pet peeve is when you look up fashion references from a specific era and you keep getting modern day '[era]-inspired' fashion like NO i want authenticity damn it. i can see your 2020 photo quality and your 2020 hair and your 2020 makeup. youre not fooling me.
hello i'm a historical fashion researcher and i have a lot of experience looking up things! this is a very widely experienced irritation and you're definitely not alone in this, but i am here to share everything i know!
so, ways to get around this:
turn off AI results. they're literally nonsense to us
don't use pinterest because the sources/provenance is often hard to trace
a standard internet search can be okay, but museum collections are the top tier (list of collections below this list)
instead of broad terms like victorian, regency, tudor, renaissance etc. try using the decade you're looking for. if you're not sure of what decade it is but have a vague image in your head, look on the fashion history timeline and just jump around until you find it. but even changing to e.g. 19th century will give better results than victorian
including terms like womenswear/menswear, daywear, formal wear, evening wear, court dress should increase the value of your search too
including "fashion plates" in your search can give you a nice impression of the intended silhouettes of the era. some of these might be a little stylised but will show you what was considered in vogue
for pre-fashion plate eras or things like makeup and styling, you'll have to look at portraiture or manuscripts. these are harder to actually find what you're looking for, but searching museum collections and limiting results to specific date ranges will be your friend
when looking at art, do bear in mind sometimes artists would paint fabric extra flow-y to show off their skills. it might not have been exactly like that in terms of fabric weight or drape. so, a pinch of salt required!
if you find something on image search where the provenance is dubious, reverse image search and you might find a source! i've been able to trace random pinterest images to real sources, but this does take a lot of time and effort and is often not worth the headache
some online resources and museum collections:
fashion history timeline is an invaluable resource if you're trying to get a feel for everything and should be your first port of call. it'll also link to good examples
the met has a vast number of extant examples of clothing, as well as fashion plates
costume institute fashion plates is a subcollection of the met for fashion plates (1800s-1922)
v&a also has many extant garments, fashion plates, and incredible articles on clothing and aesthetics. read the details of the objects because they'll often reveal a lot about the piece
lacma is good for C19th-20th pieces
nypl digital collection for photographs
national portrait gallery or similar for portraiture, or literally any museum in your country that has historical art
national museums scotland can be useful situationally but might be oddly specific
stout style history is a great collection for finding image references for fat people wearing historical clothes. survival bias of a lot of museum pieces tends towards smaller clothing that couldn't be repurposed, but this aims to counter that. it's not sortable, but is still a really nice resource
wikimedia commons is surprisingly handy! and the images, if you should need to link/repost them, are public domain
auction websites sound like a funny one to recommend. some won't have mannequins and some will. just look up historical garment auctions and you'll find some!
anyway, i hope this has been a good place to start for anyone interested! there are probably some i've missed because there are so many museums across the world and i don't know about all of them or can't remember them. but these are the ones i've used the most! (my specialisation/jobs i've had to research for have only really been in western fashion, so my resources reflect that)
Wikipedia has a list of fashion museums. Unfortunately, the page itself is only available in German, but the introductory paragraph is very short and after that, it's organised by country, and then it's a simple list. If you click on a museum's article, the website is usually linked in the overview table.
reminder to worldbuilders: don't get caught up in things that aren't important to the story you're writing, like plot and characters! instead, try to focus on what readers actually care about: detailed plate tectonics
Why is the mountain range square. How did the mountain range form. Why is there one singular volcano in the center. Why does it act like a composite volcano but have magma that acts like it’s from a shield. If it’s hotspot based volcanic activity why is there only one volcano.
And then the misty mountains!!!! Why isn’t there a rain shadow!! And why is there a FOREST where the rain shadow should be!!!!!!!!
Wind blows clouds in from the sea, but mountains are so tall the clouds can't get past 'em, so you get deserts on the windward side of mountain ranges because clouds can't get there to water the land, or do so only very rarely.
May I recommend my new favorite tool: Mapgen4. You start with a random seed and then add mountains, valleys, shallow water, or oceans as you like. You can adjust the wind direction to make wind shadows off the mountains fall where you want. You can adjust overall raininess to make the rivers larger or smaller, or have more or fewer tributaries. It works best for small, isolated landmasses (think islands more than continents) but as there’s no scale bar and it’s all slightly abstracted anyway you can do whatever you want with it. I’ve only just started playing with it but it’s SO FUN.
I do think this could be useful for writers! ...Caveat, if you're going to use this for making a map for anything published (digital or paper, even if it's only in a fanfic archive or whatever), please, please credit the creator and their program as how you made that map! The more ways information like this gets out there, the more useful it'll be to other writers, roleplaying game DMs/GMs, creators, etc.
