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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.



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