#medical error

[lifewithaview]

Sela Ward and Hugh Laurie in House (2004) The Mistake

S2E8

Chaos ensues after Chase's negligence leads to the death of a female patient. Now, after an inquiry from the hospital board, and a subpoena from the patient's brother, it's up to Stacey to protect Chase's career, as well as House's.

*At the beginning of the episode, Kayla's daughters tell her that Sally Ayersman has been teasing them, to which Kayla responds, "If Sally's mean to you again, I'm just gonna have to key her daddy's new convertible." However, later in the episode, House blackmails a surgeon into doing Kayla's liver transplant. The surgeon is a Dr. Ayersman, whose wife, getting an "anonymous" tip about her husband's cheating, decides to key his new convertible. In House's words, "Enough irony for us all."

[haridiva]

Kesalahan Penegakan Diagnosis dalam Pemeriksaan Kedokteran: Sebuah Tinjauan Keselamatan Pasien

Kesalahan diagnosis dalam praktik kedokteran merupakan isu kompleks yang dapat berakibat serius bagi keselamatan pasien. Kesalahan ini bisa terjadi karena berbagai alasan, mulai dari keterbatasan pengetahuan medis hingga kesalahan komunikasi antara dokter dan pasien. Dalam konteks keselamatan pasien, kesalahan diagnosis tidak hanya menimbulkan risiko kesehatan yang tidak perlu tetapi juga dapat…

[voidshrub]

"Follow me!"

[ourpleee]

lesbianism

[most-well-adjusted]

NOOO OLD GERMAN MAN!!! DON’T GO INTO THAT PARADE!!!

[tiredsn0w]

Discovered this false friend between german/french with a mild shock, and then I thought it would be funny to draw it with these 3.

Explanation: "bitte" means please in german but is a very vulgar word in french. It's not pronounced the same out loud, and Spy probably knows a good deal of german anyways, but just go along with it.

[suchasurfriend]

pete's voice lines are such a treasure

[bleue-flora]

Do you ever think about the fact that Punz’s hoodie is white?… like do you think he got home after the prison break and saw splotches of blood stains on his hoodie (from Dream’s hug) and got concerned? Or did he brush it off as injuries from the fight or whatever…

Like just imagine, hours later after the adrenaline has died down and he’s taking off his white hoodie and he notices blood. Alarmed, he looks down at himself but sees no wounds as expected. He scans his brain - then where would the blood be from? And then he thinks about their meetup, this time noting Dream’s appearance. The tears in the orange jumpsuit, the blood new and old crusting its edges, the scars peppering the spots of skin not covered and he realizes that “little south” meant Hell…

[postcrashcurly]

I don't know much about 'skin things' but I do have a little bit of information on it for those who are interested! (I hope you don't mind me using your comment). I'll be supplementing my knowledge with some research under the read more.

Skin grafting is a dermatological procedure utilized to facilitate wound closure.

We'll talk about some commonly used techniques:

1. Split-Thickness Skin Grafts (STSG) are composed of the epidermic and a superficial part of the dermis. These grafts are commonly used to cover large wounds, burns, and areas of skin loss. They are thinner than full-thickness grafts, which allows them to cover larger areas.

2. Full-Thickness Skin Grafts (FTSG) contain both the full epidermis and the dermis. These grafts are typically used for smaller wounds in areas where aesthetics and durability are essential, such as the face, hands, or neck. Since FTSGs retain the full dermal layer, they offer better cosmetic outcomes, including improved texture, pigmentation, and reduced scarring compared to split-thickness grafts. They also tend to resist contracture better, making them ideal for regions requiring flexibility. - FTSGs are more complex because they require a well-vascularized wound bed to survive and heal. - FTSGs are the most commonly used graft.

3. Composite Skin Grafts are usually small and include a combination of skin and underlying tissues, such as fat, cartilage, or muscle. These grafts are used to reconstruct areas where multiple tissue types are needed to restore both form and function, such as the nose, ears, or fingertips. - Composite skin grafts which combine allogeneic dermis and an expanded autologous epidermis can effect rapid wound closure.

