid response team" territory.

70s/30s is "I'm going straight to the rapid response team and calling a doctor once that's called because I'm worried this is going to turn into a full-blown Code Blue" territory.

Either the top or bottom number (systolic and diastolic, to their friends) being low to the degree above is of note--they don't exactly go up and down in lock-step. Unfortunately to get into the minutiae of "well if the systolic is THIS but the diastolic is THAT, I'm less concerned than--" would take a million years lol.

ARTISTS: there are about a million formats for vital machine readouts, so the exact design isn't important! But I do note that having several different colors is a very common feature. Here the heart-related vital signs are all red, the oxygen is blue, and the temperature is green.

"THEIR VITALS ARE DROPPING"--@ hospital drama TV what are you doing. that's nothing. it's nothing. Stop it. if I've heard any phrase used to a similar effect it's "they're crashing" but also like. If there's a team of medical professionals in the room we don't need someone to announce generally that things are going bad. We can tell. Calling out a specific vital sign--"blood pressure's tanking, 64 over 30"--"I'm getting 76% O2, I need a nonrebreather"--is way more specific and lets us know exactly how bad and in what way. 😤

CODES

Big bad! Blorbo has 1. stopped breathing, 2. abruptly stopped responding to stimuli, 3. stopped having a pulse, or some combination!

This does not just happen, so if you're going to write a code being run you might have to do some extracurricular looking around to find a story-compatible reason WHY blorbo tanked. Extreme electrolyte imbalance caused a dangerous heart arrhythmia? Very severe blood loss->hypovolemic shock? Vomited and choked on it? Vasovagal response when they were trying to poop made them pass out and it's a false alarm?

If someone's found unresponsive, you might see a "sternal rub"--a quick and dirty way to figure out if someone is just really drowsy and lethargic vs completely unresponsive, scrubbing your knuckles down hard against their breastbone. It hurts! And if someone doesn't react to it you can pretty decisively say "shit this person's unresponsive" and get help.

The phrases "CALL A CODE" and a coworker's voice yelling "I NEED SOME HELP IN HERE!" down the hallway galvanize me into an immediate adrenaline response at this point.

In a hospital, there will also be some kind of alert or alarm to immediately summon everybody. On my unit it's a little lever on the wall that immediately turns the call light system a bright flashing blue and has a very urgent and distinct alarm, but tbh most variations on "easy to activate and makes a loud distinctive alert" would be believable to me as a nurse.

The defibrillator will be brought in and hooked up (modern defibs use stick-on pads, not the paddles), but not all codes involve the classic "CLEAR!" and a shock; the defibrillator scans the heart rhythm and determines if the heart's in one of the two (2) shockable rhythms. Even when the code IS heart-related, which not all codes are, the heart rhythm is not always going to be shockable, in which case it will be a matter of CPR and IV medications for heart rhythms, and potentially intubation for breathing problems.

OF NOTE: 'no heartbeat at all' is not actually one of the shockable rhythms! People tend to treat shocking someone as a "restart the heart" thing but it's a "jolt it back into the right rhythm" thing, actually!

Just whacking somebody on the chest, AKA "precordial thump" or slapping them and telling them to Fight It are not accepted medical treatments lol. The first one has SOME very limited utility as a last-ditch thing with no other equipment available but if somebody did either one in the hospital they would look fully unhinged.

EITHER

Bedpans are essentially just a basin that a patient either rolls onto or lifts their hips onto depending on their ability to move. They're not great because lying on your back is a bad angle to actually empty your bladder/bowel and also they spill SO easy, but if somebody needs to have a BM and they're completely bedbound there aren't many other options.

We work really hard to get people out of bed as soon as we can, because being stuck in bed at length is REAL bad for your muscle tone, risk of blood clots, risk for your skin breaking down from friction with the bed, and also risk for delirium/confusion; at least at my hospital we use a lot of "bedside commodes" which are just little portable toilets that can go right next to the bed, and if people can bear weight at all we prefer to help them stand up, turn, and sit on the commode.

That said: if you're in the hospital for a trauma and/or broken bone, you're almost certainly required to have someone with you when you get up; a patient that tries to get up repeatedly without calling is likely to end up on an alarm that can tell when your weight shifts off the mattress like you're going to get up.

Reasons that someone would be unable to get to a bedside commode by ORDER:

Not allowed to bear weight on either of your legs (I usually see this from broken bones in the ankles/feet--repaired fractures in the knees/hips can usually bear weight)

Unstable spinal fracture--in which case they're almost certainly waiting on surgery to repair their spine, and after surgery will be encouraged out of bed again. Before surgery, they will also likely have limitations on how high the head of their bed can be.

(A "broken back" can mean a lot of things; many spinal fractures are just the little jutting spurs of bone and don't endanger the actual spinal cord; those are more likely to get a brace and physical therapy than a surgery.)

BLADDER

Urinals for patients with penises are a very common tool for people with limited mobility--essentially a little plastic bottle with an angled mouth. There are equivalent versions for people with vulvas, but they're somewhat less common and I haven't seen them at my hospital.

Catheters that are fully inserted into the bladder ("foley" catheters) are something we try to avoid if we can! They're a high risk for introducing bacteria into the urinary system and causing infections, especially for patients with vaginas.

They're sometimes inserted during surgery, but often taken out immediately afterward or within a day or two. Sometimes people also start spontaneously having difficulty peeing at all, especially with hip/pelvis injuries, lack of mobility and constipation; in those cases, they'll sometimes end up with a foley for a while to give things time to essentially reset, and then have it removed.

Foleys are held in place by a little balloon full of saline inside the bladder; you CAN yank it out without deflating it first, but boy it sure doesn't feel good!!

"External" catheters are something I've seen pop up fairly recently; one version that's essentially a little banana-shaped foam pad that goes between the labia and is hooked to suction; when the patient urinates, the urine is absorbed into the padding and sucked up into a suction cannister. The other version is the same concept (absorbent substance hooked to suction) but in more of a bag shape with adhesive around the mouth so the penis can be inserted into it.

BOWEL

There is actually a sort of equivalent to a catheter for your bowels, although it only help if someone is having frequent extremely liquid BMs--it's called a Fecal Management System or FMS, and it is also a tube that's inserted with a little balloon that blows up to help hold it in place. They do help sometimes but are famously kind of leaky, and as previously mentioned if we can possibly get a patient up instead we will.

As far as straining after surgery, it's mostly a matter of generous application of stool softeners and laxatives, and getting people out of bed--or helping them walk around the hospital floor if at all possible. Hydration also helps!

If there is one thing humans have always had meds for it's making themselves poop. If pills and drinks don't work, we have suppositories: if those don't work, we have enemas.