#He got a really bad case of hypothermia leading to pneumonia

[forthill]

[scifimedic]

Medical Commentary for Stargate SG-1 1x18 Solitudes 

There’s a lot going on in this episode- broken bones, hypothermia, concussions, internal bleeding… le’ts explore the accuracy and execution of this episode. 

We’ll start with Carter’s injuries, which seem to be mild. She’s initially knocked out from the hit to the head- which is always a bad sign. Any head trauma resulting in unconsciousness is an immediate trip to the ER, but they don’t have that luxury this time. She pulls herself together, but she’s already showing signs of mild hypothermia: 

Fatigue

Shivering

Pale skin

It’s important to note that this episode was shot in a frozen soundstage- it’s entirely possible with both RDA and Amanda are actually mildly hypothermic in some scenes. 

Her initial confusion could be from either the concussion or the hypothermia, and we see it progress as time goes on as she’s unable to put two and two together to come up with four. 

Now for Jack’s (more complex) injuries. He’s also knocked out, but the way he came through the gate is a little confusing. It’s implied that he has a displaced, non-compound fracture of his right tibia. This means that the bone has snapped cleanly in two, but the ends of the bones shifted out of place (but not breaking the skin.) I can guess this because of two things: 

Carter immediately knows his leg is broken, even through thick clothing, which mean’s it’s pretty much sideways. 

There’s no blood on his cloths or the bandages she later applies, which means the bone hasn’t broken the skin. 

He is also concussed I can assume, because of the unconsciousness. He was out a lot longer than Carter, which is extremely concerning. 

Jack also seems to have difficultly breathing, which we later discover is because of broken ribs. Despite Jack’s concern, the treatment for broken ribs is in fact, to do nothing. A splint wouldn’t work. :) 

Near the end of the episode, we see Jack cough up blood. 

Source

Now, most people will jump to a punctured lung for a diagnosis. I can say with near 100% percent certainty that this is not the case. 

First, Jack is still alive after what’s implied to be close to 48 hours. The bleeding caused by a punctured lung will kill you in less than one- either it’s the blood loss or the pressure on your other organs. 

Second, it’s not that much blood. Allthough it looks disturbing to see him cough it up, it’s probably only a tablespoon or so. Not nearly enough blood for a punctured lung, which would be a steady, constant stream with a wet cough (Jack’s is dry.) 

So…. what is it? 

Could be a few things. 

Lung damage from the cold. What happens when water freezes? It expands. What are your lungs and blood vessels made of? Water! When the delicate bits of your lungs freeze, it can cause rupture of teeny little blood vessles called capillaries in your lungs, leading you to cough up a small bit of blood. 

Contusions. Fancy word for bruise. If he got hit in the chest hard enough to snap his ribs, it’s likely that he also bruised portions of his lung. Although this isn’t that serious, it can lead to pneumonia quite easily. It can cause a lot of pain when trying to breathe, and yes, even coughing up blood. 

Good news- if Jack has survived this long, the bleeding in his chest isn’t that bad, and won’t kill him. The bleeding in his leg however…

In a painful scene, Carter tries her skill as field medic to set Jack’s leg. This is absolutely the right decision. If he has any chance at keeping the leg, blood flow needs to be restored, and reducing the bone is the only way to do that. Without X-Ray however, the chances of accidentally severing a blood vessle with the jagged ends of bone are extremely high. We can’t really see what Carter is doing (turn up the brightness dammit, I wanna see!) but looking at the way she’s kinda moving her arms I can tell she’s pulling away from his body and down. That’s the correct technique for this kind of fracture. 

Carter’s splint application skills, however, leave much to be desired. The way she applies the splint seems to be with a rigid backbone, then wrapping gauze around the rigid part to secure it. This is terrible for a few reasons: 

It causes a tremendous amount of pain. Every time you wrap the gauze around, you have to lift his leg up and pass the gauze underneath it. An agonzing task if you have two people to hold the leg stable!

It’s difficult to get the pressure right. Are you tying it too tight? Too loose? It’s bound to be too tight in the beginning- now you have to undo the whole thing to fix it! And… the injury is going to swell. You’re going to have to redo it all over again in less than an hour. 

It’s hard to take a quick peek at the leg and check for bruising. 

The correct method is as follows: 

Prepare all your supplies before touching him. 

Cut four strips of gauze or fabric, whatever you have and lay them out on the ground next to his leg.

Place the splint/board/whatever centered on that gauze. 

Once you’re ready to go, lift up his leg once and quickly shuffle the splint underneath. 

Tie the ties up and around his leg, avoiding the point of the break. 

Now, you can easily adjust the splint for swelling and bleeding checks, and it’s more secure. 

The final product should look something like this: 

Source

Now let’s look at frostbite. Obviously, Jack’s broken leg is at high risk of severe frostbite because of it’s compromised bloodflow. Carter mentions using the sterno to warm up his leg- which can be dangerous depending on how she’s doing it. The best way to use a camp stove to warm up a limb in a freezing environment is to take something fabric and place it near the fire to warm it, then place the dry cloth on the limb. You could even put it in a airtight bag and boil it with food to heat it up. The most important thing is that it’s dry. 

Source

Oh right, I almost forgot about that one. How could I? There’s only one thing wrong with this scene- and I say this from a completely Unbiased Medical Perspective™… they should be naked. 

Anywho… by the time they’re a few days in, Jack is unconscious, probably due to blood loss. But wait, you say, didn’t you tell me that he doesn’t have a punctured lung? Yes, I did thank you for paying attention. He’s bleeding from his leg now, for sure. I also can’t eliminated other sources of internal bleeding- like his spleen or liver. Who knows? He hit the wall hard enough to snap his leg, anything is fair game. 

Thankfully, they’re rescued in time- although Jack certainty had to fight for his life in the infirmary at McMurdo station as he came out of the hypothermia. It was at least four months of recovery time for him once he got home, significantly less for Carter. 

Overall Medical Accuracy: 9.5/10

Carter’s splint is unnecessarily painful, but we know she’s undertrained, freezing cold, and concussed. Understandable.

Solitudes

I watched the SG1 episode Solitudes last night and I forgot 1) how good it was as an episode, and 2) how well they did the splinting scene.