Emergency Room |
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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.