#rapid cpr

[heartshield1]

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when you least expect them. Knowing how to respond with CPR can mean the difference between life and death. If you’re looking for CPR classes in Grand Rapids, MI, Heartshield is here to provide top-tier training that equips you with the skills to act confidently in critical situations.

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[thinkinonsense]

Magnetic ──★ Logan Howlett x fem!oc: Chapter One

╰┈➤Summary: After years of torture, Daphne decides how she wants to spend the rest of her life; at the bottom of a lake. Out of nowhere, Logan pulls Daphne from the water and finds her help. Now they must navigate how to live with their decisions.

╰┈➤C/W: mentions of death, suicide, cursing, age gap, mild violence, issues with infertility, slight sexual themes. ᯓ★ mdni.ᐟ ᯓ★word count: 2.1k+

ᯓ★ reply to be added to the tag list <3 ᯓ★ spotify playlist link

ᯓ★ next chapter

✮⋆˙ At the bottom of the lake was cold water and silence. Years of running can bring you to the edge of a cliff. A lifetime of pain needs to be healed somehow and suddenly, life never felt so peaceful for Daphne.

Finally Free.

Until someone jumps in, wrapping his arms around her unconscious body; lifting her to the surface. Panic began to run through the man's veins as he laid her on the ground. Her heart is beating slowly which helps steady his own.

Daphne coughed up some water while blood rushed to the cut above her eyebrow. The man uses the sleeve of his brown flannel to soak up some of it.

Without a second thought, he scoops her up in his arms again; knowing exactly where he must take her.

──★

"Where did you find her, Logan?" Jean asked, watching over one of the monitors.

"Down by the lake," Logan answers, tapping his foot impatiently.

Daphne's body has barely regained consciousness before her mind starts racing as memories flood yet none of them answer her questions. Logan carefully runs his calloused fingers down her left leg, knee to ankle. 

"Charles was able to build a report on her. She's a mutant." Jean explained. "Her mutations can cause agonizing and illusionary pain, self-healing, telekinesis, and attraction control. She is quite powerful."

"Attraction control?" Logan tilts his head, never having heard of the ability. Jean bites back a smile.

"People find an attraction and gravitate towards her."

"Just sounds like an attractive woman." Logan shrugs, still not quite understanding.

"The government created her years ago; tortured and altered her as they pleased. Magneto was even after her for a while. He wanted to create a weapon out of her. She finally ran away a few months ago. I'm not sure what she was doing at the lake. Perhaps she accidentally fell in the water? I don't believe she was pushed or-"

"She was trying to kill herself," Logan states, eyes not leaving Daphne's soft features. "I saw her jump. I-I wasn't sure what she was doing at first and then..."

Jean places a hand on Logan's back, rubbing a smooth circle.

"She is going to be fine, Logan." She assures him.

He nods, trying not to worry anymore. Honestly, Logan wasn't sure why he was worried. In the past, he's felt protective over Rogue and his teammates but this woman was a stranger. It must've been due to the nature of her attempt to take her own life, he justifies.

Daphne's hair rests damp and curly against the table Logan laid her on when they arrived. On one of the monitor screens behind Logan, Jean notices a rapid change in breath, and the tables around them begin to shake. Before Logan could get his claws out, Jean and him hit the floor, groaning in pain. 

Charles had been right, the pain was agonizing. Jean felt as if someone was closing her throat; making her unable to focus and stop Daphne. Logan's pain was in his chest and abdomen. His claws break through the skin of his knuckles but he can't move.

"P-Please.." Jean begged, gasping for air. "Let us e-explain."

Reluctantly, Daphne releases them both. Logan and Jean noticed her glowing eyes as they shifted back to normal. Her top was ripped from when Logan tried to give her cpr and her pants were still soaked. She was shivering like a dog, Logan thought. Quickly, he shrugged off his flannel and offered it to her; an olive branch. Daphne knew better than to take offerings from handsome strangers. 

"Where am I?" She asked.

"Charles Xavier's School for Gifted Youngsters," Jean answers, catching her breath. "You were found unconscious at the bottom of a lake. Do you remember any of that?"

Daphne's gaze lands on the floor. She remembered all of it.

"No." She lies. "Who are you?"

"I'm Jean and he is Logan." Daphne flickers her attention to both of them as Jean continues. "Logan pulled you from the lake."

Before Jean or Logan could ask her anything else, the doors opened revealing Professor Xavier. The man in the wheelchair rolls next to the table where Daphne sits. 

"Hello, Daphne. I am Charles Xavier." The older man says to her. "Can we talk?"

"A-About?" Her voice comes out broken and shaky. 

"What were you doing at the bottom of that lake?" 

In all truth, he already knew. He could see those last moments before she jumped and he knew the pain that lived inside of her. 

"I don't know." She lies again, this time more effortlessly. "I already told them. I don't know why I am here either."

Charles was aware that it would be difficult to get her to admit why she wanted to end her life. His heart ached for her. Similar to how it did for all the other children here. Carefully, he placed a hand over her own.

"You're safe now, dear." He says. "Get some rest." 

As he turned away, he ushered Logan to follow him; leaving Daphne and Jean alone. Jean helped Daphne change into a white tank top and pajama bottoms with the school's logo on the pocket. Now, that Daphne is awake, all of the cuts and bruises that adorn her body can heal themselves. Once dressed, Jean led her to one of the empty bedrooms. As they exited, Daphne snatched the flannel left on the table.

"Some of the older children are on a mission right now but they should all be back soon for dinner." Jean's voice echoed ever so slightly down the empty hallway. "It's quite incredible to watch them and their powers evolve."

Daphne couldn't help but mumble, "I wish I had something like this when I was a child."

"You're welcome to listen in on one of the classes if that interests you." Jean smiles. "There's a lot to learn about yourself and your powers."

Daphne nods as they approach one of the bedroom doors. Jean unlocks it and both women step inside. The room was comfortable, Daphne thought. A real bed and some privacy. She was lucky to get even three hours of sleep a night due to frequent nightmares or someone pulling her for testing. There were no glass cages or lingering eyes. 

──★

On the other side of the mansion, Logan sat in the chair by Charles' desk. He wasn't sure what the other man would have to say. Instead, his thoughts moved towards Daphne and how she must be doing; If she was still cold and shaking from the lake. 

"You did the right thing by bringing her here, Logan" Charles said, capturing Logan's attention again. "She's going to be fine."

"Why'd she do it?" Logan grunted. 

Charles sighs, unsure if he should tell Logan. 

"She was tortured and used as a weapon for decades, finally having made her escape from them she discovered that they stripped away her ability to have children too." 

Logan wasn't sure if he understood exactly. He knew that the government had done that to female mutants in the past to eliminate the rise of mutant children but this girl was still young. Why would she be worrying about having children right now?

"The attraction control was only further torment installed on her," Charles explains. "They trained her to cause pain knowing how gentle her heart is. She was forced to take the lives of people she wanted to help. She is afraid to live, that's why she jumped."

Logan exhaled sharply. He wanted nothing more than to rip apart the people who tortured her with his claws. Daphne's image appears in his head again; soft features and shivering hands. How peaceful she looked with her eyes closed; and beautiful. Logan brushed the last part as the attraction control got to him. 

"She is young. She can still live a full life, get married, and settle down if she wants." Logan said. 

She looks incredibly young, Logan thought when he first pulled her from the water. Old enough to live alone but not nearly as old as him. 

"Daphne believes that she is cursed. Everyone that she has ever caused pain to has left her."

"The pain was bearable."

Charles stares at Logan and then says, "If you think so, tell her that."

"It's not like that." Logan squints at him while lighting the cigar that was in his pocket. "She's too young."

"She stops aging in two years at thirty." Charles lets slip.

"She isn't even thirty?" Logan mumbles to himself. "Jesus."

"I can see how you found her and brought her here."

"You said it yourself, I was just doing the right thing."

Charles chuckles, letting it go. Logan gets up and leaves since they both know there are more important things to worry about.

──★

The mansion is dead silent. Odd considering how many people live here, Daphne thought while staring at the ceiling. All the children were in bed by nine while the adults roamed the halls until midnight. She wrapped herself up in the flannel and locked herself away shortly after Jean left her alone. Around six, Jean knocked on the door a few times to invite her to dinner but Daphne didn't move from under the warm beige sheats. She lay there for hours staring out the window or at the ceiling. Sometime at four in the morning, Daphne figured it was a safe time to make a run for it. This place was lovely and so were the people but she had already decided where she wanted to be. 

"Where do you think you're going, bub?" Logan's voice made Daphne spin on her heels to face him. Her gaze moves up his body he's dressed in a fitted white tank top and plaid pajama pants. It was difficult for her not to stare but she fought the urge. 

"Making your life easier and leaving," Daphne responds, reaching for the door when his hand lands on her wrist with a small pull. 

"I can't let you do that." 

"And why can't you?"

Daphne glared into his hazel eyes, trying to intimidate him but he only found it amusing. 

"Because I don't want to have to save your ass again."

Daphne couldn't help but laugh. Did he seriously think she cared about how this affects him?

"I don't need you to 'save my ass'."

"You sure did earlier." He cockily adds. "Plus they want you to stay."

"Why? So they can use me how they want and discard me when they are done? Look, I've done that whole thing before and it never ends well." Unknowingly to Daphne, her eyes glow maroon again, causing Logan's claws to peak out a bit in case.

"I get it. Trust me, I do but running won't help you either." He says, attempting to calm her before deciding to jump into action. "These people won't hurt you, Daphne."

Daphne's hand drops from the door, releasing his grip and her eyes roll back to their original shade of green.

"Are there any leftovers from dinner?" She asked, seeing one corner of his mouth curl up a little.

Logan led the way into the kitchen, pulling out the leftovers and a beer. Daphne made a plate and warmed it up while he pretended not to watch her. So many questions left unanswered about each other yet neither of them wants to be the first one to ask. It was silent while Daphne twisted spaghetti on a fork and Logan slowly drank his beer.

"Where are you from?" He asks, breaking the silence.

"Not entirely sure." She shrugs. "How old are you?"

 He didn't look much older, she thought. Maybe mid-thirties?

"What's it matter to you?" He answers in a rough voice, almost sounding irritated by the question.

"Curiosity."

"Curiosity killed the cat, ya know?"

"Good thing I'm no cat." Daphne smiles for the first time. Now he knew he had to give in.

Logan sighs, looking defeated. "I'm over 200 years old."

He moves on immediately, not giving Daphne any time to respond.

 "Parents?"

"None."

"None?"

"Nope. I'm nobody's daughter." 

Daphne avoids Logan's stare. He thinks back to his talk with Charles earlier about her life; isolated, tortured, and trained to cause damage. How lonely she must be.

