Should a nurse watch Knives Out? (Spoilers)

Someone asked me this today when I mentioned the country of origin Macguffin in the film.

I don’t know if it’s a generational thing or symptomatic of being only 18 in nurse years, but the idea that not reading the labels on medication is a sign of being a good nurse was pretty glaring. It could be generational. Perhaps there was an era where if it could make you more efficient, knowing an injectable medication by look and feel would be a desirable skill. But since the 1999 IOM report “To Err is Human” with it’s finding that 100,000 people are killed by medical mistakes annually, saving time has taken a back seat to saving lives by double checking yourself. Additionally, in the plot ketorolac is something the deceased had begun taking recently, and morphine is a high alert medication where you should triple check yourself. I’m not sure how long it took for these safety principles to get into curricula and the NCLEX, let’s say Marta has been an RN for over 15 years, then I could be wrong. It is important to know the physical characteristics of injectables, so you can use the needle that will get the job done with the least tissue damage.

Then there’s the concentration problem. Marta used a 2 or 3 mL syringe for both drugs. The film probably played on the idea that 100 mg of ketorolac and 3 mg of morphine could both fit in this mostly common size range syringe. (Though it’s highly unlikely they would be the same volume, since 3 mg of morphine would involve 1.5 or 0.75 mL depending on the concentration). To inject 100 mg of morphine would require at least 6 2/3 mLs in a putative 15 mg/mL solution (looking up the available concentrations reveals that IV morphine is only packaged in prefilled syringes). If she had this concentration, 3 mg would be 0.2 mL, which should be given with a 1 mL syringe. While larger syringes have tenths marked, they aren’t very precise. It would like trying to buy a can of soda with a $50 bill.

It’s far more likely she would have had the 2 mg/1 mL concentration, taking us back to the issue where it would be 1.5 mLs and not an even quantity. To give 100 mg would require a 50 ml syringe, which I’ve never actually seen. I do see 60 mL syringes, but they don’t have a Luer lock tip- a feature to discourage this kind of error of scale. They are used for tube feedings (enteral, not IV). 50 mL would be a nontrivial amount of diluent to add directly to the blood circulation (which is around 5 Liters); another reason injectable concentrations are attuned to need. I’ve done a bit of math and googling here, not every nurse would work all this out. Pharmacists and computerized dispensaries take care of a lot of these things, but I’d worry about any nurse who didn’t sense that something was wrong with the idea of easily crossing up 100 mg of morphine/ketorolac with 3 mg using the same size vials and syringes. Nurses who operate in the community would need an even stricter functional grasp of pharmacology.

And then the point that prompted this post: does a holistic vs. cynical strategy really give one an advantage in game theory? I haven’t played Go, and perhaps I should try it. But in Scrabble, considering plays that open more of the game board rather than a simple focus on points hasn’t served me well. I guess I could try it, but I wouldn’t enjoy it. Or maybe I need to go with the house rules my husband was raised with, where you can reuse the pink and blue bonus squares. I mean, they also combined 2 sets and did 25 tile racks.

I do find that not buying attack cards in Dominion is typically better. At least this has been true in my in person games. I’ve never seen an attack card that was better than just buying treasure of an equivalent value. My husband also really likes Vault and I never buy it. But if you’re too much better at a game than someone, they never want to play with you.

Syringes image:

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