It is further broken down by the following:

Permanent Skin Grafts

1. Autografts (autologous graft): skin collected from the patient 2. Isograft (syngeneic graft): skin collected from a genetically identical donor (twin)

Temporary Skin Grafts

1. Allocrafts (heterologous graft): skin from a cadaver (living donors are possible) 2. Xenograft (heterograft): skin from another species

Can be Temporary OR Permanent

1. Synthetic skin substitutes: use of manufactured skin - The only technique that is permanent is cultured epithelial autograft (CEA), which is essentially a skin graft grown from a patient's own skin cells.

NO NON-SELF TISSUE IS GUARANTEED TO COMPLETELY AVOID DEATH OR REJECTION.

Transplant Rejection: a patients immune system identifies the graft as a foreign body, which triggers an immune response to get "rid" of the tissue.

Skin implant compatibility is based on three highly polymorphic MHC genes (HLA-A, HLA-B, and HLA-C) that encode proteins and are a part of the Human Leukocyte Antigen (HLA) system. This system identifies foreign bodies.

Knowing this, the use of modified donor animals, such as pigs, to provide transplantable organs, is gaining some renewed research. It involves excising the genes in the pig that are most responsible for the rejection reaction after transplantation. However, finding these genes and effectively removing them is a challenge.

The use of autologous skin grafts is the most common approach in the treatment of chronic wounds. However, in the case of deep and/or large wounds or with extensive severe burns, the use of autografts is limited, and either allogeneic (from cadaver) or xenogeneic skin grafts are used for transplantation.

The use of allogenic/xenogenic tissue carries a high risk of graft rejection, limiting their clinical applications.

Tissue Engineering

Advanced therapies for chronic wounds involve application of bioengineered artificial skin substitutes to overcome graft rejection as well as topical delivery of mesenchymal stem cells to reduce inflammation and accelerate the healing process.

Photo shows potentially ideal artificial skin graft:

Modern treatment includes skin tissue engineering aiming to produce bioengineered biomaterial-based artificial skin grafts. Therefore, the main roles of bioengineered skin grafts is to supply oxygen (by being oxygen permeable), keep the wound from dehydration, promote healing, and prevent infections. - Depending on the type of biomaterial used for the production of artificial skin grafts, they may function as skin equivalents providing temporary wound covers or permanent skin substitutes. - When the biomaterials are pre-seeded or have cells incorporated within their matrix, they are classified as cellular artificial skin grafts, whereas biomaterials without or deprived of cells are defined as acellular artificial skin grafts.

Here are some current commercially available synthetic skin grafts I found applicable to Curly's injuries:

Definitions for Clarity: 1. Epidermal: Pertaining to the outermost layer of the skin. 2. Cellular Content: the complex structures and biomolecules that make up cells, the smallest units of life. 3. Acellular: not consisting of, divided into, or containing cells. 4. Fibroblasts: a cell in connective tissue which produces collagen and other fibers. 5. Keratinocytes: an epidermal cell which produces keratin (a fibrous protein forming the main structural constituent of hair).

Articles to Reference

Organ Transplantation and Rejection by Libretexts biology. LINK

(CW: Images) Skin Grafting by Joseph Prohaska and Christopher Cook. LINK

A Concise Review on Tissue Engineered Artificial Skin Grafts for Chronic Wound Treatment: Can We Reconstruct Functional Skin Tissue In Vitro? by Agata Przekora LINK

Composite skin graft: frozen dermal allografts support the engraftment and expansion of autologous epidermis by E L Heck, P R Bergstresser, C R Baxter LINK

[dandelion-wings]

For the angst/gore prompts, could we please have “06: Not Realizing They’re Injured” from the first list with Kujou Sara? Especially something to do with those poor wings I sincerely doubt she was ever taught how to properly take care of.

Thank you for the ask! <3 I have to apologize for this one too, anon, because it's another one that ended up not very whumpy--more a mix of hurt/comfort and angst (and a dose of 'how much can I villain Takayuki?'), because your particular prompt sideswiped a fic idea(s)(really more a constellation of fic premises and themes) that I've been turning over for a while and just kind of. stuck to that until it was irretrievably gummed together. I hope it is still sufficiently wing-focused to earn your forgiveness!