The grandfather clock reads five forty-five. Everyone would be awake soon. Daphne had to ask this question while she had the chance.

"Why did you bother to save me in the first place?" She asks quietly, not looking up from her plate. 

Logan didn't answer for a minute but he watched her intensely. Something about being under his microscope intimidated me.

"You were dying." He states in a matter-of-fact tone.

"Regular people die every day. I bet you don't save all of them." The response flies out of her mouth before she can catch it.

"You aren't a regular person."

"Right," She sighs. "The mutant of it all."

Suddenly, she rises from the stool and places the plate in the sink, no longer feeling hungry. Logan calls after her twice but neither time does she turn back. Instead, she shut the bedroom door and crawled back into the bed alone again.

[literaryvein-reblogs]

Writing Notes: Carbon Monoxide Poisoning

Carbon monoxide (CO) poisoning - occurs when carbon monoxide gas is inhaled.

CO - a colorless, odorless, highly poisonous gas.

Produced by incomplete combustion.

Interferes with the ability of the blood to carry oxygen.

Found in: automobile exhaust fumes, faulty stoves and heating systems, fires, and cigarette smoke.

Other sources: woodburning stoves, kerosene heaters, improperly ventilated water heaters and gas stoves, and blocked or poorly maintained chimney flues.

The result is headache, nausea, convulsions, and finally death by asphyxiation.

Symptoms

The symptoms of CO poisoning in order of increasing severity include:

headache

shortness of breath

dizziness

fatigue

mental confusion and difficulty thinking

loss of fine hand-eye coordination

nausea and vomiting

rapid heart rate

hallucinations

inability to execute voluntary movements accurately

collapse

lowered body temperature (hypothermia)

coma

convulsions

seriously low blood pressure

cardiac and respiratory failure

death

In some cases, the skin, mucous membranes, and nails of a person with CO poisoning are cherry red or bright pink. Because the color change doesn’t always occur, it is an unreliable symptom to rely on for diagnosis.

Although most CO poisoning is acute, or sudden, it is possible to suffer from chronic CO poisoning. This condition exists when a person is exposed to low levels of the gas over a period of days to months.

Symptoms are often vague and include (in order of frequency) fatigue, headache, dizziness, sleep disturbances, cardiac symptoms, apathy, nausea, and memory disturbances.

Little is known about chronic CO poisoning, and it is often misdiagnosed.

Treatment

Immediate treatment: Remove the victim from the source of carbon monoxide gas and get him or her into fresh air.

If the victim is not breathing and has no pulse, cardiopulmonary resuscitation (CPR) should be started.

Depending on the severity of the poisoning, 100% oxygen may be given with a tight fitting mask as soon as it is available.

Taken with other symptoms of CO poisoning, COHb levels of over 25% in healthy individuals, over 15% in patients with a history of heart or lung disease, and over 10% in pregnant women usually indicate the need for hospitalization.

In the hospital, fluids and electrolytes are given to correct any imbalances that have arisen from the breakdown of cellular metabolism.

In severe cases of CO poisoning, patients are given hyperbaric oxygen therapy. This treatment involves placing the patient in a chamber breathing 100% oxygen at a pressure of more than one atmosphere (the normal pressure the atmosphere exerts at sea level). The increased pressure forces more oxygen into the blood.

Prevention

Carbon monoxide poisoning is preventable.

Particular care should be paid to situations where fuel is burned in a confined area. Portable and permanently installed carbon monoxide detectors that sound a warning similar to smoke detectors are available for less than $50.

Specific actions that will prevent CO poisoning include:

Stopping smoking. Smokers have less tolerance to environmental CO.

Having heating systems and appliances installed by a qualified contractor to assure that they are properly vented and meet local building codes

Inspecting and properly maintaining heating systems, chimneys, and appliances

Not using a gas oven or stove to heat the home

Not burning charcoal indoors

Making sure there is good ventilation if using a kerosene heater indoors

Not leaving cars or trucks running inside the garage

Keeping car windows rolled up when stuck in heavy traffic, especially if inside a tunnel.

Source ⚜ More: Writing Notes & References ⚜ Poison ⚜ Fictional Poisons

[notfeelingverywell]

near-drowning is such a good whump trope, not just on its own but also for what comes after

convulsive coughing or vomiting water after being pulled out

violent shivering and/or hypothermia (or concern about potential hypothermia)

bruised or cracked ribs from CPR

rapid breathing and heart-rate for hours afterwards, even if their body is tired and achy

Exhaustion and chest pain - they're limp, lethargic, but still needy for touch and comfort

Chest infections settling in their lungs from the cold and the dirty water they inhaled

Lingering trauma about the event- nightmares of sinking, panic attacks in darkness, nervousness around water, claustrophobia

[sparkletastic-cookiedough]

I’ve seen a number of imagines where due to interdimensional shenanigans or being liminal, Danny Phantom is more durable than most people in the dc dimension.

And those are cool and fine and all, but imagine if it was the opposite?

Danny Fenton gets punched twice and dies.

Which is fun on its own, but Danny is half ghost. He’s cursed to an existence where he can never truly be alive or dead for all eternity. Meaning that after a little while, Danny is back at it again, on the streets of Gotham in the same fleshy body he just died in.

He has to turn into ghost form first, but he can turn invisible as a ghost, so it’s fine, no one sees him glowing before he heads into an inconspicuous alleyway to return to life.

The blood stains would be a problem, but it’s Gotham so no one bats an eye.

Except for the bats.

(Warning: some death, corpses, and gore ahead)

—————

It always haunts Duke when he fails to save someone. He’s a hero now, and that’s part of the gig, but still.

He keeps wondering if maybe he had been faster, or stronger, or just a moment sooner, maybe then the civilian would’ve lived.

He sees the corpse in his nightmares, a reminder that he wasn’t good enough. It’s not rational, but Duke can’t get the image of the dead teen out of his head- the lifeless blue eyes, the dark hair, the…

… is that him?

No, it can’t be. It looks a lot like the kid, but his mind must be playing tricks on him or something. Because he saw that kid die. This kid, across the street, they must be someone else. Maybe they’re related?

Duke hears a commotion down a nearby alley, and leaves the mystery for later.

—————

Cass is concerned about this dead body.

In her line of work, it’s normal to see a lot of corpses. What’s strange about this one is that it makes no sense.

It’s splattered on the ground like it fell from a skyscraper. The tallest building in the area is five stories high.

The body is too fresh to have been from a while ago. It doesn’t show signs of having been moved. There weren’t any helicopters in the area recently it might’ve fallen from.

She surveys the area again. Perhaps this is a trap?

No security cameras or bad guys in sight.

She turns back to the body-

It’s gone. Only a pool of blood remains, undisturbed.

No one could have snuck past her. Something strange is going on.

—————

The bullet Jason shot shouldn’t have done this much damage.

The teenager was accidentally hit in a hostage situation. Usually Jason doesn’t miss like that, but the bullet should have just nicked him. A bandaid should have done the trick.

But this kid is leaking blood like a fire hose. It’s absolutely gushing out.

You never realize how much blood a human body has in it until you see it spread out all over the floor.

Jason puts pressure on the wound, damn the bad guys he is not having a dead civilian on his hands if he can help it.

He grabs a tourniquet from the first aid pack he carries. Fastens it around the kids arm-

- and the kid’s arm flops off. Not normal. Either Jason has just gotten Superman-levels of strength, or something is wrong with the kid.

The kid’s rapid breaths devolve into quick gasps. The blood from his wound slows to a trickle. Jason feels the kids heart go from pounding to nothing-

Fuck.

Instinct driving Jason more than any sense of reason, he puts the kid on his back to do chest compressions.

Jason pushes down. He hears a loud Squelch. His hands go through the kid’s torso.

Double fuck. Jason might know CPR, but he doesn’t know how to deal with this. His panicked-brain remembers he’s in a fight right now, and Jason turns towards the people who held the kid hostage.

They immediately surrender.

[cabin13cappuccino]

coming out of my well to shame the fandom re: treating Nico like he's from 1840 rather than 1940 in terms of living with medical innovations

Vaccines for the following diseases were available during this time:

Smallpox- first generation vaccines were available and work on second generation vaccines occured in the 1930s with production of an egg-based vaccine begun by the Texas Department of Health in 1939. DC schools required smallpox vaccination for children to be allowed to attend by 1930, so Nico would have gotten immunized for this even if he didn't get anything else.

Diphtheria- first vaccine was developed in 1913, then a cheaper version in 1924. Yep, it's the "antitoxin" they call for in Balto (1995)- it can be used to either treat active infection or immunize.

Pertussis (whooping cough)- first vaccine was licensed in the US in 1914, then another in 1931, and another that became the basis for the modern vaccine in 1932.

BCG vaccine for Tuberculosis (TB)- first available in 1921, but neither the US nor Italy mandated it. This vaccine is still given around the world today.

Tetanus ("lockjaw") - first vaccine was produced in 1924, then a more effective version in 1938. The combo DTP (diphtheria, pertussis, tetanus) vaccine was first released in 1948 and was used all the way up to 1996 when a new, safer version was released.

Anthrax- the veterinary vaccine in use today is based on the one developed in 1935 in South Africa. The Soviet Union developed a human vaccine that was available beginning in 1940.

Yellow fever- the vaccine still in use today (17D strain) debuted in 1939.

The first rabies vaccine was developed in 1885, for crying out loud!

Penicillin was used to cure infections as early as 1930, though it didn't hit mass-production until 1945. Other antibiotics (Salvarsan and Prontosil) were in use in the early 1900s (by 1910 and 1935, respectively).

Thyroxin (1914) and insulin (1923) were known quantities for treating endocrine disorders.

Medical radiography (x-rays) was a thing before 1900. There were portable ECG/EKG machines as early as 1927.

Cocaine was taken out of Coke in 1903. Like, not even Maria di Angelo would remember that.

Yes, a whole bunch of things changed in medical science between 1942 and the mid-2000s- plenty of fodder for "Will blows Nico's mind with modern medicine." I will even provide suggestions!

Vaccines for major childhood illnesses: polio (1952), measles (1962), mumps (1967), rubella (1969). IMO the polio thing is way slept on given how big the March of Dimes got in the public consciousness.

Closed-chest defibrillation (1950s) and CPR (1970s for the public)

Organ transplants (1953)

Ultrasound (1949/1961)

Not giving aspirin to anyone under 16 due to Reye's Syndrome risk (1980s) and the advent of other OTC painkillers (ibuprofen, 1969; paracetamol/acetaminophen, 1952; naproxen, 1976)

Insulin that comes from genetically engineered E. coli instead of purified animal pancreases (1978) so as to keep allergic reactions from happening

Rapid strep or flu tests (1980s/1990s) rather than waiting days to culture stuff

If y'all want a "they took the cocaine out of Coke" moment, might I suggest "what do you mean cigarettes/asbestos give you cancer" and/or "they took the lead out of the gasoline"?

