If you would like to make a patient with a particular problem appear in the Waiting Room, here's the "secret" way to look at any of the 400 problems you want to. 1.Start the game. 2.Choose any patient and click on the "Select Patient" button. 3.Choose "Waiting Room" from the "Go To" menu. 4.While at the sign-in desk, when a video is playing, press the letter "P" (for "problem") on the keyboard. The video should stop, and you should see the doors that lead to the hallway. 5.Click the cursor on the far left side of the screen (the cursor should be a red, left-facing arrow). 6.On the next screen, type in the number of the medical problem you want to see and press Enter. The patient with that medical problem will appear in the Waiting Room. A few examples of interesting and gross graphics are: 172 Lawnmower injury with amputated toe 173 Firecracker injury with amputated fingers 174 Finger caught in lawnmower 176 Gunshot injury to forearm 200 Finger caught in engine 202 Powersaw accident with deep thigh cut 294 Arrow impaled in head 295 Gunshot wound to head 388 Burned soles of feet 389 Bad hand burn See the back of the Player's Guide for a listing of the 400 available medical problems and their corresponding numbers. WALK-THRU: The Midnight Shift A Review of Emergency Room I really hate working the midnight shift, you don't get enough sleep, the constant noise, and the long hours reading the Continuing Medical Education (CME) brochures and reports. Just yesterday I was reading about knee injuries, simple fractures and stab wounds. Oh, the joy ! Don't take me wrong, late shifts at Legacy Memorial Hospital can be very lively at times to say the least. Take for example last weekend, fifty-five emergency cases in less than three hours. I guess I should have expected it during campaign season. Politics, I will never understand them. Me, I would much rather work during the day. There are more doctors available for consulting and treatment which really makes a difference. Besides, a really cute nurse works that shift. But when you are just a medical student, life gives you no choices. Dr. Boss, the shift supervisor, is a tyrannical attending physician. He is a great doctor, no doubt, but he sure could benefit from some interpersonal relationship skills. Great, here he comes, I better go to the waiting room and look like I am busy. I w onder what is on TV tonight. Hey, maybe I will get lucky and intercept a code blue on the way in. No code blues here but, I did find Allan. His full name is Allan Alvarez, a 17 year old Hispanic male. The ambulance attendants are rolling him into the wai ting room as I am getting ready to look busy. Allan looks disoriented and fearful. He does not speak English but his facial expression communicates that which needs no language: He needs help. A short conversation with the paramedic reveals that Allan is suffering from a stab wound on his right side, he is also allergic to pollen, exercises regularly and has no record of immunizations. In accordance to the new state laws, I must not admit Allan as a patient until I can verify that he is not an illegal alien. However, I don't have the luxury of extra time or the personal conviction to deny Allan medical treatment so, I take him in as my patient. Lucky for me, Dr. Boss is not close at hand. I immediately start to fill in my SOAP (Subjective, Objective, Assessment, Plan). I always think of it as the medical equivalent of the army's KISS (Keep It Simple Stupid). After completing the subje ctive sections I order that my patient be taken into the examination room. Allan's skin is diaphoretic (sweaty), pale and cool to the touch. He looks ill and in pain. I move quickly to place the stethoscope over his heart and abdomen. I then place the sphingonanometer on his right upper arm and find that his blood pressure is b elow normal and falling quickly. I am relieved, however, to find that his pulse is functional and strong. A quick examination of the abdomen area reveals a palpable liver edge and a stab wound on the upper right quadrant next to the rectus abdominus (cen tral stomach muscles). I finish my examination and request that Allan is transported to the treatment room. On the way to the treatment room, I finish filling the objective part of the SOAP: a skin tear located on the right upper quadrant and an increase d heart rate with bowel sounds absent. The increased heart rate, decreased blood pressure, clammy-pale skin and penetrating trauma indicate internal hemorrhaging. Hospital policy requires that all doctors keep their observations, treatments and plans well documented (for legal protection). This is the main reason for diligently filling the SOAP questionnaires (it also helps to keep you concentrated on the task at hand during those occasions when a few lost second could mean the difference between life and death). By the time we reach the treatment room I have also made my assessment of the situation: liver puncture wound with internal bleeding. With this diagnosi s in hand, I know what to do next: read the CME on stabbing to assist me in finding the correct treatment. I knew from medical school that the liver is a large, reddish-brown, glandular organ that secretes bile and is active in the formation of certain b lood proteins. It is also very fragile and any puncture wound causing continuos bleeding will likely result in hemorrhaging shock and eventually permanent damage or even death. This is one of those cases where every second counts. I follow the CME treatment directions and provide Allan with much needed intravenous (IV) fluids, a blood transfusion, oxygen via nasal prongs and order his immediate transfer to the trauma unit. Ther e, a dedicated trauma surgeon will take care of the internal bleeding and perform any needed surgery. Once I perform the immediate emergency treatment, I finish my SOAP requirements by completing the plan directives: IV access, IV fluids, blood substitut es, oxygen and transfer to trauma unit. As the head nurse prepares Allan for the transfer, he holds my hand and says something in Spanish. I smile at him and then think for a moment, what would had happened if I had denied him admission into our hospital. As a dedicated team of nurses takes Allan away, I ready myself for the forthcoming reprisals from Dr. Boss and the politicians. Oh well, when you are a medical student, human dignity gives you no choices. Note: It is the hope of the reviewer that this "w alk-through" will help you get a glimpse of "Emergency Room". In addition to scenarios similar to this one, there are a wide variety of medical situations covered (400 total) by this emergency room simulation. These situations range in complexity from a simple bee sting, to sexually transmitted diseases and Code Blues. Emergency Room requires that you do a lot of on-screen reading of different subjects regarding emergency medical treatment and general human anatomy and physiology. I do not recommend this title for the faint of heart, but if you spend any time in the em ergency room of Legacy Memorial Hospital, you will learn a thing or two. I know I did.