One of my favourites for mapping plates, biomes, etc is Tectonics.js. If you're familiar with how tectonics shape a planet, you can guess where the features go by toggling plates, crust thickness, etc. Between Mapgen4 and Tectonics.js, we've got some pretty sweet tools at our disposal.
European Geosciences Union Blog — Beyond Tectonics: Building fictional worlds to better understand our own
Reshaping Reality's Worldbuilding Tips
Worldbuilding pasta's series, An Apple Pie from Scratch also check their resources page!
R/worldbuilding's Reading List. Also check out their collected resources link. This basic geology guide from 11 years ago is still nice.
Creating an Earth-Like Planet, and The Climate Cookbook (aka Geoff's Climate Cookbook) technically the climate cookbook is a part of Creating an Earth like Planet I think.
Related: Worldbuilding Workshop's "Working Out Climates Using Geoff’s Climate Cookbook." Which goes through using the resource in order to map make. Also just the Worldbuilding Workshop in General.
Madeline James Writes's Worldbuilding Guide
Worldbuilding 101 (this links to the Biomes section but there's like...everything.)
Also I would recommend looking into Landscape Archaeology as well! That's because Landscape archeology is basically adding the social/cultural layer on top of all that geology and geography. Environments change when communities live in them, and communities likewise adapt to various environments.
This is a short free introduction to the concept: "Notes on Landscape Archaeology." To summarize, Landscape archaeology sort of like...studies the relation of people to places/spaces (that is, landscapes) in time.
Also this paper [An Archeology of Landscapes] breaks down/introduces the key concepts that I learned which is first that you can form the "construct paradigm" of a landscape from settlement ecology,
ritual landscapes, and ethnic landscapes.
And then the highlights of their summary of what constitutes defining a landscape:
Landscapes are not synonymous with natural environments. Landscapes
are synthetic (Jackson, 1984, p. 156), with cultural systems structuring and
organizing peoples’ interactions with their natural environments ...
Landscapes are worlds of cultural product ... Through their daily activities, beliefs, and values, communities transform
physical spaces into meaningful places. ...
Landscapes are the arena for all of a community’s activities. Thus landscapes not only are constructs of human populations but they also are the
milieu in which those populations survive and sustain themselves. A landscape’s domain involves patterning in both within-place and between-place
contexts ...
Landscapes are dynamic constructions, with each community and each
generation imposing its own cognitive map on an anthropogenic world of interconnected morphology, arrangement, and coherent meaning ...
Basically a "landscape" is made by a community living in an environment. Once you have a geological environment that makes sense, landscape archaeology is like... Basically how I feel confident knowing where trade routes would be on a map, where there are areas of continual high conflict, what kinds of agriculture exists where, etc. once the geological stuff is hammered out, it's like...I know how that would influence the local cultures and vice versa. At that point, it's easy to start marking the natural borders, settlements, trade/port cities, and even strategic fortresses. If you have properly put rivers on a map, then marking your port cities is effortless, basically.
Also:
This course syllabus for a Landscape Archaeology class is freely accessible. It includes an online resources page.
Place, Landscape, and Environment: Anthropological Archaeology in 2009
(Landscape Biographies is open access, as is Landscape Archaeology between Art and Science: From a Multi- to an Interdisciplinary Approach. But I wouldn't try to read every essay.)
If you are like me and find it helpful to have video reference for a process/activity in addition to a written guide, Artifexian is a YouTube channel that does a LOT of world building stuff and specifically he's in the process of creating a world following a lot of Worldbuilding Pasta's methodology!
reminder to worldbuilders: don't get caught up in things that aren't important to the story you're writing, like plot and characters! instead, try to focus on what readers actually care about: detailed plate tectonics
not doomed by the narrative but saved by the narrative. yeah i know you'd rather die than keep suffering but the story doesn't actually care what you want. you have to keep going, even when it hurts. even being erased from existence won't stop you from being salvaged from the wreckage of un-being. get up. keep pushing. keep bleeding. keep living.
no one can save you but yourself. thats why its important to start swinging your deadly sword around in a circle. dont stop regardless of what people tell you just keep swinging it around
There used to be a lot of activities that took place around a populated area like a village or town, which you would encounter before you reached the town itself. Most of those crafts have either been eliminated in the developed world or now take place out of view on private land, and so modern authors don't think of them when creating fantasy worlds or writing historical fiction. I think that sprinkling those in could both enrich the worlds you're writing in and, potentially, add useful plot devices.
For example, your travelers might know that they're near civilization when they start finding trees in the woods that have been tapped, for pitch or for sap. They might find a forester's trap line and trace it back to his hut to get medical care. Maybe they retrace the passage of a peasant and his pig out hunting for truffles. If they're coming along a coast, maybe your travelers come across the pools where sea water is dried down to salt, or the furnaces where bog iron ore is smelted.