But yeah...we've made a lot of progress since 1942 but it wasn't "you got ghosts in your blood and bad air do some drugs about it" back then- not by a long shot.

Wah wahwah wah wah back in my day we scoured Wikipedia and the rest of the internet to do background research on fandom-related minutiae and we liked it

[specialmedicalcentre]

Cassie Codes in the ICU

Nurse Farah watched quietly as Cassie's chest rose, then fell, as the ventilator breathed for her. There was an intermittent whoosh-click that came from the vent each time Cassie's breasts rose. Farah could not remember how many times she had checked on Cassie today, and she knew this would not be the last.

A quick succession of sounds from the vitals monitor shook Farah out of her reverie. Bip-bi-biiip-bipbipbip-biiip. Cassie's heart was threatening arrhythmia again. Instinctively, Farah placed her finger against Cassie's neck, feeling directly for her pulse. The skin was cool and a little clammy. Farah felt Cassie's heart trying to push blood, but she feared that Cassie would probably fall back into arryhthmia and, from there, into V-fib again.

Just as soon as it began, Cassie's cardiac rhythm corrected itself.

Farah pressed a button on the monitor and began a blood pressure reading. She heard the familiar sound of the pump, grinding away inside the monitor. She saw the cuff bulge on Cassie's slim arm - bruised and sweaty from the abuse - and heard the pulling and straining of the velcro as the cuff reached its limit. With a few deflations, and a long beeeep, the machine deflated the cuff.

102/70. Cassie was not doing well. Her pressure has been dropping and her heart wasn't doing its work. Cardiomyopathy? Some kind of rhythm problem?

The attending physician had told Farah that Cassie had come in to the Emergency Department the previous night complaining of light-headedness, headache, chest pains. Naturally, they processed her immediately as a potential cardiac case. Slim, 22, possible anorexia…the case almost wrote itself. Her low blood pressure wasn't unusual for a woman her age and build, but a 5-lead EKG gave some ominous signs. They shifted her to a 12-lead and got her a bed. After several hours in observation in the ER, it seemed that she was stable, although still weak and hypotensive. The arrhythmia was already obvious.

Then she coded. For the first time, at least.

It was unexpected and very sudden; Cassie's cardiac deterioration was very rapid - she complained of a flutter, which was probably A-fib, and then she lost consciousness and seized briefly. After a short round of CPR and a 120 J cardioversion, they had a rhythm and she was breathing on her own, although she was not conscious. They decided to move her to ICU.

That's when I first saw her, Farah thought to herself. Farah had immediately found herself suddenly fond and protective of Cassie. Maybe more than other patients; she couldn't be sure.

Still unconscious during Farah's morning shift, Cassie coded again, briefly. Farah performed CPR this time. They got her back on rhythm again and decided to intubate for safety, given her uncertain condition. The ER team had left her in her bra and panties; when Farah's team decided to put in a Foley, she decided that she would leave Cassie as dressed as possible.

Farah looked away from the vitals monitor and its terrible information, and looked down at Cassie, her body uncovered for observation.

Cassie was reclined in the ICU bed, slightly head-up for postural circulation. Her arms were laid away from her body. She was on a vent, the tube holder creasing her face where it had been quickly strapped in place. Her hair fell in disheveled curls out of the bouffant cap they had put on her. As her chest rose and fell, Farah ran her eyes slowly down Cassie's body, thinking about how she looked. EKG electrodes pressed quickly to her chest, IVs in her wrists. The thick yellow cath clumsily running out of her panties to the collection bag.

They had done all the necessary things, and now Cassie was totally transformed from how she was when she came in. Farah's fascination was deep. She found herself staring at the catheter bulge in Cassie's panties.

"Farah?" Nurse Yasmin's greeting startled Farah, and it probably showed. She tried to stifle her gasp, but she was unable to hide her blushing.

"H…hi, Yas. What's up?" Farah smiled at the junior nurse.

Yasmin looked briefly at Cassie, then up at the monitor. "How is she?"

"Same. BP is down some, and she's still throwing PVCs." Farah sighed. "What's up?"

Yas looked at Farah. "Attending told me to tell you that we should put an AED on her and prep for corrective cardioversion. The team is on the way."

Farah looked at Cassie again. Here we go.

"Can I help out?" Yasmin asked.

"Of course," Farah smiled. "Let's get her prepped."

=====

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[hayatheauthor]

A Writer's Blueprint for Realistic Drowning Scenes

This guide is designed to help writers depict drowning scenes with authenticity and detail. I’ll walk you through the step-by-step process of drowning, the physical signs to look for and clear up some common misconceptions. With this information, you’ll have the tools to craft vivid, compelling, and believable drowning scenarios that will captivate your readers and add depth to your narrative.

Fair warning; this is a comprehensive and pretty explicit guide, so if you're uncomfortable with those topics, please just scroll away. 

The Stages of Drowning

1. Initial Entry

When a person first enters the water, especially unexpectedly, their initial reaction is often one of shock and panic. The sudden change in environment, temperature, and the feeling of being submerged triggers an immediate response from the body.

Shock Response

Cold Water Immersion: Sudden immersion in cold water can cause a cold shock response, which includes involuntary gasping, hyperventilation, and a rapid increase in heart rate and blood pressure.

Panic and Disorientation: The person may become disoriented and panic, struggling to stay afloat and breathe normally.

2. Involuntary Breath-Holding

As the person struggles to keep their head above water, they instinctively hold their breath to prevent water from entering their lungs.

Burning Sensation in Lungs

The buildup of carbon dioxide in the blood creates a burning sensation in the lungs, which intensifies the feeling of panic.

Increased Heart Rate and Blood Pressure

The body's stress response causes an increase in heart rate and blood pressure, further depleting oxygen reserves.

3. Uncontrolled Breathing

When the person can no longer hold their breath, the body's reflexes take over, leading to involuntary attempts to breathe.

Aspiration of Water

Water enters the mouth and is aspirated into the lungs, causing coughing, choking, and a strong gag reflex.

Coughing and Choking

The person may cough and choke as water enters the respiratory tract, leading to more panic and struggle.

Gasping for Air

The body's desperate attempt to get oxygen leads to gasping, but often results in inhaling more water.

4. Laryngospasm

The body's protective reflex to prevent water from entering the lungs can cause the vocal cords to spasm, temporarily sealing the airway.

Temporary Airway Closure

The laryngospasm closes the airway, preventing both water and air from entering the lungs.

Increased CO2 and Decreased O2

As carbon dioxide levels rise and oxygen levels fall, the person becomes increasingly hypoxic.

5. Loss of Consciousness

Due to the lack of oxygen, the person loses consciousness.

Hypoxia and Hypercapnia

Hypoxia (lack of oxygen) and hypercapnia (excess carbon dioxide) cause confusion, dizziness, and loss of motor control.

Fading Senses

Vision blurs, hearing diminishes, and the sense of touch becomes numb.

Blackout

The brain, deprived of oxygen, shuts down, leading to unconsciousness.

6. Cardiac Arrest

Prolonged oxygen deprivation leads to cardiac arrest, where the heart stops beating.

Cessation of Breathing

Respiratory effort ceases as the brain's control over breathing is lost.

Heart Stops Beating

The heart, deprived of oxygen, stops beating, leading to complete circulatory failure.

Brain Damage and Death

Without intervention, brain cells die from lack of oxygen, leading to permanent brain damage and eventually death.

7. Aftermath (if Rescued)

If the person is rescued and resuscitated, there are immediate and long-term consequences to consider.

Immediate Aftermath

CPR and First Aid: Immediate resuscitation efforts, including CPR and the use of a defibrillator if necessary.

Hospitalization: The person will likely need to be hospitalized for further treatment and monitoring.

Long-Term Effects

Lung Damage: Inhalation of water can cause damage to the lung tissues, leading to conditions like pneumonia or acute respiratory distress syndrome (ARDS).

Neurological Damage: Prolonged lack of oxygen can result in brain damage, affecting cognitive and motor functions.

Psychological Impact: Survivors may experience PTSD, anxiety, and a lasting fear of water.

Physical Appearance During Drowning

1. Initial Entry

Shock Response

Wide Eyes and Gasping Mouth: Eyes are wide open, and the mouth is often open in a gasp or scream.

Flailing Limbs: Arms and legs are moving rapidly in an attempt to regain balance and stay afloat.

2. Involuntary Breath-Holding

Tensed Muscles

Rigid Body: Muscles are tensed, and the body may appear stiff as the person tries to maintain control.

Strained Facial Expression: The face may show strain, with furrowed brows and tightly closed eyes.

3. Uncontrolled Breathing

Coughing and Choking

Reddened Face and Eyes: The face may turn red from the effort of coughing and choking.

Foaming at the Mouth: A frothy mixture of saliva and water may be visible around the mouth.

Gasping for Air

Open Mouth and Wide Eyes: The mouth is open wide in an attempt to gasp for air, and the eyes may be bulging with fear.

Erratic Movements: The person’s movements become more erratic and uncoordinated as they struggle to breathe.

4. Laryngospasm

Silent Struggle

Mouth Opening and Closing: The person may appear to be gasping silently as the airway is temporarily sealed.

Clenching Throat: Hands may instinctively clutch at the throat in a futile attempt to open the airway.

5. Loss of Consciousness

Limp Body

Floating Limply: The body becomes limp and may float face down or sink slightly below the surface.

Pale or Blue Skin: Skin may turn pale or blue (cyanosis) due to lack of oxygen.

Relaxed Facial Features

Closed Eyes: Eyes close as the person loses consciousness.

Slack Jaw: The jaw may go slack, and the mouth could be partially open.

6. Cardiac Arrest

Unconsciousness

Still Body: The body is completely still, with no voluntary movements.

Gray or Blue Skin: Skin color becomes ashen, gray, or blue, particularly around the lips and extremities.

7. After Drowning (Post-Rescue Appearance)

If the person is rescued, their appearance post-drowning can indicate the extent of their ordeal and the immediate aftermath.

Immediate Aftermath

Waterlogged Clothing: Clothes may be heavy and waterlogged, clinging to the body.

Coughing and Vomiting: The person may cough up water or vomit as they are resuscitated.

Shivering: If the water was cold, the person might be shivering uncontrollably due to hypothermia.

Long-Term Appearance

Bruising and Cuts: There may be bruises or cuts from the struggle in the water or the rescue process.

Pale or Blue Skin: Skin color might still show signs of cyanosis if oxygen levels are low.

Labored Breathing: Breathing may remain labored and shallow as the lungs recover.

Ways to Drown

Being Tied Down with a Stone

An ancient method where a person is weighted down with a heavy object, preventing them from surfacing.

