Clinical Archive - The Ultimate Medical RP Guide

Ocean Man

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Mentor

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Preface:

In my opinion, medical roleplay is such an interesting dynamic of HL2RP that's often not utilized to its full potential. There are a few reasons for this, as outlined by the following guide, but the overarching theme seems to be that the area often seems niche until there's a trauma case to operate on. This guide will attempt to educate both non-medical and CMRU people to diversify Medical RP in order to make it enjoyable for both patient and CMRU characters.

Common Medical RP concerns:

"I don’t know much about medical RP" - This is both a barrier for patient RP as well as induction into the faction, whilst having some knowledge of the condition you're either presenting with or treating is recommended, this isn't real clinical practice and there isn't an expectation to know a great deal on either side. For CMRU workers, a lot of the RP education and learning happens whilst roleplay.

"I don’t want my character to be PK’d or have debilitating injuries" - A totally valid point, players who engage in Medical RP may often feel they risk losing their character or will be forced into some disability for the rest of their characters' existence. This is not the case in most scenarios as due to being player-led roleplay, those on the brink of death often make a full recovery. However, freedom should be balanced with logic and those who undergo massive surgery should incorporate recovery into their RP somewhat.

"Medical RP can take a long time, I don’t want to sit around for hours." - Engagement from both sides is important to consider, whilst in best practice we will attempt to include our patients in the roleplay, there is also the option to "Fade to black" if longer procedures, such as surgeries, take too long.

Repetitiveness, Burnout and Lack of Variety:

From my own experience, 90% of all roleplay interactions as CMRU tend to be wounds from stabbings, Xenian creatures and the occasional major surgery for a citizen lurking in the wrong side of the slums. Whilst this can provide some interesting moments, you can only patch up the same leg wound a few hundred times before it becomes monotonous, boring and routine. I believe this to be one of the deterrents for both patient and CMRU roleplay, and to fix this I propose this guide to inform all on the different conditions commonly seen in real life clinical practice, particularly in Emergency Medicine (from my own experience). This guide will cover the basics, but I recommend that you research signs and symptoms of these before you engage in RP.

So, without further rambling, here are the most common conditions in practice, an explanation of what they are, and their treatments.​
Overview What is Medicine and What is Healthcare?

Acute and Emergency Conditions:
Acute (meaning sudden onset) and Emergency (Dangerous and life-threatening) are conditions that may pose an immediate threat to an individual's health and well-being. It is for this reason that Acute and Emergency conditions are considered top-priority when presented to a medical establishment. Later in this document we will explore how we priorities treatment, known as "triage" for instances where there may be an overwhelming number of cases, known as a "Major Incident". Below are a collection of common conditions considered under this term, as well as a brief explanation with symptoms and treatments used to manage them.​
Condition​
Brief Explanation​
Treatment​
Acute HypothermiaWhere the body's internal temperature falls below 35°C which disrupts regular cell function and homeostasis.

Symptoms: Rigors (shivering), slow and shallow breathing, confusion, loss of consciousness (coma), death.
Remove cold or wet clothing and wrap in foil blankets to conserve body heat (don't apply direct heat as can damage skin integrity). If unconscious, monitor breathing, warm intravenous fluids may be required.
Acute Radiation Syndrome (Radiation Poisoning)​
Caused by exposure to harmful radiation (particularly low wave-length EM radiation) which damages Cell DNA.

Symptoms: Nausea, vomiting, diarrhea, confusion, hair loss, internal bleeding, skin damage.​
Decontamination (removal of irradiated items such as clothes and washing), Administration of Potassium Iodide.​
Anaphylaxis​
An exaggerated immune response to an allergy, can result in closing of the airway (from inflammation) which can be stop breathing.

Symptoms: Chest tightness, problems breathing, vomiting, abdominal pain.​
Adrenaline (for controlling initial inflammation) and IV fluids.​
Asthma (Flareup)​
A chronic condition that causes overproduction of phlegm (secretions) which cause airway blockage, often brought on by exercise.

Symptoms: Breathlessness, coughing, bringing up lots of secretions.​
Medication known as "Bronchodillators" that open up the airway.​
Cardiac Arrest​
The heart stops beating, so organs are starved of oxygen and start to die.

Symptoms: No pulse, unresponsive.​
Cardiopulmonary resuscitation (CPR) followed by defibrillation and oxygen therapy.​
Cardiovascular Accident (Stroke)​
A blockage or damage to a blood vessel which has caused a lack of oxygen to reach the brain, causing damage. Three main types: Ischemic, blockage to a blood vessle caused by a blood clot. Hemorrhagic, blood vessle has blown (usually an aneurysm) causing a brain bleed, or TIA (transient Ischemic attack) where a clot has blocked a vessel but been dislodged in less than 24 hours.