Maybe they see a column of smoke and follow it to the house-sized kilns of a potter's yard where men work making bricks or roof tiles. From miles away they could smell the unmistakeable odor of pine sap being rendered down into pitch, and follow that to a village. Or they hear the flute playing of a shepherd boy whiling away the hours in the high pasture.
They could find the clearing where the charcoal burners recently broke down an earth kiln, and follow the hoof prints and drag marks of their horse and sledge as they hauled the charcoal back to civilization. Or follow the sound of metal on stone to a quarry or gravel pit. Maybe they know they're nearly to town when they come across a clay bank with signs of recent clay gathering.
Of course around every town and city there will be farms, more densely packed the closer you are. But don't just think of fields of grains or vegetables. Think of managed woodlands, like maybe trees coppiced-- cut and then regrown--to customize the shape or size of the branches. Cows being grazed in a communal green. Waiting as a huge flock of ducks is driven across the road. Orchards in bloom.
If they're approaching by road, there will be things best done out of town. The threshing floor where grain is beaten with flails or run through crushing wheels to separate the grain from its casing, and then winnowed, using the wind to carry away the chaff. Laundresses working in the river, their linens bleaching on the grass at the drying yard. The stench of the tanners, barred from town for stinking so badly. The rushing wheel-race and great creaking wheel of the flour mill.
If it's a larger town, there might be a livestock market outside the gates, with goats milling in woven willow pens or chickens in wooden cages. Or a line of horses for the wealthier buyer or your desperate travelers. There might be a red light district, escaping the regulations of the city proper, or plain old slums. More industrial yards, like the yards where fabric is dyed (these might also smell quite bad, like rotting plant material, or urine).
There are so many things that preindustrial people did and would find familiar that we just don't know about now. So much of life was lived out in the open for anyone to see. Make your world busy and loud and colorful!
This is a big reason that I have always loved the Brother Cadfael novels, set in the mid 1100s. Written by Ellis Peters, each book has such a vivid sense of the place and the time period. Many different settings around Shrewsbury are described, along with the people and their various jobs.
I love that kind of world building and would add that many resources were tightly regulated that we don't consider nowadays. Examples are the right to herd your pigs in an oak forest belonging to a specific monastery (saw an example where an altar piece had a carved pig to make sure the claim was known and advertised) or down to which farmers had the right to tree leaves in the fall (shortage of other animal bedding in certain Swiss valleys). The idea of a wilderness in a medieval setting is not what we think.
Forever recommending A Collection of Unmitigated Pedantry as an introductory resource for this! The author is a historian of the ancient mediterranean and he has a lengthy two-part blog post on "lonely cities": how fictional cities tend to look in pseudomedieval fantasy versus how real cities actually worked, specifically how they reshaped the land use for many miles around. Part I, part II, or available read aloud on YouTube here.
died and came back wrong but only to myself. died and came back and nobody noticed i died. died and people think i came back better. died and came back wrong only in a specific sense of "wrong". died and fought like hell to come back and everyone thinks it was easy. died and came back mentally wrong and physically fine and tearing myself apart from the inside. died and hiding everything that went wrong. died and trying so hard to show what is wrong and nobody notices.
came back imprisoned by obligation to bear responsibility for the love and grief that others feel for you. came back painfully aware of the horror of existence. came back to a life you cannot bear to live anymore, to a body you cannot bear to call yours.
✧ Broken ribs suck. You don’t just “walk it off.” Breathing hurts. Laughing hurts. Existing hurts. Characters with rib injuries won’t be doing heroic sprints.
✧ Concussions aren’t instant naps. Dazed vision, nausea, dizziness, maybe even personality changes, but they’re not going to collapse neatly like in the movies.
✧ Blood loss is sneaky. It’s not just about dramatic pools of blood. It’s dizziness, confusion, and the body getting cold as circulation tanks.
✧ Adrenaline lies. Someone can take a serious injury and not feel it until the fight’s over. That “I didn’t realize I was bleeding until later” trope? Very real.
✧ Twisted ankles are brutal. One bad step and suddenly running is off the table. Even walking hurts like hell. Perfect way to ground a chase scene.
✧ Burns linger. Even small burns hurt more than most people expect. Blisters, infection risk, constant pain, it’s not just a cool scar later.
✧ Dislocated shoulders = useless arm. Characters can’t keep swinging a sword or firing a gun. They’re basically fighting one-armed until it’s fixed.
✧ Shock is a thing. Pale skin, trembling, rapid heartbeat, and eventually disorientation. A character might not even realize how bad their wound is.
✧ Stitches aren’t magic. Getting sewn up is painful and recovery takes time. They’re not instantly battle-ready after a needle and thread.