---

ETA: now on AO3.

---

Kujou Takayuki has never once told Sara that she isn't permitted to fly.

She remembers his frown when she was a child, the one time she had leapt into the air to gain an advantage in training. Even though it had given her tactical superiority, he had penalized her for it when evaluating those training exercises. At the time, she had thought it about honor, about the unfairness of exceeding her peers not by outdoing them through the same efforts, but by using an advantage they did not.

When she was older, rising through the ranks in the field, she had once in extremis made an attempt to scout from the air. That time she had seen the frowns on other officers' faces before she had even landed, and understood that honor didn't figure into this at all. It was about being different, being *other*, about the fear some of her soldiers couldn't hide when reminded that she was a youkai, about the contempt some of her superiors showed when they thought she could not see or hear. About her adoption by humanity and what was required of her to uphold the Kujou name.

By the time she becomes a general herself, she doesn't need to be told to stay on the ground.

Flight might have been an advantage for her on the battlefield, but it had never been a necessity. No other tengu has served in the Almighty Shogun's military for almost five hundred years. *Certainly* none served in Watatsumi's. Perhaps she might have gained an edge by taking to the air, but she did not lose significantly by refraining.

After the war, after the Sakuko Decree is lifted, after Takayuki is removed as head of the Kujou Clan and the Tenryou Commission alike, that changes. Gliders have existed for hundreds of years, but have never before been a popular import, nor often even a permitted one; they are different and foreign, and the Almighty Shogun was so long resistant to things that were different and foreign that the Tri-Commission feared to march in lockstep. So has it been with many imports that the Kanjou Commission is only now slowly coming to authorize.

Gliders are particularly popular, due to the mountainous nature of many of Inazuma's most populated islands, where they no doubt would have been popular long before if not for the Tri-Commission's care, but the traveler had made their use seem particularly alluring and permissible. Unfortunately, it isn't only law-abiding citizens who can obtain them now that the sea around Inazuma is clear. The Doushin are struggling to keep up with bandits and smugglers who can just glide away from arrest.

Kamaji, after the third report of such in a row, orders a shipment of gliders from the Knights of Mondstadt to be distributed to the Doushin. When he tells Sara, he smiles, and nods to her wings, and adds, "Though you're fortunate enough not to need them."

Which is all but an order. Even if Takayuki *had* told Sara she wasn't permitted to fly, this would be the new head of the Kujou Clan countermanding that instruction. That the thought of spreading long-disused wings leaves her uneasy doesn't affect her duty.

---

The next such encounter occurs before the shipment of gliders has even arrived. This is a particularly troublesome group of bandits, who have escaped the Doushin twice before; when another report of their activities comes in, Sara leads her forces after them herself. They find the bandits' camp on the edge of a cliff, and when they're startled while celebrating their ill-gotten gains, it seems inevitable that the less drunken and more sharp-witted of them attempt to glide to an escape.

"You, securely bind our existing captives. You, take your troops down that way, and you, that way," Sara orders, pointing out the fastest safe routes down the cliff. "They seem to be aiming for that cliffside, so they may have a secret tunnel or hatch. I'll attempt to cut them off before I get there."

She turns away as the Doushin rush to follow her commands, and spreads her wings at the edge of the cliff. This isn't the first time she's done this, of course--flight is powered by muscles, and any muscle must be exercised. As soon as Kamaji had given his instructions, she'd begun practicing each day, finding a private place in the caverns beneath Inazuma City and attempting first short glides, then short flights, then longer ones. None have been in so open a place as this mountainside with the canyon at its foot, wind whistling through, but she trusts in her training. She could have flown this easily as a child.

Her wings catch the air as she leaps off the edge, and then she's swooping down, flapping to gain speed and get past the gliding bandits, diving towards the cliff to which they're trying to flee. From now she can indeed see a too-deep shadow at the base, where bushes grow. Despite the seriousness of the situation, there's a lightness in being aloft in the open air, a *joy* in flight, that only now that she feels it again does Sara recall, dimly, from her boisterous early childhood. She smiles to herself, all the unease she'd felt when anticipating this change falling away.