Pulled Under by a Strong Current

Strong currents or rip tides can overpower a swimmer, pulling them away from safety and making it difficult to stay afloat.

Trapped Under a Capsized Boat

In the event of a boat capsizing, a person can become trapped underneath, unable to reach the surface for air.

Caught in Underwater Vegetation

Dense underwater plants can entangle a swimmer, restricting their movements and preventing them from surfacing.

Unable to Swim in Deep Water

Lack of swimming skills or fatigue in deep water can lead to drowning if the person cannot keep themselves afloat.

Falling Through Ice

Falling through thin ice can trap a person in freezing water, with the ice making it difficult to find an exit.

Getting Caught in a Riptide

A riptide can drag a swimmer out to sea, making it hard to swim back to shore due to the strong current.

Swimming Exhaustion

Overexertion while swimming can lead to exhaustion, making it impossible to continue treading water or swimming to safety.

Diving Accident

A diving mishap, such as hitting one’s head or getting disoriented underwater, can result in drowning.

Shipwreck

In a shipwreck scenario, a person may be stranded in open water, facing potential drowning due to exhaustion, exposure, or lack of flotation devices.

Common Misconceptions About Drowning

1. Drowning is Always Loud and Dramatic

Many people believe that drowning involves a lot of splashing, shouting, and waving for help. In reality, drowning is often a silent and quick event.

Instinctive Drowning Response: When a person is drowning, their body prioritizes breathing over waving or shouting. The struggle to get air means they can’t call for help.

Quiet Struggle: Drowning individuals might be bobbing up and down, with their mouths at water level, making little noise as they gasp for air.

2. People Always Recognize Drowning

It's a common belief that drowning is easily recognizable. However, many drownings go unnoticed until it’s too late.

Subtle Signs: Drowning can look like someone treading water or trying to swim. Signs can be subtle, such as bobbing up and down, head tilted back with mouth open, or eyes glassy and empty.

Misinterpreted Behaviors: Bystanders might mistake a drowning person for someone playing or simply floating.

3. Only Weak Swimmers Drown

Many assume that only those who can’t swim well are at risk of drowning, but even strong swimmers can drown under certain conditions.

Fatigue and Cramps: Strong swimmers can become exhausted, suffer from cramps, or panic, leading to drowning.

Environmental Factors: Strong currents, cold water, and underwater hazards can overwhelm even the best swimmers.

4. Drowning Happens Immediately

There’s a misconception that drowning happens instantly. While it can be quick, it often takes a few minutes for a person to drown.

Struggling Phase: The initial struggle can last for 20-60 seconds, during which the person is trying to stay afloat and breathe.

Silent Submersion: After this, they may silently submerge, often unnoticed.

5. Drowning Only Happens in Deep Water

Many people think that drowning only occurs in deep water. However, shallow water can be just as dangerous.

Shallow Water Drowning: Drowning can occur in as little as a few inches of water, especially with young children or if someone is unconscious.

Bathtubs and Pools: Many drownings occur in bathtubs, kiddie pools, or even buckets.

6. Life Jackets Are Only Needed on Boats

It's commonly believed that life jackets are only necessary when boating, but they are crucial in many other water-related activities.

Swimming and Water Sports: Life jackets provide essential buoyancy and can save lives in swimming pools, lakes, rivers, and during water sports.

Unexpected Situations: Wearing a life jacket can prevent drowning in unexpected situations, like sudden falls into water.

7. People Float After Drowning

A prevalent myth is that drowning victims float on the surface after they die, but this is not always the case.

Initial Sinking: Initially, a drowned body may sink due to the density of the tissues and lack of air in the lungs.

Later Floating: Bodies often float later due to gas buildup from decomposition, but this can take days.

8. Drowning Victims Always Look Distressed

People often think that drowning victims will look distressed or visibly in danger, but many can appear calm and quiet.

Passive Drowning: Drowning individuals may appear to be calmly treading water or just floating.

Lack of Visible Struggle: There may be no visible struggle, making it hard to identify the danger.

9. CPR is Ineffective After Drowning

Some believe that once a person has drowned, CPR cannot help. However, immediate CPR can be life-saving.

Restarting Breathing: CPR can help restart the victim’s breathing and circulation, buying crucial time until emergency services arrive.

Rescue Breathing: Effective rescue breathing can oxygenate the lungs and increase the chances of revival.

Resources

Books

"The Science of Drowning" by Sports Aid Intl

“It offers a significant departure from how drowning is traditionally treated by combining discussions about medical, prevention, and intervention issues.”

Link

"The Perfect Storm: A True Story of Men Against the Sea" by Sebastian Junger

A gripping account of the 1991 storm that hit the North Atlantic and the fishermen caught in its deadly grip, providing insights into the perilous nature of the sea and drowning.

Link

Articles

"Drowning vs Aquatic Distress" by Crunderwood

An article detailing the science of drowning + some interesting points.

Link to article

"Drowning Victim" by SLRG

How to identify a drowning person besides the typical flailing. 

Link to article

"Drowning Treatment" by WebMD

Guidelines and tips for healing/treating a drowning person.

Link to article

Websites

American Red Cross: Water Safety Tips

Provides extensive information on water safety, drowning prevention, and emergency response.

Link to website

National Drowning Prevention Alliance

A dedicated organization focused on preventing drowning through education, research, and advocacy.

Link to website

Centers for Disease Control and Prevention (CDC): Drowning Prevention

Offers statistics, prevention strategies, and safety tips to reduce the risk of drowning.

Link to website

Looking For More Writing Tips And Tricks? 

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[frownyalfred]

Hey Res! Please ignore this ask if it's too troublesome or bothersome

I saw you had an guide for non-drikers writers that wanted to write about a character who drink. I was wondering if you could the same about guns?

I read synchronicity and I loved it how you used Jason's knowledge with guns to control the narrative and pacing. I don't know if you have actual technical knowledge on handguns (I think it's a no? But maybe you do?) But any tip is nice

Thank you a lot 🩷

Hi anon! This is such a fascinating question and I hope I can provide a somewhat plausible answer. I am familiar with some guns and have shot a few in my lifetime, but I am far from an expert.

Some things I think writers need to keep in mind while writing their firearm-related scenes. For clarity, I'm just going to call them guns below.

Are you thinking of a specific gun? Make sure you know its full name but ALSO make sure you know its nickname. Your character might think of it as "the Berretta" instead of its full name, etc.

What does your gun fire? Does it take shells, bullets, cartridges, etc? Shotguns, for example, don't fire bullets. That's a common mistake I see.

How do you reload said gun? Is it easy? What parts of the gun do you have to touch? Reloading a shotgun is MUCH different from reloading a handgun, for example.

Most guns get hot and release gunpowder residue when shot. They're LOUD. You can have several cascading things happen to a character who fires a gun or is near a gun when it fires: ringing ears, the smell of gunpowder, the hot feeling of the gun's muzzle, etc.

Even the best sharpshooters miss shots. IRL shooting is HARD, especially when moving. Different guns have different benefits to shooting style, stance, targets. Firing a handgun willy-nilly will rarely result in accurate shots, even if you dual wield (which is silly, this is SO hard).

Stance MATTERS. If you've ever seen Hannibal, there's a scene where Will talks about his choice of shooting stance with Beverly. They bicker over Isosceles and Weaver, which are two standard stances. One uses a triangle between your arms and the gun to brace for the kickback of the shot, while the other moves that brace to one side with a different grip. Will eventually chooses the latter stance because of a past shoulder injury. (GIF of Will struggling with his original isosceles stance)

If a gun isn't properly braced when fired, it will kick back and hit you. Sometimes in the face. Yes this has happened with me and a rifle. My first day shooting cans, I had a huge bruise on my face AND on my chest where the rifle butt kicked back.

If your gun uses bullets, there are different calibers. If you've ever watched Mythbusters, you can see why caliber matters -- it depends what or who you're shooting. Are you trying to penetrate armor? Are you sacrificing accuracy for power? Different guns use different calibers for numerous reasons, and guns can be altered to use other ammo as well.

With respect to discussing caliber while writing: It's all VERY complicated if you don't know guns, so make sure you're not giving too much detail if you can avoid it. That's a very easy way to spot a lack of experience with guns, in my experience. Your reader doesn't need to know the caliber just because the character is shooting a gun -- but in an autopsy, sure, the caliber is relevant.

You will lose your hearing eventually if you fire guns close to your ears unprotected. It's not sexy, and it also causes something called tinnitus. The real pros wear ear protection.

In terms of realism for writing, here's a couple rapid fire busted myths: You can't dodge bullets unless you're superhuman. Bullet wounds to the legs/arms/shoulders can absolutely still be fatal. Cardiac arrest caused by being shot is usually fatal, and CPR doesn't really help on its own. "Running out of shots" depends on the gun AND the modifications someone has made to it. You can't always tell just by looking at a gun what it will do. Silencers are rarely "silent" and are heavily regulated.

Injuries: Some bullets tear through bodies. Some aren't high enough caliber to do more than go in and lodge in some tissue. Some fragment and bounce around in weird ways. Depending on how gruesome you want to get, there's a lot of different ways to describe gunshot injuries. I've always been the kind of person to google images for better understanding, but I understand that's not for everyone. I think NYT or WaPo did a good piece on traumatic gun injuries a few years back, complete with an interview with an ER doc from Chicago (?). One thing I learned there -- sometimes people lose their legs, or both legs, after being shot in their leg.

In terms of describing how someone uses/fights with guns, I know the John Wick movies are a little cheesy, but they are staged by people who REALLY know their guns. They talk about what he's using usually before the scene starts, and there's very few frills when it comes to stance, firing, etc. John does a cool trick in the first or second movie where he ejects a casing one-handed away from his face, a notoriously hard maneuver that most people usually do with two hands to avoid getting burned. I highly recommend watching the John Wick movies for blocking ideas.

Which reminds me -- holding a gun sideways is a terrible idea. For many reasons. Stance, casing ejection, stability, etc. Someone can use it against you.

Never point a gun at something you're not willing to shoot. Well-trained characters should follow this rule religiously. If they were soldiers, agents, etc, they will know this rule.

Similarly, multiple people with guns will "clear" a room before entering. They will be trained for something called crossfire, which is when someone is downrange of their gun and could potentially be shot. A group of characters bursting into a room without clearing their shot is a nightmare. This is how people shoot their friends or random civilians.

I hope someone more knowledgeable can add onto this! These are just some big things that stick out to me when reading. I highly recommend checking out Mythbusters, John Wick, and even Hannibal for some semi-realistic shooting references. Good luck!