✧ Scars tell stories. Some fade, some don’t. Some stay sensitive forever. Don’t forget the aftermath when the wound becomes part of the character.
There used to be a lot of activities that took place around a populated area like a village or town, which you would encounter before you reached the town itself. Most of those crafts have either been eliminated in the developed world or now take place out of view on private land, and so modern authors don't think of them when creating fantasy worlds or writing historical fiction. I think that sprinkling those in could both enrich the worlds you're writing in and, potentially, add useful plot devices.
For example, your travelers might know that they're near civilization when they start finding trees in the woods that have been tapped, for pitch or for sap. They might find a forester's trap line and trace it back to his hut to get medical care. Maybe they retrace the passage of a peasant and his pig out hunting for truffles. If they're coming along a coast, maybe your travelers come across the pools where sea water is dried down to salt, or the furnaces where bog iron ore is smelted.
Maybe they see a column of smoke and follow it to the house-sized kilns of a potter's yard where men work making bricks or roof tiles. From miles away they could smell the unmistakeable odor of pine sap being rendered down into pitch, and follow that to a village. Or they hear the flute playing of a shepherd boy whiling away the hours in the high pasture.
They could find the clearing where the charcoal burners recently broke down an earth kiln, and follow the hoof prints and drag marks of their horse and sledge as they hauled the charcoal back to civilization. Or follow the sound of metal on stone to a quarry or gravel pit. Maybe they know they're nearly to town when they come across a clay bank with signs of recent clay gathering.
Of course around every town and city there will be farms, more densely packed the closer you are. But don't just think of fields of grains or vegetables. Think of managed woodlands, like maybe trees coppiced-- cut and then regrown--to customize the shape or size of the branches. Cows being grazed in a communal green. Waiting as a huge flock of ducks is driven across the road. Orchards in bloom.
If they're approaching by road, there will be things best done out of town. The threshing floor where grain is beaten with flails or run through crushing wheels to separate the grain from its casing, and then winnowed, using the wind to carry away the chaff. Laundresses working in the river, their linens bleaching on the grass at the drying yard. The stench of the tanners, barred from town for stinking so badly. The rushing wheel-race and great creaking wheel of the flour mill.
If it's a larger town, there might be a livestock market outside the gates, with goats milling in woven willow pens or chickens in wooden cages. Or a line of horses for the wealthier buyer or your desperate travelers. There might be a red light district, escaping the regulations of the city proper, or plain old slums. More industrial yards, like the yards where fabric is dyed (these might also smell quite bad, like rotting plant material, or urine).
There are so many things that preindustrial people did and would find familiar that we just don't know about now. So much of life was lived out in the open for anyone to see. Make your world busy and loud and colorful!
The coppice and pollard systems are one of my favorite pre-modern things, it's just so visually unique and sensible, but most people haven't heard about it.
When you coppice, you cut the tree close to the ground, so only the trunk is left, then the tree puts out fairly straight shoots that are great for firewood. They would typically have these trees harvested on rotation so new trees would be ready every year.
This is a coppiced tree:
When you pollard, you cut the tree to the trunk, but higher, and let the branches grow for longer. They'll be be nice and straight (depending on species) with fewer knots, and suitable to various crafts without much need to work the wood. Sadly seems to be etymologically unrelated to "pole", though the branches from these trees were used to make poles. Part of why you do this instead of coppicing is that the shoots are out of reach of animals.
This is a pollarded tree:
It's very likely that you'd see something like this as a sign of civilization as you came toward a town or village, depending on the species of tree that they have available, though note that this is something you do when you have a timeline of many years, rather than something you set up for the year after.
Because someone asked me, a million billion years ago: some information, reference, and explanation of things that might be around when you're writing/drawing someone in the hospital. And if you just,,, have seen some of these things in hospitals and would like to understand them better. It's good for that too I guess lol. Under the cut, because this is long and image-heavy
(Disclaimer--this is mostly for characters hospitalized for traumatic injury, broken bones, etc--I don't work ICU so my advice is less applicable there)
((Double Disclaimer: I've tried to keep this applicable to the general concept of hospitals, but apologies if over-generalization has slipped through!))
IVs
Item one! Because it's very visible and often misunderstood: our friend the IV. Shown below, a pretty bog-standard hand IV, a dressing with a clear window to show the insertion site, and technically-optional but very commonly-used J-loop tubing
(You can also just screw the long infusion tubing directly onto the IV itself, but it's a pain in the ass to do and often pinches the patient when you take it on or off.)
Common Misconception: If we are "taking you off the IV" we are not removing the IV! We're unhooking the tubing from that hub you can see at the end of the J-loop.
Common Misconception: The actual “IV” is the very thin plastic tube that goes into the vein itself, and the plastic hub that rests on the skin outside. The needle used to guide the IV is retracted once the catheter is into the vein. There’s no needle in there. Irritation to the inside of the vein may feel sharp, but it's not because you're being literally stabbed.
