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.