The bandits are behind her now, and the cliff close ahead. She flares her wings again to catch herself in the air and adjust, so that she can turn the dive into a plunging attack before she hits the cliff-

A gust of wind hits her broadside as she spreads her wings wide. The force of it wrenches her right wing with a pull that flares into lancing pain, and then the wing collapses in on itself at the wrong angle.

Sara finds herself spiraling as she flaps only the left, desperately trying to slow herself down, to change her bearing. Shifting her grip on her bow, she closes that wing before she reaches the cliff, the other not drooping and dragging limp, and manages to plummet the last few meters and land on both feet. Her right ankle twinges at the awkward landing.

She still manages to turn and straighten and aim before the bandits actually reach her. The uncooperative wing is still alight with pain, but she grits her teeth and lets Electro crackle around her. The bandits hesitate and spread wide to flank her, putting themselves right into the arms of her Doushin.

Lowering her bow, Sara takes a step forward and collapses to one knee as the fractured bone in her ankle snaps under her weight.

---

To add to the humiliation of being carried home by her subordinates, one of her officers goes out of their way to report her injury directly and immediately to Kamaji.

He arrives in the infirmary before the medic has even finished wrapping her ankle. Sara can't even rise to acknowledge his presence properly, only straighten her back, stiffening against the urge to wince when that grinds her injured wing against the back of the chair.

"The operation was a success," she tells him, keeping her voice level even as the medic pulls the bandage tight. "We've captured the entire gang. Their leader is undergoing interrogation now."

"I'm glad to hear it," Kamaji says. "Are you all right? The Doushin told me your wing... it doesn't look good."

Sara looks straight ahead, poised to give her report as best she can. "I trained inadequately for the conditions in the field, and overestimated my ability to handle them. I will have to temporarily remove myself from field operations. That will make the Tenryou Commission's situation more difficult if any complicated matters come up, and I apologize. However, I am still fit to coordinate the Doushin's administrative affairs and handle concerns within the city."

"You can delegate the physical work to your subordinates until you recover. This is a good opportunity to season some of our new officers. If anything serious arises, I *am* the Provisional Clan Head, and willing to take personal responsibility."

Which is in theory his duty--but Sara is accustomed to being Takayuki's right hand, the reason he didn't *have* to handle what he assigned her to personally, even if she had once or twice failed him in that role. She doesn't let herself think, sitting here directly in front of him, that Kamaji also lacks the experience to handle very serious Doushin affairs on his own, but certain conversations with Masahito do impinge vaguely upon her dismay. What matters is not his capability, but her responsibility to manage this department of the Commission, and that he currently considers her unable to do so.

"It will be useful for determining which officers are ready for more advanced duties," Sara agrees. It isn't her place to argue, especially with the results of her own failures. The medic has moved to her wing, prodding at it cautiously, and Sara grits her teeth against a stab of pain.

Kamaji smiles at her. Then he looks at the medic at work, and his smile fades. "How bad is it?"

"I'm not sure, Lord Kujou," the man says. "I've never treated a tengu's wing before. I think I can splint it, but I don't know how well it will heal."

"I don't see how it would be any different from my ankle," Sara says. "I have broken bones before. So long as it's properly aligned and held straight, I've always healed well."

---

The ankle heals faster. Sara is on her feet again within three weeks, though the medics are firm about limiting how much she walks about, and free of their restrictions in six. Her wing, though, lags behind.

It hurts at every slight bump against the back of a chair or a too-close wall, hurts jagged and sharp the first time she grasps a would-be escapee from an unwary Doushin by the arm and he turns and strikes her, and burns bitter and aching if she sits or stands for too long without finding something on which to prop the unwieldy limb up. The medics attempt a frame of bamboo that leaves it stuck awkwardly out; Sara has to discard that after a day of turning sideways to pass through doorways and feeling a fool in front of her men. At no point do they feel it's knit enough to abandon the splint and exercise it again.