Artists: Note that the IV is inserted pointed up the arm, toward the heart! I've seen it drawn the other way once or twice. Nope!
Artists: most likely areas to see an IV placed ^^^
Writers: IVs in the elbow-bend/antecubital vein/"AC" tend to kink when the arm bends, which causes the pump to beep. Perhaps to the annoyance of Blorbo, who would like to be able to use their arms for things.
Somebody more critical could be getting medications and fluids through several IVs at once, and will often have at least one that's not currently in use as well--the most IVs I've seen in one patient is five, with three of those all running infusions at once, but generally I'd expect one or two IVs in a routine surgical patient, and probably two to three in a trauma patient.
Patients who have had surgery or a traumatic injury, or who aren't able to eat/drink like normal, will often be getting a slow drip from a big bag of fluid (i.e. saline! laypeople know saline, I think right?)
Artists: these bigger hydration infusions are compatible with most other medications, so when someone gets an IV medication--an IV antibiotic, an electrolyte, etc--they'll often be hung "piggyback" or as a "secondary infusion" (see below). If blorbo has two bags hanging on connected tubing, one should be notably lower than the other.
If Blorbo has medications running, and/or is anywhere but the emergency room, the tubing will also run through an IV pump, to moderate how fast it goes. (reference: IV pump).
There are other types of venous access, and also arterial lines, but we don't have a million words to do a primer on access types unfortunately.
RE: IVs being dramatically yanked out so Blorbo can run off to do Drama: should stop bleeding with a minute or two of light pressure, and bleed in a dark, welling trickle, not a bright red gush or spurt. Unless Blorbo got an IV accidentally placed in their artery, which is *LOUD INCORRECT BUZZER*.
Dressings/Bandages
There are approximately eight billion types of dressing, but this is specifically a PSA that there are a lot of options that aren't the classic White Wrapped Bandage.
Dressings of the Wrapped Bandage genre are used, especially on things like a hand or foot wound, or to (try to) wrap a head wound. (Bandaging somebody's face/head, my beloathed. it does NOT stay on.)
BUT injuries not on a part of the body with fiddly surfaces like toes/fingers or facial orifices are often covered by what I'd broadly call an "island dressing"--essentially a big bandaid sealed on all sides, or gauze pads laid down and taped to fit the wound. Looking up "surgical dressing" has provided me with a lot of the ones I was thinking of, and minimal gore, so I recommend it! Things of this general species:
Those dressings ARE sometimes paired with essentially a wide ACE bandage--in my field, I often see a smaller dressing on the hip/knee/ankle surgery site, and then an elasticated wrap around a large part of the leg, to gently compress the limb.
Oxygen (reference:nasal cannula or hospital oxygen mask)
Writers: Oxygen flow is measured in "liters per minute" which is confusing but true. You'll hear medical people shorten it to "they're on two liters nasal cannula" or "they're on ten liters nonrebreather", etc--or if Blorbo isn't on oxygen at all, they're on "room air".
The nasal cannula is a tube to deliver extra oxygen through the patient’s nose; the tubing goes back over the top of the ears, loops forward and meets under the chin. The other end is usually hooked to a wall port if the patient’s in bed.
This is one of the biggest ones I see people draw funky. The versions people come up with are very funny but also that's probably not what you're going for so pls. Take this reference I am gently handing to you.
A CLOSED LOOP: two small tubes in the nose, then the tubing goes back over the ears, then down onto the chest where the loop joins back up into one length of tubing.
It’s not actually as common to wear an O2 mask--masks deliver a higher concentration of oxygen than the cannula does, and if someone is struggling enough on a regular nursing floor that they need a mask to get their oxygen up, that's something their nurse is most likely keeping a close eye on. The Intensive Care Unit/ICU, the Emergency Room after a trauma, or in the hour or two after surgery are the places I'd expect to see a lot of O2 masks.
Artists: If you're looking up reference for oxygen masks, note that the kind shown on the left, with the bag (a nonrebreather) is a further step past the simple face mask shown on the right and delivers a pretty hefty dose of oxygen. Things have gotten pretty serious breathing-wise if Blorbo needs a nonrebreather.
Many people in the hospital don't actually need oxygen. Some common reasons people DO: lung injuries/diseases, a sleepy/sedated/unconscious patient, or something like broken ribs, where breathing is painful/hard. (looking at u, hurt/comfort writers).
We check oxygen on the finger the majority of the time (reference: pulse oximeter clip, pulse oximeter sticker)--if the patient’s unstable/sedated or has problems with their oxygen levels, the sticker is made to stay on continuously while the clip is easier to apply for occasional checks and then take off.