[mvltisstuff]

how to disappear - e.b

summary: after a series of tragic losses, y/n’s bright mood begins to disappear. so buck and the 118 try to bring it back

evan buckley x reader

this lowkey broke my heart a bit 🥲 i am def not the biggest fan of this, it was just rushed but i hope you still enjoy, leave any requests you’d like i’m in a big 911 writing era :)

10 minutes of cpr on the way to the hospital, rapid beeping on the machine, blood on the ground. hen places a soft hand on y/n’s arm, and pulls it away from the patients body. “y/n,” she says, making pitying eye contact with her. “time of death, 14:36.”

y/n sits back with a brush to her hairline with the heel of her palm and a sigh. she looks down at her hands and uniform, covered in a man’s blood. a son, a friend, and she feels like she just took that from him.

it’s been person after person, it feels. like she’s failing at her job and is failing all these people. she wants to scream. a few days before, she had lost a girl, new to adulthood, who had driven her car off the side of the road due to a drunk driver. her best friend, watching from the side and being held back by bobby and athena, was wailing in agony from watching the life escape her soul sister.

that wasn’t the last time, it’s been a few. everyone tries to reassure her that she did everything she could, and she knows she did. but was it enough? y/n’s been quiet, not wanting to hurt anything else around her. she felt like everything was glass in her hands and she couldn’t help but drop it. her eyes were dry and red from the sleepless nights and tearful showers, and her arms were tired from the endless compressions and the feeling of being completely burnt out.

buck had recognized this feeling, they all had, but it hurt to see her beating herself up so much over it. y/n already felt ridiculous, as this is partially what she signed up for, and he didn’t want her to feel ashamed. the 118 has been assigned to a ton of casualties and bad accidents recently, but it seems like they’ve been piling up and she feels like it is a result of her work.

everyone knows y/n is great. she’s smart and careful in her work, always checking over herself and being gentle with everyone, young and old.

another quiet night at home, y/n picks around her food not being able to find her appetite. the screams of the friend from earlier rang in her ear and the flatline of machines were stinging her brain. the pounding headaches were washed away with another tylenol, as buck tries to start another conversation.

“so, um,” he starts, quietly. “eddie invited us over to dinner tomorrow, do you wanna go?”

he tells a white lie because buck sort of invited himself to dinner. he wants to help y/n, and make her feel better and know that there are people still alive from her rescues. “maybe, i’m not sure.” she says, not having the energy to go tomorrow as she wants to just come home and fight with her sleep again. buck nods, deciding not the fight it. his heart breaks seeing her in this condition, and it pains him even more to know she’s helped him in this situation. he’s had his own losses, and he so desperately tries to climb out of the pit it puts him on. y/n was always the hand, the ladder that he called to climb out. he wanted more than anything to be hers.

they don’t teach you in training how to deal with this. they warn you, surely, but you always try to sugarcoat it in your mind. however, the agonizing sobs and screams will wake you up at night. you remember the names, the family, the details, the autopsy, the medicine that was inserted. every small detail haunts you, until you learn to handle the pain. it never gets easier to lose someone on the job, but the embraces and relief from saving someone is an incredible feeling.

“i’m just going to head to bed,” y/n says, her voice cracking as it’s barely above a whisper. she walks over to buck, placing her plate in the dishwasher. “i’ll meet you upstairs, i’m going to shower first.”

buck nods and gives her a sweet smile that conceals a bit of pity. watching her smiles fade from feeling like she’s not good enough makes his heart skip a beat in the worst way.

a few days later, y/n stayed a little longer at work than buck did. maddie had asked him to watch jee-yun, and when y/n walked in, she saw buck playing with her in their living area. he has a bright smile on his face in response to the little words and babbles from jee. “hey, baby. wanna come join us in here?”

she had completely forgotten that they agreed to babysit. she sighed and mumbled at buck for a minute. “i, um, forgot we’re watching her.”

“it’s ok, we just got done pulling uncle bucks hair out,” he says, scooping jee up and blowing light kisses into her baby cheeks. “who’s that, jee? y/n’s home!”

y/n forces out a small grin, making the side of her mouth raise a bit. “sorry, guys. i was gonna call it an early night, it’s been a really long day.” she replies, because she has no more energy left to give. she feels like shit, leaving her boyfriend and his niece alone, who she adores completely. she doesn’t want to bother their time together.

“oh,” buck says, surprised. y/n never denies extra time with jee-yun, always begging maddie and chimney to bring her over for a bit. “i get it, honey. go lay down.” he says, the smile on his face growing again in attempts to make her feel more comfortable.

“thanks, buck.” y/n walks over to the two, leaving a kiss on bucks lips and one on jee’s forehead. when she walks away, stepping back up the stairs like her muscles are worn out, jee mumbles out the few letters of her name.

“i know, jee-yun,” buck says, comforting her. “she’ll be back soon, i hope.”

days pass and y/n’s brightness that comes into the room when she walks in still isn’t back. buck has tried to give her space, but also giving her the love she needs to feel better. sitting around the table, the team talks for a little.

“kid, something on your mind?” bobby asks, taking a bite of his breakfast while looking at a zoned-out buck.

“s-sorry, cap,” he stumbles over his words. “it’s y/n. i just feel so bad, i wish i could magically fix everything but…”

“it’s hard, she’s been really taking it on these calls.”

“i’m just worried, i don’t know how much more stress she can handle.”

“she’s tough,” eddie adds. “i think she just needs time.” buck nods, still feeling indifferent on the situation.

the alarm sounds later in the night, and they climb into the truck for the last call of the shift. they’re all tired, ready to go home, but also ready to face whatever battle the world has for them tonight. y/n rides in the back, glaring out the window. she listens intently to the instructions in her headphones, and they climb out of the truck.

they see yet another tragic incident on the side of the road, a massive delivery truck had been completely turned upside down with two people inside of it. they team had all sprint up the the flipped vehicle, getting on the ground to see the damage to their bodies. “hi, sir,” y/n says first. “can you tell me your name?”

“r-richard.”

“ok, richard, can you tell me if you feel this?” y/n applies pressure to his legs. he shakes his head, and begins to panic at the numbness in his lower half.

“it’s ok, stay still,” y/n reassures him. “we’re gonna help you. can you tell us your friends name?”

“his n-name- is tyler.” he answers. “am i going to die in here?”

“we are all here to help you, richard, you are in some of the best hands out there,” y/n stands up and faces hen and chimney. “we have numbness in his legs, passengers name is tyler.”

“got it,” chim says, jogging over to see his friends condition.

on the side, after excusing themselves, the team meets up. “driver is not looking good, cap. i think the damage was already done when we got on scene.” hen says.

“can we get the other person out safely?” bobby asks, hesitantly. they all nod, knowing what is going to have to happen. “he’s pinned under that seat, he doesn’t have enough time.”

“what? no, we have to get both of them out!” y/n interjects.

“we can’t, y/n. we have to keep richard comfortable while they work to get tyler out.”

“but-“

“there’s nothing we can do, y/n/n,” buck says, stepping in. “there’s nothing that can save him.”

y/n keeps her cool, just barely letting the pot boil over the edge. she walks back over to richard without any directions, but knows that she is the one to keep him comfortable. “this is it, huh?” he coughs a bit, blood pooling at the corner of his lips.

“you have a family, richard?” y/n asks, hoping to keep his mind off the pain that has already been minimized with morphine. no morphine in the world can save his family from the pain they’ll endure.

he nods, slowly. “i have three girls and two boy, and my beautiful wife.”

“wow, a full house, isn’t it?” y/n laughs.

“we have, two dogs too.”

“can i hear their names?”

“the girls are, layla, and she’s the oldest.” he starts, ready to take the time to explain his precious kids. tears are already forming in y/n’s eyes, and she’s relieved he is able to talk over her. “she’s so smart, she was valedictorian, jesus, i was so loud at graduation. and then there’s jake, he’s so amazing, he’s the sweetest kid. and then there’s makenna and sarah, they’re two little,” he pauses to take a few deeps breaths. “firecrackers. and then the youngest is nathan, and he is a r-replica of his mom.”

“what’s their mom like?” the drilling and buzzing from the other side is faint, the two’s thoughts being drowned out by the stories of his family.

“oh, she’s amazing,” he smiles, with red-stained teeth. “the- the most beautiful woman. you think i could call her?” her shaky hand reaches over to his phone that had fallen out of the truck and onto the top. she puts the phone up to his ear, holding it, as some more jargon about the rescued man comes through.

“h-hey honey!” he says, like it’s almost muscle memory. “i, uh, it’s ok, i just wanted to call and see how everything is.” he smiles at the chaos on the other side. “can you, uh, put me on speaker phone?”

the tears are falling down y/n’s face freely, as the sirens of the other ambulances are turned on to drive away with other paramedics. her breaths are shaky, and the team gathers behind them. glass cuts the skin on her knees, but she is not fazed by the feeling. the husband, son, father, says his final goodbyes to his family, and the final breath from his lips is stolen in a matter of seconds. one of the police officers leans down and takes the phone, speaking to the widow and her young family.

y/n places a few fingers on the side of his neck, feeling for a non-existent pulse. her voice cracks, and a few broken cries come out of her sad mind. “i’m so sorry, richard. i’m so, so sorry.” she repeats, over and over again before her boyfriend has to remove her from the nightmare. she yanks her gloves off and wipes the mix of blood from her hands, sweat, and tears off her face.

buck has never seen her breakdown like this, and it was honestly one of his biggest fears. he knew it was going to happen, he just hoped he would make her feel better before it did. “i really tried, buck, i did, i couldn’t keep him up…”

“i know, it’s not your fault. none of this has ever been your fault.”

as y/n’s pained thoughts surround her mind on the way back to the station, she climbs out of the truck and slowly walks back into the locker room. she ignores everyone around her. she tries to ignore everyone, but buck is too quick to understanding her that he is following right behind.

“let’s just go home, buck,” y/n says, her voice is raspy from the sobs and exhaustion.

“i need you to know that you are doing everything you can,” he says, stepping closer to her.

“i know, buck. i’m not doing this right now.”

“you are amazing at this y/n. it is not your fault. these people were doomed from the second they called into dispatch. if anything, you were there for them when we got there.”

“then why? why does this keep happening, buck? since you seem to have an answer for all of this why can’t you tell me that? why does it feel like it’s my fault?” she snaps, raising her voice with him near. she’s not yelling at him, more at herself.

“y/n, please,” buck whispers. “i don’t have the answer for everything. but i know for a fact that you are doing the best you can. and that is enough. and i will say it is enough for the rest of time until you believe me.”

y/n stops and stands still. she looks at him with sad eyes, her mouth opened lightly. she shrugs her shoulders and feels like every word is draining her from everything she has left. “i cant sleep without hearing them, buck.”