A few days after that she's summoned to the Almighty Shogun's presence regarding some aspects of the palace's security. She can feel the Shogun's eyes on her splinted wing, impossible to fold completely against her back, for much of the discussion. Fortunately, the Shogun doesn't force her to recount her mistakes and explain her condition.

Instead, the next day Kamaji summons her to his office and opens with, "I received a message from Her Excellency yesterday regarding your wing." The mortification is so immediate that Sara almost doesn't hear him continue, "Once I explained everything, she arranged for help from Guuji Yae."

That explains the shrine maiden standing in the corner--not one of the bright-eyed young women or sweetly maternal figures who serve the public, but a grey-haired old woman with a lined face and keen eyes. She steps forward before Sara is able to suggest any place private for this examination and begins examining Sara's wing.

"They call this a splint," the woman mutters, and begins to undo it, her gnarled hands steady and sure.

As this was the Shogun's will, Sara simply extends her wing as far as she can when instructed and stands impassive as the woman pokes and prods at it, much more confident than the medics but no more gentle. Kamaji watches with unaccountable anxiety. His expression makes Sara have to breathe deep to quell some of her own. She has no idea what results the Shogun may wish from this examination, nor what instructions she may have given Kamaji regarding Sara's disposition if it does not go well.

Grasping the outer edges of Sara's wing, the woman flexes the joint to its fullest extension, pushing it so far past the point of comfort that Sara can't hold back a gasp as strained and swollen muscles complain. Then she folds it in to the same extent, almost as tightly as Sara has ever pinned them to her back. It can't quite make the full pivot in either direction.

"It never healed properly the last time," the woman says, waspishly. "Breaking it again has only made it worse. Did he have someone with a Vision heal it? I told him it should heal on its own."

"Heal what?" Sara asks, and at the same time Kamaji draws a breath in and says, "He did have a military medic with a healing Vision treat her. He said he didn't have time to wait for her to lie in bed."

The question's context falls into place. Sara knows she had needed tending, and healing, after her fall as a child, even with the Almighty Shogun's blessing to keep her alive. The haze of pain she'd been in afterwards had seemed to wrack every part of her, inspecific, but yes, she well could have broken a wing, plummeting from the air like that. Furthermore, she does recall the healer who tended her after she was brought to the Kujou stronghold, a man whose Vision's power had seemed another blessing on top of the one the Shogun had already given her.

"Not if they weren't used to hollow bones. They over-thickened it and impinged on the joint. And the way it's mending--have you been skimping on your grit?"

"My... grit?" Sara dislikes being so on the back foot in this conversation.

"Powder, sand, whatever you call it. Your mineral supplement. Don't tell me he listened to Mirei and you've been drinking *milk* all this time. I don't want to think about what that could do to your digestion."

"I don't have a mineral supplement."

The woman's grimace of disgust falls away a little too quickly to have been anything but performative, especially given the look that follows. Sara has seen medics giving dire news before. "That does explain why this isn't healing. And shattered into so many fragments, at that. Tengu are just like ravens in this respect. If they don't get enough grit in their diet, their bones go brittle. *Especially* the wings."

"Ah." Sara feels the air go out of her, and makes herself draw it back in. "What is the supplement composed of? I'll begin adding it to my diet immediately."

"Ground eggshells, or fish bones, or snail shells. But that's not going to fix this. It's started setting wrong, and it was already so fragmented that breaking it and resetting it would be a fool's errand. You needed to have been eating your grit the whole time to hope that this could be mended now, especially with that earlier break."

"Are you saying that it won't heal?" Kamaji asks, sounding agonized. Sara wonders again what instructions the Shogun may have given him.

"Not properly. Not such that she'll be much of a flier ever after."

Sara holds herself very still against the wave of despair. She is a competent warrior and an able servant of the shogun without her wings; she's served in that way her entire adult life. There should be no import to being told that she must continue to do so. Even if the issues with the joint preclude a tengu's proper flight, perhaps she can glide, or a glider can be adapted to her, so she can continue to assist the Doushin as Kamaji wishes. Even if the Almighty Shogun desires her wings mended... surely Sara's service has been sufficiently loyal that the Shogun will not reject her for this alone. Even if that disastrous flight had begun full of joy, the satisfaction in carrying out her duties should eclipse this strange sense of loss at something she had for years voluntarily put aside.