A little guy of this general variety, although you can honestly freestyle the shape. Note the norm is that the cord comes out on top. These can actually be used on any finger, or even the toes, although the fingers tend to read better.
Fun fact: the little finger doodad, whichever kind you choose, simultaneously reads oxygen and heart rate. If Blorbo has a little clip on their finger, their monitor should probably be showing both!
Drains (Careful looking up ref of these--they’re usually used for wounds, and the image searches can sometimes be unexpectedly graphic)
Inserted into somewhere there’s going to be drainage (because of infection or after some kinds of surgery/injury)
There are a million kinds of these, but I most commonly see the JP/Jackson-Pratt. The little hand grenade guy. He shouldn't be round unless he's full and needs emptied; the suction comes from compressing the bulb and corking it that way.
On a non traumatic-injury-related topic: to my knowledge, this is commonly what you'll see placed after top surgery! Congratulations to Blorbo on the top surgery.
Another useful friend for more traumatic art/writing is the humble chest tube, inserted for injuries around the lungs; severely broken ribs, blunt or penetrating trauma, etc.
Injuries around the lungs can cause air or blood to pool in the space the lungs are supposed to take up, and a tube can be inserted so the lungs can do their thing again. They drain into a weird flat tall little box that collects the drainage and can be hooked up to suction to help the drainage along. (reference: chest tube dressing, pleur evac)
There are a million pieces and parts to a pleur-evac and I could explain them all but to be frank you do not need to know. Face it away from the illustration and I will still be applauding, impressed that someone drew a chest tube.
Heart monitors
Most people who are hospitalized for a run-of-the-mill fanfic-style traumatic injury (and who don’t have heart problems/symptoms) don’t necessarily need their heart monitored, but if they’re critical/have heart issues, a telemetry box is a common piece of hospital equipment.
It’s hooked up by five wires to five stickers that go on the patient’s chest--if you want to get the placement right and make a nurse quietly impressed, look up five-lead telemetry
Incredible. A whole eight pixels of telemetry setup. >:Ic To simplify it down: one on either side a little below the collarbones, one on either side of the ribs, and one about in the middle. That's close enough for horseshoes or hand grenades, at least!
I've talked about this on the blog before, but the formula for a passable heart rhythm is a little rounded bump up from the base line, then a narrow spike up, down below baseline, and back to center, then another rounded bump. That makes one total heartbeat. Keep those clustered pretty close; if it’s a slower heartbeat, they space out slightly more but most of the space comes BETWEEN those clusters, not separating the parts themselves.
This is another one I see artists freehanding often, to often very humorous effect! Remember y'all, BUMP SPIKE BUMP.
Feeding Tubes
Unless the character’s going to need tubefeed long-term, hospital feeding tubes mostly go through the nose rather than in through the abdominal wall. They can be taped onto the nose (reference: NG tube tape) or we can loop something up one nostril and down the other to hold it in if it’s staying for a while/it keeps getting pulled out (reference: bridled corpak).
If your character had a gut injury/surgery, or is very malnourished from some form of illness and needs concentrated nutrition but can’t tolerate a lot of food, a hospital might give them tubefeed.
(we can also give nutrition through an IV! Sometimes tubefeed and TPN or PPN (IV nutrition) are given at the same time, especially for very malnourished patients or ones we're weaning off of the IV nutrition)
Vital Signs
This one's mostly for the writers lol. A very simplified rundown:
Vital signs are usually taken at regular intervals, often every 4-8 hours on a regular nursing floor, or more frequently in ICU/ER, where they often leave the machine hooked to the patient and can set it to automatically cycle at an ordered frequency
TEMPERATURE:
often in celsius, yes even in America
PULSE:
Patients who have lost blood and are stressed and in pain--aka most trauma patients--will often run faster heart-rates. Some young traumas especially will sometimes just maintain 100s-120s even at rest.
BREATHS PER MINUTE:
Pretty self-explanatory. I often hear respirations shortened to "respers". Counting them is not often noticeable but might include glancing from the patient to the clock/a watch and/or having a hand on their shoulder or back.
Narcotic pain medications are a notorious reducer of respiratory rate/depth, especially when somebody has had enough to make them drowsy.
OXYGEN SATURATION:
(AKA "pulse ox"/"sats"/"O2")
100% is obviously the best
95-ish on a young person who's been sedentary or sleeping heavily wouldn't surprise me too greatly but I would expect it to come up with deep breaths and coughing.
If young previously-healthy Blorbo is needing oxygen to get above the 93-94% range or below, especially all of a sudden, I'm looking for why! Sometimes "why" is obvious--rib fractures, sedation from anesthesia or pain medication, pneumonia, etc--but if it's not, we might be getting a chest x-ray.