Symptoms: Remember BEFAST - Balance (Can the person remain standing up straight), Eyes (Is there new blindness or blurred vision in one eye or double vision), Face (Is there a facial droop on one side?), Speech (Can the person produce clear coherent sentences or understand you?) Time (A stroke can cause permanent disability in minutes)​
IT IS IMPORTANT TO FIRST DIAGNOSE WHAT TYPE OF STROKE AS TREATMENT FOR THE WRONG TYPE CAN CAUSE FURTHER DAMAGE.
For Ischemic stroke - CT Scan to rule out Hemorrhagic stroke, administer heparin (or any other anticoagulant medication) then D-Dimer to confirm clot, proceed to administer thrombolytic treatment.
For Hemorrhagic stroke - CT Scan to confirm and measure extend of brain bleed, if blood is significant surgery may be required to stop swelling (which can cause brain stem death). Administer Anti-Coagulant reversal agent to encourage clotting.
Choking​
A foreign object (usually food) has blocked the oesophagus and the patient can't breath.

Symptoms: Clutching at throat, gagging, pale appearance.​
Back slaps and abdominal thrusts, oesophageal suctioning if prolonged.​
Chronic Obstructive Pulmonary Disease (Flareup)​
A condition that causes more ineffective breathing overtime, usually caused by smoking damage to lungs. Flareups in struggling to breath are usually caused by chest infections.

Symptoms: Rapid and shallow breathing, producing lots of secretions, fatigue, blood in cough, wheezing.​
Medication known as "Bronchodillators" that open up the airway, oxygen is also given.​
Heart Attack​
A blockage, usually caused by a blood clot, has traveled to the heart valve and stopped blood flow causing poor circulation.

Symptoms: Sharp pain in chest and left arm, chest tightness, low or high blood presure, signs of acute heart failure.​
Initially blood thinners such as Aspirin, then either breaking down the clot (thrombolysis) or surgery to implant a stent.​
Hypoglycemia​
Low blood sugar, often a complication of Diabetes. Causes cells to not receive required energy. Considered a medical emergency.

Symptoms: Sweating, heart palpitations, fatigue, confusion and eventually coma.​
Administered glucose (sugar) by either eating or IV (depending on if patient is comatose).​
Major Trauma​
Significant structural damage to the body including extensive blood loss, broken bones, burns and injured organs.

Symptoms: Catastrophic Hemorrhage, one or more organs shut down.​
Major, often complex surgery with IV bloods, fluids and medications given. Escalation to intensive care.​
Pulmonary Embolism​
A blood clot in the lungs blocking (occluding) effective respiration (gas exchange of oxygen and carbon dioxide). 'PE' can cause lung damage or the clot can travel towards the heart and cause a heart attack.

Symptoms: Chest pain, coughing blood, dizziness or fainting.​
Initially blood thinners such as Aspirin, then either breaking down the clot (thrombolysis) or surgery to implant a stent.​
Seizure​
A surge of electrical activity in the brain causing temporary dysfunction, there are different types of seizure ranging from focal (area specific, such as shouting or absence seizures) to generalized (full body, most commonly tonic-clonic seizures that result in convulsions). Any seizure lasting over 5 minutes is considered an emergency requiring treatment. Epilepsy is the most common seizure disorder.

Symptoms: Dependent on seizure, but can include; vacant expression, unresponsiveness, convulsions, loud vocalizations (shouting) and anxiety.​
Any seizure lasting more than 5 minutes is considered "Status Epilipticus" and considered an emergency. Benzodiazepines are used to control symptoms, underlying causes must then be treated (e.g., pain).​
Sepsis​
Known as septicemia (blood infection), the body's immune system over-reaction to an infection causing a decrease in blood pressure and high pulse, low temperature and oxygen desaturation (low oxygen levels in the blood). Sepsis left untreated results in septic shock which causes organ failure, each hour sepsis is left untreated, fatality risk increases by 10%.

Symptoms: Low blood pressure (due to low blood volume), fast pulse, high or low temperature and decreasing oxygen levels, pale mottled-skin appearance, low frequency of urination, feeling of going to die, confusion.​
See "SEPSIS 6"; fluids, antibiotics and oxygen therapy.​
Shock (Cardiogenic, hypovolemic, obstructive and distributive)​
Reduced perfusion (oxygen exchange) between cells due to changes in blood distribution. Four main types (distributive - including septic shock, cardiogenic, hypovolemic, obstructive).

Symptoms: Pale or cyanosis (blue skin), fast pulse, shallow breathing, restlessness or unresponsive.
For more information about shock: Click Here
Treating the underlying cause, vasoconstriction that tighten blood vessels, blood and fluids.​
Traumatic and Non-Traumatic Brain Injury​
A traumatic brain injury includes physical impaction of the head causing structural damage to the brain. non-traumatic brain injury is internal factors including hypoxia (oxygen starvation), stroke or overdose.

Symptoms: Loss of consciousness, seizures, cognitive impairment (issues with thinking, planning and understanding), neurological impairment (nerves, muscle control etc).​
Treating the underlying cause (surgical repair, removing blood clot etc.) Brain injuries often result in long-term, irreparable damage to nerves resulting in cognitive impairment, epilepsy, muscle weakness and dysphasia (trouble with speaking).​
Overdose​
Overdose is a type of poisoning and can vary greatly on affects, but essentially is the introduction of substances that are either toxic or consumed in toxic amounts. In this we are including alcohol as a substance.