“oh, my god. baby,” he says, rushing over to her and pulling her in before her heartbroken knees gave out under her. his arms wrapped around her waist and sat her weak body down on the bench. he held her until she had nothing else to weep out. “let’s go home, love.”

several days later, and several shifts later, y/n had started to feel more normal. things had been looking up, but she was still dealing with the loss of her patients. it never would not bring her pain, each bruise would never heal, but she would rather not forget about them.

buck had taken her out of the house for a day, meeting up with everyone for dinner. they all had been supporting y/n in their own ways. spending time with her, listening to her, giving her advice, and just being there for her was the best they could do. they figured it would be good for her to spend time out of the firehouse and their small shared apartment.

her bubbly personality wasn’t back yet, as she still thought about the casualties consistently. they still haunted her dreams and lay in her brain. having buck there made everything easier. the way he cared for her and never judged her feelings had caused them appear more valid. having someone that understands you like that can open doors to new feelings so fast.

sitting around, they all talked for a bit as y/n still stayed quiet, her hand and bucks never unwinding. her grip on his soft hands has been still like they were stuck in cement. being able to listen to his voice and the casual meetings between everyone brought her back to reality.

“hi, sorry, excuse me?” a woman said, standing next to another one. she had a hearing aid in, and was doing sign language while making eye contact with y/n. “i had just recognized the whole team, and i remembered seeing you. i wish i could remember your name, but it must’ve gotten mixed up somewhere.” the lady signs, pointing at y/n. “you saved my life, you came right back into that building and i would not be here today. you saved me and my family. i wish i could give you all the world, but seeing your face still brings me comfort. so thank you, from the bottom of my heart.”

y/n was completely speechless. she had no idea what to say. her eyes were welling up again, but she blinked them back down and tried to force a few quiet words out. “of course, i’m so glad you remember me! that’s what i’m here for.”

her interpreter signs y/n’s words back to her, and she blows a quick kiss to y/n and walks away with a bright smile. y/n faces back around to buck, with a shocked smile on her face. it was bright, and it seemed like something that reminded her of all the good in this world that she has done.

buck knows that aside from a beautiful face, her soul had a wonderful outcome on the people around her. he wanted to give her everything and make her feeling like the most loved person on the planet. his admiration for her and complete head over heels mind brings him back to her hold every day, and he would spend the rest of his life being her hand to hold.

[dr-jesuscpr]

Lila's Convulsions Part 2

The pulse in Lila’s chest had been weak but steady when the team had finished the resuscitation. After securing her vitals and adjusting her machines, the doctors and nurses gradually left the room, one by one. Her hospital gown, bunched up from the frantic CPR efforts, was left half-pulled up, exposing her abdomen.

Clara lingered at the door, her hand still resting on the frame. She could feel the tension in her own body starting to ease now that Lila’s heart was beating again. She took one last glance at Lila before heading down the hall, silently praying the worst was over.

Moments passed, and the room was left quiet again, the only sound being the rhythmic beeps of the heart monitor. Lila’s chest rose and fell in slow, measured breaths, her body still. But something began to stir. A sudden, violent tremor rippled through her body. Her legs kicked, then her arms jerked uncontrollably.

It happened fast.

Lila’s body convulsed on the bed, her eyes rolling back as her muscles seized and contracted. The heart monitor began to beep erratically, signaling the impending crisis. She was having a seizure.

Clara, at the nurse’s station, noticed the abnormal pattern on the monitor, her heart sinking. "Not again," she whispered, grabbing the emergency phone.

"Dr. Jesus, we need you back in 302!" Clara shouted as she sprinted down the hallway toward the room, her shoes slapping against the tile floor.

Dr. Jesus arrived almost as fast as Clara, the crash cart rolling behind him. They burst into the room, finding Lila’s body rigid, her chest heaving irregularly, and her hospital gown still disheveled from the earlier resuscitation.

Clara’s eyes widened in alarm. "She’s seizing," she said, her voice tight as she moved toward Lila’s bedside. "We need to stabilize her, fast!"

Dr. Jesus nodded sharply, already preparing the crash cart. They had to act quickly. He pulled the gown further up, exposing her chest, and immediately placed the defibrillator pads on her bare skin. There was no time for modesty—only survival. Clara rushed to assist, her hands shaking slightly as she checked Lila's vitals, watching her body tremble under the effects of the seizure.

The monitor blared again. Her heart was in chaos, unable to maintain a proper rhythm. Clara’s pulse quickened as she glanced up at Dr. Jesus. He was calm but focused, his eyes never leaving the monitor.

“Charging,” he said, reaching for the defibrillator paddles. “Clear!”

The first shock jolted Lila’s body upward, her chest rising violently before crashing back down onto the bed. The room fell eerily silent for a beat, but then—nothing. The flatline persisted.

“Starting compressions,” Clara said, her voice steadier than her heart felt.

She placed her hands firmly on Lila’s chest, pressing down with controlled force, her own breaths matching the rhythm of each compression. Her mind raced, wondering how much more Lila’s fragile body could take.

Dr. Jesus prepared the next shock. “Clear!” he shouted again, sending another charge through Lila’s unresponsive body. This time, the monitor flickered. A faint pulse. They had something.

Clara kept her eyes fixed on Lila’s face, searching for any sign that she was fighting her way back. But her body was still trembling, the seizures continuing to wreak havoc.

"Come on, Lila, stay with us," Clara muttered under her breath as she continued compressions.

Dr. Jesus injected a dose of medication to calm the seizure and stabilize her heart. Slowly, painfully, the tremors began to subside. The erratic jerking of her limbs quieted, leaving her chest rising and falling in rapid, shallow breaths. Her heart rate steadied, though it was fragile.

Dr. Jesus let out a deep breath, glancing at Clara, his eyes filled with exhaustion but also hope. “We’ve got her back—for now.”

Clara exhaled in relief, wiping the sweat from her forehead. She carefully pulled Lila’s hospital gown back over her body, covering her body again with a sense of respect and care.

Lila was stable for the moment, but they knew how close she had come, once again, to slipping away. Clara stayed beside her, watching her every breath, unwilling to leave her alone this time.

“We’ll keep her monitored closely,” Dr. Jesus said, his voice softer now. “But she’s a fighter. She’s not giving up.”

Clara nodded, placing a gentle hand on Lila’s arm. The machines hummed quietly in the background, a reminder that life could hang on by the thinnest thread. And yet, Lila had fought through it, her body weak but her will unbroken.

[heartshield1]

CPR Classes in Grand Rapids, MI: Lifesaving Skills with Rapid CPR by Heartshield

In an emergency, seconds count. Knowing how to administer CPR (Cardiopulmonary Resuscitation) could make the difference between life and death. For the residents of Grand Rapids, MI, Rapid CPR by Heartshield offers expert training in this essential lifesaving skill. Whether you’re looking to get certified for professional reasons or just want to be prepared to help a loved one, Heartshield’s CPR classes are the perfect place to start.

Why Choose Rapid CPR by Heartshield in Grand Rapids?

Expert Instructors One of the standout features of Rapid CPR by Heartshield is their team of highly qualified, experienced instructors. Each trainer is certified, bringing years of knowledge to the classroom. They don't just teach techniques; they provide practical, real-world advice to help you stay calm and effective during an emergency.

Flexible Scheduling Heartshield understands the busy lifestyles of Grand Rapids residents. That’s why they offer flexible class schedules, including weekday evenings and weekend sessions. This flexibility allows you to find a class that fits into your routine, ensuring you can get trained without disrupting your schedule.

Comprehensive Hands-On Training CPR is a hands-on skill that requires practice to master. Heartshield’s classes offer ample time for you to practice CPR techniques on manikins and learn to use Automated External Defibrillators (AEDs). The instructors guide you through each step, ensuring you understand not just the “how,” but the “why” behind each technique.

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First Aid Training CPR is essential, but first aid knowledge is equally important. Heartshield integrates basic first aid training into their CPR classes, covering situations such as bleeding control, burns, and choking. This broadens your scope of help in emergencies.

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Why CPR Training Is Essential in Grand Rapids

With the bustling community in Grand Rapids, emergencies can happen at any moment. By learning CPR, you can play a crucial role in improving survival rates during a cardiac emergency. Early bystander CPR, especially when paired with an AED, can significantly increase the chances of survival. Taking CPR classes at Rapid CPR by Heartshield ensures that you’re ready to act when someone’s life is on the line.

How to Register

Getting certified in CPR is easy. To sign up for a class with Rapid CPR by Heartshield, simply visit their website or give them a call. They’ll help you find the class that best suits your schedule and needs. Don’t wait—empower yourself to be the person who can save a life.

[gallifreyinstituteforlearning]

Help! I think my timelord has a fever? I can't tell 100% but they don't look good. Do I need a special thermometer to check? (Where do I buy/find one?) What do I do??

Gallifreyan Pyrexia

Disclaimer: This guide is not suitable for humans. Always consult your human medical people.

🌡️ Checking Temperature

First things first, you don’t need a special thermometer to check your Time Lord’s temperature—a human one will do just fine. Here are some key points to remember:

Every Gallifreyan will have their own normal temperature baseline, somewhere between 15-19°C (59-66.2°F).

This shouldn't deviate by more than 2-3 degrees.

If their temperature rises above 19°C (66.2°F), they could be suffering from hyperthermia.

📋 Recognising Hyperthermia

Hyperthermia occurs when their body temperature exceeds 19°C (66.2°F), potentially leading to heatstroke and other serious complications. Signs and symptoms include:

Flushed Skin: The skin may appear red and feel hot to the touch.

Sweating: While not as common as in humans, excessive sweating may occur.

Weakness: A general feeling of fatigue or weakness.

Dizziness and Confusion: Disorientation and dizziness can be significant signs.

Rapid Heart Rate: Increased heart rate can accompany the rise in temperature.

Nausea and Vomiting: Digestive upset can be a symptom of severe hyperthermia.

🏡 Home Treatment for Hyperthermia

If your Time Lord shows signs of hyperthermia, here’s what you can do at home:

Move to a Cooler Environment: Get them out of the heat and into a cooler, shaded area immediately.

Hydration: Encourage them to drink cool, non-alcoholic fluids. Water is best. Avoid caffeine.

Cool Compresses: Apply cool, damp cloths to their forehead, neck, armpits, and groin.

Fan Air: Use a fan to circulate air around them or gently fan them to increase evaporative cooling.

Remove Excess Clothing: Help them remove any excess clothing to allow their body to cool down more effectively.

🚑 When to Seek Immediate Help

Temperature above 19°C (66.2°F)

Unresponsiveness or severe confusion

Severe vomiting or inability to keep fluids down

Signs of shock (rapid heartbeat, low blood pressure, clammy skin)

You suspect Sepsis (Refer to the Guide Sepsis Emergency Response (SER))

🏥 Advanced Treatment Guide

If home treatments are not effective or the patient's temperature is rising rapidly, seek medical attention immediately. If you're in a TARDIS, the medbay has an automated interface that can guide you through these next steps.