Older patients who smoke and/or have long-term respiratory diseases can sometimes just run around 88-90%, but it's sure the fuck not a sign of good health. :T
BLOOD PRESSURE:
Hoo boy there's a lot here. In case this is new information: "blood pressure" is TWO numbers, written as X/Y and usually spoken as "X over Y". "120 over 80" being the old textbook "normal" number.
The patient's BASELINE blood pressure and how it's TRENDING (is it going up, down, has it dropped or spiked suddenly) are very important parts of assessing a blood pressure, so trying to assign meaning to specific numbers gets tricky!
High blood pressures are not usually going to be the problem in Blorbo-torment situations, which tend toward blood loss etc, so to broadly cover the opposite:
100s/60s is what I'd generally call a "soft" blood pressure; on the low side but not necessarily concerning in isolation.
90s/50s is eyebrow-raising. We're looking closely at other vital signs, assessing the patient, seeing if they've had a lot of medication that can lower blood pressure (pain medication/narcotics a common suspect). We're likely calling doctors for blood work (to look for signs of bleeding) and/or asking for a "bolus" (a half or whole liter bag of fluid run very quickly). Some people just exist in the 90s/50s! But if Blorbo doesn't, or if they're having other symptoms (dizzy, sleepy, lethargic, pale, heart-rate rising from their baseline rate). CONCERNING.
80s/40s is "if a doctor doesn't come up here ASAP and/or order some stuff right now, I'm activating my hospital's rapid response team" territory.
70s/30s is "I'm going straight to the rapid response team and calling a doctor once that's called because I'm worried this is going to turn into a full-blown Code Blue" territory.
Either the top or bottom number (systolic and diastolic, to their friends) being low to the degree above is of note--they don't exactly go up and down in lock-step. Unfortunately to get into the minutiae of "well if the systolic is THIS but the diastolic is THAT, I'm less concerned than--" would take a million years lol.
ARTISTS: there are about a million formats for vital machine readouts, so the exact design isn't important! But I do note that having several different colors is a very common feature. Here the heart-related vital signs are all red, the oxygen is blue, and the temperature is green.
"THEIR VITALS ARE DROPPING"--@ hospital drama TV what are you doing. that's nothing. it's nothing. Stop it. if I've heard any phrase used to a similar effect it's "they're crashing" but also like. If there's a team of medical professionals in the room we don't need someone to announce generally that things are going bad. We can tell. Calling out a specific vital sign--"blood pressure's tanking, 64 over 30"--"I'm getting 76% O2, I need a nonrebreather"--is way more specific and lets us know exactly how bad and in what way. 😤
CODES
Big bad! Blorbo has 1. stopped breathing, 2. abruptly stopped responding to stimuli, 3. stopped having a pulse, or some combination!
This does not just happen, so if you're going to write a code being run you might have to do some extracurricular looking around to find a story-compatible reason WHY blorbo tanked. Extreme electrolyte imbalance caused a dangerous heart arrhythmia? Very severe blood loss->hypovolemic shock? Vomited and choked on it? Vasovagal response when they were trying to poop made them pass out and it's a false alarm?
If someone's found unresponsive, you might see a "sternal rub"--a quick and dirty way to figure out if someone is just really drowsy and lethargic vs completely unresponsive, scrubbing your knuckles down hard against their breastbone. It hurts! And if someone doesn't react to it you can pretty decisively say "shit this person's unresponsive" and get help.
The phrases "CALL A CODE" and a coworker's voice yelling "I NEED SOME HELP IN HERE!" down the hallway galvanize me into an immediate adrenaline response at this point.
In a hospital, there will also be some kind of alert or alarm to immediately summon everybody. On my unit it's a little lever on the wall that immediately turns the call light system a bright flashing blue and has a very urgent and distinct alarm, but tbh most variations on "easy to activate and makes a loud distinctive alert" would be believable to me as a nurse.
The defibrillator will be brought in and hooked up (modern defibs use stick-on pads, not the paddles), but not all codes involve the classic "CLEAR!" and a shock; the defibrillator scans the heart rhythm and determines if the heart's in one of the two (2) shockable rhythms. Even when the code IS heart-related, which not all codes are, the heart rhythm is not always going to be shockable, in which case it will be a matter of CPR and IV medications for heart rhythms, and potentially intubation for breathing problems.
OF NOTE: 'no heartbeat at all' is not actually one of the shockable rhythms! People tend to treat shocking someone as a "restart the heart" thing but it's a "jolt it back into the right rhythm" thing, actually!
Just whacking somebody on the chest, AKA "precordial thump" or slapping them and telling them to Fight It are not accepted medical treatments lol. The first one has SOME very limited utility as a last-ditch thing with no other equipment available but if somebody did either one in the hospital they would look fully unhinged.
