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Emergency Room


     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.

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