📋 Assessment

Initial Assessment: Check vital signs, including heart rate, respiratory rate, blood pressure, and oxygen saturation. For a detailed scoring system, refer to the Guide Gallifreyan Assessment Scoring System (GASS).

Continuous Assessment: Continuously monitor body temperature and vital signs. Use an accurate thermometer capable of reading low temperatures.

🧊 Cooling Methods

IV Fluids: Start intravenous (IV) fluids immediately to rehydrate and cool the body from the inside.

Cooling Blankets: Use cooling blankets or pads to lower body temperature. Ensure these are set to a safe temperature to avoid overcooling.

Ice Packs: Place ice packs in the axillae (armpits), groin, and neck to rapidly reduce core body temperature.

Evaporative Cooling: Use misting fans and cool water sprays to enhance evaporative cooling.

💊 Medications

If deemed appropriate by a medical professional/the TARDIS medbay computer:

Antipyretics: Administer antipyretics to help lower fever.

Anticonvulsants: Administer anticonvulsants to help reduce risk of seizures.

Sedation: In severe cases, sedation might be necessary to control agitation and allow for more effective cooling.

🖥️ Monitoring and Support

Electrolyte Monitoring: Regularly check electrolyte levels, as hyperthermia can cause imbalances.

Cardiac Monitoring: Continuous cardiac monitoring is crucial due to the risk of arrhythmias. Refer to the Guide Gallifreyan CPR for reviving a Gallifreyan in case of cardiac arrest.

Neurological Checks: Regular neurological assessments to monitor for signs of brain damage or seizures.

Mechanical Ventilation: If respiratory distress or failure occurs, mechanical ventilation may be necessary. Follow the ABCDE Assessment Guide to quickly assess and treat a sick Gallifreyan.

🚑 Post-Emergency Care

Once the immediate threat is over, following up with a specialised Gallifreyan medic is vital. Your Gallifreyan might need specific treatments to fully recover and prevent future incidents.

Remember, while these steps provide a general guide, each situation is unique. Always prioritise professional medical advice when available.

Medical Guides These are all practical guides to assessing and treating a Gallifreyan in an emergency.

📓|⚕️Gallifreyan CPR: Guide for reviving a Gallifreyan in cardiac arrest.

📓|⚕️Gallifreyan Assessment Scoring System (GASS): Guide for assessing vital signs.

📓|⚕️ABCDE Assessment: Guide for quickly assessing and treating a sick Gallifreyan.

📓|⚕️Sepsis Emergency Response (SER): Guide for identifying and treating sepsis.

📓|⚕️Gallifreyan Pyrexia: Guide for assessment and treatment of fevers in Gallifreyans.

Hope that helped! 😃

Any purple text is educated guesswork or theoretical. More content ... →📫Got a question? | 📚Complete list of Q+A and factoids →😆Jokes |🩻Biology |🗨️Language |🕰️Throwbacks |🤓Facts →🫀Gallifreyan Anatomy and Physiology Guide (pending) →⚕️Gallifreyan Emergency Medicine Guides →📝Source list (WIP) →📜Masterpost If you're finding your happy place in this part of the internet, feel free to buy a coffee to help keep our exhausted human conscious. She works full-time in medicine and is so very tired😴

[literaryvein-reblogs]

Writing Notes: Drowning

Drowning - death due to submersion in liquid (usually water) long enough to prevent oxygenation of the blood.

Near-drowning - the term for survival after suffocation caused by submersion in water or another fluid.

Some experts classify as drowning those cases of temporary survival that end in death within 24 hours.

A reduced concentration of oxygen in the blood (hypoxemia) is common to all near-drownings. Human life depends on a constant supply of oxygen-laden air reaching the blood by way of the lungs.

When drowning begins, the larynx (the air passage in the throat) closes involuntarily, preventing both air and water from entering the lungs.

In 10–15% of cases, hypoxemia results because the larynx stays closed. This is called ‘‘dry drowning.’’

Hypoxemia also occurs in ‘‘wet drowning,’’ the 85–90% of cases where the larynx relaxes and water enters the lungs.

The physiological mechanisms that produce hypoxemia in wet drowning are different for freshwater and saltwater, but only a small amount of either kind of water is needed to damage the lungs and interfere with the body’s oxygen intake.

All of this happens very quickly:

Within 3 minutes of submersion, most people are unconscious.

Within 5 minutes the brain begins to suffer from lack of oxygen.

Abnormal heart rhythms (cardiac dysrhythmias) often occur in near-drowning cases.

The heart may stop pumping (cardiac arrest).

An increase in blood acidity (acidosis) is another consequence of near-drowning.

Under some circumstances, near drowning can cause a substantial increase or decrease in the volume of circulating blood.

Many victims experience a severe drop in body temperature (hypothermia). Hypothermia sometimes can have a protective effect on the brain, so survival after prolonged cold immersion is occasionally possible.

Some Symptoms

The signs & symptoms of near-drowning can differ widely from person to person.

Some victims are alert but agitated, while others are comatose.

Breathing may have stopped, or the victim may be gasping for breath.

Bluish skin (cyanosis),

coughing,

and frothy pink sputum (material expelled from the respiratory tract by coughing) are often observed.

Rapid breathing (tachypnea),

a rapid heart rate (tachycardia), and

a low-grade fever are common during the first few hours after rescue.

Conscious victims may appear confused, lethargic, or irritable.

Treatment

Treatment begins with removing the victim from the water and performing cardiopulmonary resuscitation (CPR) if there is no breathing or pulse.

One purpose of CPR is to bring oxygen to the lungs, heart, brain, and other organs by breathing into the victim’s mouth.

When the victim’s heart has stopped, CPR also attempts to get the heart pumping again by pressing down on the victim’s chest.

Oxygen is administered to the victim as soon as possible.

If the victim’s breathing has stopped or is otherwise impaired, emergency personnel insert a tube into the windpipe (trachea) to maintain the airway (this is called endotracheal intubation).

The victim is also checked for head, neck, and other injuries, and fluids are given intravenously.

Hypothermia victims require careful handling to protect the heart from developing abnormal rhythms.

In the emergency department, victims continue receiving oxygen until blood tests show a return to normal.

About one-third are intubated and initially need mechanical support to breathe.

Rewarming is undertaken when hypothermia is present.

Victims may arrive needing treatment for cardiac arrest or cardiac dysrhythmias.

Comatose patients present a special problem: although various treatment approaches have been tried, none have proved beneficial.

In the mildest cases, patients can be discharged from the emergency department after 4-6 hours if their blood oxygen level is normal and no signs or symptoms of near-drowning are present.

But because lung problems can arise 12 or more hours after submersion, the medical staff must first be satisfied that the patients are willing and able to seek further medical help if necessary.

Admission to a hospital for at least 24 hours for further observation and treatment is a must for patients who do not appear to recover fully in the emergency department.

Prevention

Prevention depends on educating parents, other adults, and teenagers about water safety.

Parents must realize that young children who are left in or near water without adult supervision even for a short time can easily get into trouble, not just at the beach or next to a swimming pool, but in bathtubs and around toilets, buckets, washing machines, and other household articles where water can collect.

Research on swimming pool drownings involving young children shows that the victims have usually been left unattended less than 5 minutes before the accident.

Experts consider putting up a fence around a home swimming pool an essential precaution, and estimate that 50–90% of child drownings and near-drownings could be prevented if fences were widely adopted.

The fence should be at least 5 ft (1.5 m) high and unclimbable, have a self-closing and self-locking gate, and completely surround the pool.

Pool owners—and, indeed, all other adults— should learn CPR.

Everyone should follow the rules for safe swimming and boating.

Those who have a medical condition that can cause a seizure or otherwise threaten safety in the water are advised always to swim with a partner.

People also need to be aware that alcohol and drug use substantially increase the chances of an accident.

The danger of alcohol and drug use around water requires special emphasis where teenagers are concerned. Teenagers can also benefit from CPR training and safe swimming and boating classes.

Sources: 1 2 ⚜ More: Writing Notes & References

[darkstrawberrytimetravel]

Come hell or high water. Pt.2

18+, MDNI. Tags: Gore, severe injury, trauma, amputation

Pt.1

Gaz.

Gaz watches as the whole operation turns to shit. One minute he's at the back of the line as the small group silently pick their way through the wooded area back towards soap and the rendezvous point, daring himself to think about what he'd do as soon as he's back on solid ground at the Garrison. Next both he and Price are blown onto their backs, as he watches you take the whole force of the explosive and roughly land in pieces on the upturned earth. While nothing could have prepared him for this moment, both he and Price automatically reverted back to the SOPs drilled into them from the start of their careers. Price flicks the switch on the Comms, informing Soap of the unfortunate development.

Price: “MAN DOWN!”

Soap : “SIT REP, NOW!"

Price: “CONTACT IED!”

He listens as Price updates Soap further, telling him to get the HALO free fall rig kit they'd stashed close by to the RV point before they'd engaged with the targets. And not to leave his position.

The next few minutes drag on, it seems like hours as Gaz and Price manually belly crawl forward and around you as they use their combat knives to check for any further IEDs within that immediate vicinity, digging into the soil carefully so as not to further detonate anymore. As soon as they've established the area to be as safe they get to work providing first aid. Flipping you over, they dig through your uniform pockets for the standard issue tourniquets all soldiers must carry.

“Mum… I want my mum… Fuck… can't die…like this.” Gaz hears as you whimper. The fear in your voice grips at his heart.

“S’alright, see Price and me are patching you up? You stay with us. We'll all laugh about this when we go for our pint, they'll slap a fucking bugs bunny plaster on you and call it a day.” He says, self assured. Only then does he look up and meet Price's gaze, the odds of you making out of this alive… he doesn't even want to think about that.

Tying off mid way up the thighs of the bloody stump and wrecked remains of your legs, tight, Gaz watches as the blood slows to a trickle. Looking up he spots Price as he tends to a penetrating injury on your right arm, applying another tourniquet there. Only then do they pause for a moment, realising that you've become still. Price puts his hand on your chest and simultaneously leans forward to listen for your breaths. There's nothing.

“Fuck! COMMENCING CPR!” He shouts, both he and Gaz work at cutting and tearing the clothing from your upper body until they see bare skin. Gaz moves to your head to provide the rescue breaths as Price compresses his fists hard into your chest.

“...twenty-six, twenty-seven, twenty-eight, twenty-nine, thirty!”

Gaz watches as Price gives the allotted compressions before stopping and allowing Gaz to give the two rescue breaths. They go through three repetitions,Gaz about to take over from Price's exertions, before you finally take your own breath. It's shallow, weak. But you're breathing.