This has turned out very meandering, but hopefully also helpful in some regard! Obligatory disclaimer again that my experiences are not universal, although I've tried to keep this generally applicable. UoU
@iceemoon I can certainly try! This is honestly less about blorbo-writing and more about just, hospital information, but! Let's see, toileting options. This is more about clinical practice than general medical info, so caveat that this might be less generally applicable, but in my experience:
(Obviously, discussion of toileting/bowel/bladder stuff below the cut)
EITHER
Bedpans are essentially just a basin that a patient either rolls onto or lifts their hips onto depending on their ability to move. They're not great because lying on your back is a bad angle to actually empty your bladder/bowel and also they spill SO easy, but if somebody needs to have a BM and they're completely bedbound there aren't many other options.
We work really hard to get people out of bed as soon as we can, because being stuck in bed at length is REAL bad for your muscle tone, risk of blood clots, risk for your skin breaking down from friction with the bed, and also risk for delirium/confusion; at least at my hospital we use a lot of "bedside commodes" which are just little portable toilets that can go right next to the bed, and if people can bear weight at all we prefer to help them stand up, turn, and sit on the commode.
That said: if you're in the hospital for a trauma and/or broken bone, you're almost certainly required to have someone with you when you get up; a patient that tries to get up repeatedly without calling is likely to end up on an alarm that can tell when your weight shifts off the mattress like you're going to get up.
Reasons that someone would be unable to get to a bedside commode by ORDER:
Not allowed to bear weight on either of your legs (I usually see this from broken bones in the ankles/feet--repaired fractures in the knees/hips can usually bear weight)
Unstable spinal fracture--in which case they're almost certainly waiting on surgery to repair their spine, and after surgery will be encouraged out of bed again. Before surgery, they will also likely have limitations on how high the head of their bed can be.
(A "broken back" can mean a lot of things; many spinal fractures are just the little jutting spurs of bone and don't endanger the actual spinal cord; those are more likely to get a brace and physical therapy than a surgery.)
BLADDER
Urinals for patients with penises are a very common tool for people with limited mobility--essentially a little plastic bottle with an angled mouth. There are equivalent versions for people with vulvas, but they're somewhat less common and I haven't seen them at my hospital.
Catheters that are fully inserted into the bladder ("foley" catheters) are something we try to avoid if we can! They're a high risk for introducing bacteria into the urinary system and causing infections, especially for patients with vaginas.
They're sometimes inserted during surgery, but often taken out immediately afterward or within a day or two. Sometimes people also start spontaneously having difficulty peeing at all, especially with hip/pelvis injuries, lack of mobility and constipation; in those cases, they'll sometimes end up with a foley for a while to give things time to essentially reset, and then have it removed.
Foleys are held in place by a little balloon full of saline inside the bladder; you CAN yank it out without deflating it first, but boy it sure doesn't feel good!!
"External" catheters are something I've seen pop up fairly recently; one version that's essentially a little banana-shaped foam pad that goes between the labia and is hooked to suction; when the patient urinates, the urine is absorbed into the padding and sucked up into a suction cannister. The other version is the same concept (absorbent substance hooked to suction) but in more of a bag shape with adhesive around the mouth so the penis can be inserted into it.
BOWEL
There is actually a sort of equivalent to a catheter for your bowels, although it only help if someone is having frequent extremely liquid BMs--it's called a Fecal Management System or FMS, and it is also a tube that's inserted with a little balloon that blows up to help hold it in place. They do help sometimes but are famously kind of leaky, and as previously mentioned if we can possibly get a patient up instead we will.
As far as straining after surgery, it's mostly a matter of generous application of stool softeners and laxatives, and getting people out of bed--or helping them walk around the hospital floor if at all possible. Hydration also helps!
If there is one thing humans have always had meds for it's making themselves poop. If pills and drinks don't work, we have suppositories: if those don't work, we have enemas.
When someone has surgery or a procedure under anesthetic (again, especially when they're not moving/getting out of bed!) sometimes their bowel has trouble waking back up after they're out of anesthesia, and so stool isn't blocked but doesn't really move through; that's called an "illeus" and can lead to them being put on an "NPO" (nothing to eat or drink) order for several days and getting a nasogastric ("NG") tube put down their nose into their stomach and hooked to suction to keep things from backing up until their gut starts moving again.
"I have depression." - character who has been through extensive therapy.
"I feel dead inside all the time and nothing helps!" - character who does like, regular introspective thinking and is aware of the concept of mental health.
"Leave me the fuck alone I'll be fine once I get over my stupid shit." - repressed character.
"It's fine I'm just having an Empty Time. What? Yeah, empty times, you know, when everything is like bzzzzzz in your brain and you don't shower for two weeks. Why, what do you call it?" - ooooughhh now we're talkin
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