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1998-06-02
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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 wonder 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 waiting 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 subjective 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 below 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
(central 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 increased 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 diagnosis 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 blood 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. There,
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 substitutes,
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 "walk-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 emergency room of Legacy Memorial Hospital, you will learn a
thing or two. I know I did.