Gaz watches Price gingerly pick you up in a fireman's hold, and they cautiously retrace their steps back to the tree line before Price finds the original route the group had taken. They march in silence, it's only a matter of minutes before they're on the other side of the copse and they see Soap further down the road, waving his torch at them in the dark. They quickly make their way forward, meeting Soap half way, Price slowly and carefully laying you down on the dirt road as if you're made of bone china.

The next few moments are filled with Price's rapid fire shouting into the Sat phone, updating HQ of the situation, Gaz can barely keep up with the communications and the roaring in his ears. He looks down at you, unconscious, carefully laid down on the dirt road, your breaths short, gasps even.

Price: “ZERO, FOUR ZERO ALPHA, CONTACT IED. ONE CASUALTY. WITH CAUSALITY, NOW HAVE STABILISED AS BEST, NOW AT RV. GRID 542 736. WILL MARK WITH TORCH LIGHT. OVER.”

HQ: “BRAVO BRAVO ONE, HAVE ENGAGED MEDICS ON EVAC FLIGHT. ETA FIVE MINUTES. OVER.”

Pt.3

[kk095]

Maddie in Trauma

*Merry Christmas everyone! Here's my present to you. Hope you all enjoy!*

Through the automatic doors of the emergency department, a beautiful 33 year old woman arrived tethered to a gurney after being involved in a high speed crash on a chilly, rainy night. Her name was Maddie. She had bleach blonde hair, blue eyes, and stood at 5’5 with a slim build. Maddie was a conventionally attractive woman many would say was a solid 10, but that night, she was turning heads for all the wrong reasons. She laid on a backboard in a c-collar, stripped down to only her bra and underwear, littered in cuts, bruises, and abrasions. EKG electrodes were stuck onto her chest, and had IVs in both arms. The paramedics’ urgent chatter with our usual trauma team echoed the chaos of the accident that had left her in this vulnerable state. Maddie was awake and alert while being wheeled into the trauma bay, crying hysterically. Her eyes scanned the unfamiliar environment full of complete strangers, wondering what was going to happen next. “on my count. One…two…THREE!” Dr Lindsay’s voice called out, echoing in the room, taking charge of the situation.

Maddie then laid under the large overhead light on the trauma room table. The room was loud and hectic. Monitors were beeping and chirping fast and loud, and the members of the trauma team were all barking orders at one another. It was all happening so fast for Maddie. She was just driving to meet some friends for a night out, and now she was fighting for her life in the ER just a short while later. Maddie’s chest slammed into the steering wheel during the accident, and as a result, she felt a tearing pain in her chest, along with shortness of breath. She had never experienced this level of pain before, and knew she was hurt bad, and that frightened her. “am I gonna die?!” a terrified Maddie asked nurse Nancy, who connected a bag of blood products to Maddie’s IV line nearby. “it’s ok sweetie, you’re gonna be fine. Just stay calm and let us take care of you, ok?” Nancy replied in a soothing, reassuring voice. “My chest!...it hurts so much…” Maddie replied, still sobbing. “we’re gonna take a look hun. It’s all gonna be ok!” Nancy again reassured, gently stroking the frightened lady’s blonde hair for a brief moment. “I don’t wanna die…” Maddie sobbed, grabbing Nancy’s hand, holding it. “you’re not gonna die sweetie, it’s ok.” Nancy calmly replied.

Over the coming minutes, Maddie began to decompensate rapidly. Her blood pressure had taken a free fall, and her heart rate was increasing at an alarming rate. Maddie began spitting up blood, her eyes wide with fear, knowing something was terribly wrong inside her. The tearing pain was 10 times worse, and Maddie felt as if her heart was going to leap right out of her chest. “pressure’s dropping. Hang another round of o-neg to the rapid infuser.” Dr Lindsay ordered. Maddie’s mouth was suctioned out since her airway had become a bit obstructed from all the blood that had entered the area. She laid on the gurney staring upwards, beginning to zone out, taking rapid, shallow breaths. Maddie fought with everything she had left in her over the next minute or two to remain conscious, but she couldn’t do it anymore. She let out one final calm exhale. Her rapidly rising and falling chest was completely still now. Her eyes still wide open, now glazed over. “Maddie? You there hun?!” nurse Nancy shouted, doing a sternal rub. Maddie didn’t even react to the sternal rub. Her eyes just stared upwards, her mouth ajar. “no pulse, someone start CPR.” Dr Sarah announced to the team. Maddie’s bra was snipped off and her perky, C cup tits spilled out. Nurse heather then placed her hands on the center of Maddie’s bare chest and began pumping away hard and fast. At the head of the bed, Dr Sarah was placing an ET tube in Sarah’s airway. The tube was navigated in place quickly, and held in place with tape.

When the code had started, Maddie was in pulseless electrical activity, so CPR, ambu bagging, and IV meds were all the team could do. The beautiful blonde’s chest caved in and recoiled, her belly bouncing outwards. Her tits bounced and jiggled around, and 1 arm dangled off the side of the table, lightly bouncing in sync with the chest compressions. Her head bobbed and lolled, while her beautiful blue eyes were still wide open, with an ET tube hanging out the side of her mouth. At the other end of the table, her feet gently swayed and wobbled in time with the compressions. Maddie had size 9 soles with plenty of soft, silky, prominent wrinkles throughout- another asset to her already perfect appearance.

The trauma team had gotten to the 10 minute mark of the code with no improvement whatsoever, so Dr Lindsay had ordered an echocardiogram to see what was going on inside the stunning blonde’s chest. Lindsay looked over at the ultrasound monitor and saw cardiac tamponade, with some blood clots floating around in the mix. At that point, Lindsay decided to perform a left anterolateral thoracotomy in an attempt to get this life threatening tamponade squared away, then restart the hot blonde’s heart. Betadine was squirted all over Maddie’s chest, staining it and orangey brown sort of color. Lindsay picked up the scalpel and made a quick, decisive incision beginning slightly to the left of Maddie’s sternum, extending the cut across the left half of her chest, underneath her perky left breast, and ending a few inches away from her left armpit. Lindsay then incised the underlying tissue further, and placed a rib spreader into the large, freshly made cut in Maddie’s chest. The knob on the spreader was turned, forcefully prying apart Maddie’s ribs over the coming moments. Once the 33 year old blonde’s chest was cracked open, there was no rush of blood. Her boggy, fibrillating heart twitched weakly and erratically in plain sight. Lindsay reached into Maddie’s chest and examined the heart, noting it felt a lot heavier than normal. Lindsay made a cut in the thick, fibrous lining around the heart and peeled it back, delivering the heart itself and attempting to relieve the tamponade. Thick, gooey, clotted blood oozed out at first, which was suctioned away, only to be instantly replaced with bright red arterial blood. The area was once again suctioned out to reestablish the line of sight, and Lindsay placed a vascular clamp on the descending part of the aorta near the diaphragm to quell any bleeding in the area and redirect blood flow to critical parts of the body. The clamp temporarily stopped the rush of arterial blood, but Lindsay didn’t know where it was coming from. Lindsay began investigating, poking, prodding, and reaching around inside the blonde’s chest cavity, but came up empty during her initial efforts.

The team noticed Maddie was still in v-fib despite the meds and initial internal resus efforts, so the internal paddles were called for. The large, spoon shaped paddles were charged to 20 joules and lowered into her chest. A dull, wet thump was heard when the shock was delivered. Maddie’s body twitched sharply for a moment before falling limp. “no change, charge again to 30.” Lindsay called out. The high pitched electrical sound of the paddles charging filled the room for a moment, then shock #2 was delivered. Maddie’s heart stopped for a brief moment, then started twitching uselessly once again. The internal defibs were charged again to 30, and another shock was delivered. Maddie’s toes curled at the other end of the table, showing off the fresh coat of black nail polish and her hot, wrinkly soles once again. “still nothing, charge again to 40.” Dr Lindsay called out. The paddles were placed back around Maddie’s twitching heart, and a shock was promptly delivered. Her torso flopped abruptly, her tits shaking, her lifeless blue eyes stared helplessly above. “No change, resume internal massage.” Dr Lindsay called out. This time, Dr Sarah took over internal massage. Perhaps a different set of hands and a different pair of eyes can figure out what the exact cause of Maddie’s arrest was. Sarah could feel the blonde’s heart squirming around in her hands while she massaged it. While performing cardiac massage, she also tried to feel around to see if anything felt out of place. “something’s not right in the posterior portion of the left ventricle. Feel that.” Sarah said to Lindsay. Lindsay reached into Maddie’s chest and worked her hands to the spot Sarah had discovered. “yeah. Something isn’t right, I see what you mean.” Lindsay agreed, but still couldn’t quite figure out what was going on.

Lindsay and Sarah had investigated the area for a bit, but couldn’t draw a conclusion. Since Maddie was still in v-fib, they had opted to shock her again. Sarah performed a cycle of internal massage, and Lindsay got the paddles readied, charging them to 40. The paddles were lowered back in, and the next jolt of electricity went straight into the hottie’s heart. Maddie’s feet kicked around at the opposite end of the table, wrinkling up the soles of her feet once again. “still nothing, hitting her again at 40. Everyone…CLEAR!” Lindsay shouted. KA-THUNK. Maddie’s limp, lifeless body jolted around for a brief moment, but v-fib was still winning this battle. Lindsay shocked the beautiful patient with the internal paddles another 4 times to no avail, so Sarah decided to push more meds and perform a cycle of internal massage. While performing internal massage, Sarah felt a long, thinner, fleshy structure poking one of her fingers. “huh? What is that?” she thought. “charging paddles to 40.” Lindsay called out. “hold on a sec…” Sarah told Lindsay, as she held the blood soaked paddles in her hands. Sarah felt the structure with the tips of her fingers and it all dawned on her. Sarah took her hands out of Maddie’s chest and immediately peeled her gloves off, looking over at Lindsay. “massive aortic dissection. It ripped off the left ventricle almost completely and got trapped. She bled out into the pericardium that way.” She tells Lindsay. Sarah pauses, looks over at the clock, then continues. “time of death, 21:17.”

Lindsay places the internal paddles back onto the crash cart, and nurse Nancy detached the ambu bag, a small amount of air hissing out when the bag is detached while Maddie’s eyes remained open, which was an eerily beautiful sight. The monitors were turned off, and the EKG electrodes were plucked off the lady’s chest. A blue surgical drape was hastily thrown over the thoracotomy site while Maddie’s heart fired off its last handful of desperate, useless signals. Maddie’s eyes stayed open when her body was covered up, looking almost as if she was watching the trauma team’s basic postmortem care on her. Lastly, a toe tag was filled out and placed on the big toe of her left foot. The tag dangled in front of her perfect, wrinkly soles while the trauma team exited the room, bringing a heartbreaking end to her case.