The woman seems to sense something in her stillness, though Sara knows she's kept her feelings off her face. "Honestly, I'm surprised this hasn't happened well before this, the number of battles you've been in."

"I've never flown in battle," Sara corrects her, voice flat. "This was the first time I've attempted to fly in the field."

"Why," the woman asks, looking at her in disbelief, "would a *tengu warrior* stay grounded?"

Sara holds her tongue, because she knows the answer. She knows it, and yet to say it would be to disparage Takayuki--to suggest that he had forbidden her to fly, when he never had, when he had never said a word on the subject one way or the other. He had only frowned.

He had only impatiently had her healed in a way this woman, familiar with ravens' wings and apparently with tengu's, had advised against. He had only disregarded the same woman's instructions on her diet, knowing that it would be to her detriment should she attempt to take to the air. He had only put her in a position that destined her, when she did try to take wing, to inevitably fall back to the ground.

"We'll find a solution to this," Kamaji says, determined in that way Sara has always admired, as if she, too, would be cause to challenge the Almighty Shogun if he had to. The words barely register as what Sara had always thought her understanding of the situation shifts once again.

Takayuki has never had to tell Sara she isn't permitted to fly. He's built that limitation into her very bones.

[sexycornenthusiast]

I love komaeda but for some reason that love manifests exclusively as death wishes. I see him and start giggling and kicking my feet and then the first thing I say is "omg I hope he gets more illnesses 😍"

[onebizarrekai]

I've been going back and forth trying to decide whether I want to make the old ibvs oneshots be available on ao3 but every time I look at them I go into a state of shock at how… absolutely teenager they are

also this

[telesodalite]

Been thinking about idw1's outliers lately, and how sort of wild the whole concept is from a worldbuilding standpoint, and it struck me that most confirmed outlier abilities tend to be really useful, or flashy, or powerfully dangerous, and few to none tend to be like, really boring, or totally impractical, or even entirely useless? Which, doesn't really make sense when considering the fact that outlier abilities are seemingly random.

Surely not everyone who's born an outlier gets something useful?

And I don't mean like, "good" useful, but any sort of useful, even if that means you can kill people with your voice, or give a power boost by exploding yourself, those are still "useful".

But surely there had to be some with abilities that were totally impractical, or nonbeneficial, or at the very least just insignificant or purely aesthetic and pointless?

[mitochondriaandbunnies]

A little comic about how I am a currently an impetuous toddler piloting an adult-sized meat suit and I fucking hate it

[moccasins]

i realized i don't always have to use blog this for art..

so last night i had a dream where all the "godlike" aus, fanon or canon, were all created in a white void. the ones i could see were life, reaper, ink, error, dream, and nightmare. my dream was from the pov of error, but he didn't have his strings.

the dream started with them appearing in what looked like the anti-void, confused. none of the other aus were created yet, but us creators had made these gods to start the balance that would eventually form the aus. most of the ones there were excited at the idea, but error wasn't. he didn't know why he was there and what was happening, but as he watched from a few feet away he heard a voice calling to him from somewhere in the void. curious, he followed it.

after only a little bit of walking he met a figure, idk who it was, and they were the source of the voice. they told him that they could help him find his place among the other gods if they made a deal with him and, after a little bit of convincing, he agreed.

almost immediately some weird symbol was burned into his forehead and the sides of his eyes where his tear tracks would go, they kinda reminded me of a circuit board? or some kind of celtic symbol?? idk. he was on the ground in pain when the other gods found him. ink tried to figure out what was happening but error wouldn't respond, the voice in his head was so much louder now and he just wanted it to stop.

my dream ended with error touching the marks near his eyes and the strings came out of them and he, and all the other gods, were horrified.

[tj-crochets]

Hey y'all! Do you have any advice about making smoothies? Like, what kinds of fruit and veggies go well together, what combos very much don't work, and especially if you have any advice on what frozen fruits or veggies work best. I am thinking about trying making smoothies but I know pretty much nothing about it lol