Symptoms: Dependent on substance but may include; diarrhea and vomiting, seizures, liver failure, high temperature, respiratory depression, cardiac arrest.​
Usually involves either removing or flushing out the toxin with IV fluids, activated charcoal can be used if overdose was taken recently.​
Coming Soon...
Just when you thought Medical Practitioners were going to hog the spotlight, here come the Nurses...

What is Triage?

Triage is the term used for deciding who is in need of the most urgent care, and who is able to wait for for non-urgent treatment. Triage in a clinical setting usually involves admission (either from "walk-ins" or emergency handovers) where current symptoms are assessed by a nurse in order to be directed into the most appropriate level of care. Adding elements of real-world Emergency Departments, here is the different areas where a patient may be sent when presenting to the clinic.

Resuscitation Unit (Resus)

Reserved for the most critically ill patients, Resus a wing consisting of usually 5 - 6 beds heavily outfitted with oxygen, cardiac monitors, ventilation and "crash" trolley. The resuscitation is usually staffed with 2 to 1 (patient to staff) specialist nurses, and two stationed doctors (one of which is usually a senior doctor). Conditions which warrant admission include; peri or post cardiac incident, cardiovascular accident (Stroke), severe shortness of breath, major trauma or catastrophic bleeding, severe hypo-tension (low blood pressure), septic shock among others. Patients in Resus are generally escalated to Intensive Care Units or stepped down to Majors if condition improves.

Rapid Assessment Unit (RAU)

All patients presenting to the clinic will go through RAU to assess their symptoms, this consists of a pre-admissions trained nurse that will assess symptoms and co-ordinate the patient into the appropriate level of care. This area consists of a set of initial observations (Blood Pressure, Pulse, Oxygen Saturation, Temperature and Respiration rate) which may factor into the decision. Neurological observations may also be required (If reason to suspect neurological injury such as head trauma, stroke, alcohol excess or substance misuse).

Majors

Patients who are sick enough to require a bed are escalated to Majors, an area staffed by 5 - 1 nursing care and doctors on standby, treatment is provided within this area with consistent observations dependent on patient condition. Conditions that may warrant admission to Majors include; moderate trauma, falls and acute frailty, substance misuse, seizure, hypoglycemia, asthma, acute radiation poisoning.

Minors

Treated more as an outpatients section that doesn't admit patients, Minors is staffed by nurses and doctors specializing in same-day care. Conditions that may warrant this area include; Minor trauma that can be treated same-day (such as a broken arm), missed medication, post-choking incident, non-traumatic head injury.

Critical Incident / Major Incident

Critical Incident is the term for when the number of patients presenting to the clinic is overwhelming to the extent that resources cannot be managed (staff and/or beds). A Major Incident is where an incident has occurred outside of the clinic resulting in multiple casualties in critical condition. In instances where this happens, medical practitioners treat patients according to their needs following a system such as this:

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Priority 1 - Requires immediate care and is in imminent risk of death.

Priority 2 - Requires immediate care but is not at immediate risk of death, can be left

Priority 3 - Requires care but not considered critically unwell, usually treated once all P1 and P2 patients attended 2.

Dead - Classed as dead on arrival, may not be clinically dead but intervention is unlikely to benefit the patient.​
Clinical Procedures - Medical
Clinical procedures are actions used to perform some investigation specifically for medical interventions. The skills required to perform these range greatly depending on complexity, frequency and required pre-knowledge in order to perform them. Here listed is the most common procedures used in practice, their rationale (why they are performed) and brief instructions as to how to role-play them.
Clinical Procedure
Restriction of Practice
Rationale
Instructions
Observations / Vital Signs Taking (Blood Pressure, Pulse, Oxygen Saturation, Temperature and Respiratory Rate)
Intern or higher​
Used to indicate the unwellness of an individual and to manage deterioration.
Normal Values:Blood Pressure (110/75 to 130/90), Pulse (60 - 80 beats per minute at rest), Oxygen Saturation (96% or above for non-chronic respiratory conditions and 88% - 94% for chronic respiratory conditions), Temperature (36.1°C - 37.9°C), Respiratory Rate (12-20 per minute)
Blood Pressure - Equip Blood Pressure Cuff and use stethoscope on just below on arm, inflate until pulsing noises are heard, deflate until they cannot be heard anymore, note when they started (top number) and when they ended (bottom number).
Pulse & Oxygen Sats - Equip Oximetre and read numbers.
Respiratory Rate - Count number of breaths in a minute, don't alert patient to this as can give false number.
Temperature - Use probe in ear or under tongue.
Electrocardiogram (ECG)​
Intern or higher​
Measure heart rhythm, used for patients with acute cardiac issues (chest pains, shortness of breath) or known heart problems (Heart Failure, Atrial Fibrillation)Attach 10 stickers to patients chest and limbs, 2 on the top of the chest and 4 under the heart, put one sticker on each wrist and ankle. Attach leads from ECG to each sticker and record rhythm. Can be performed by Intern+ but interpreted by doctor. Can be normal or abnormal.
Specimen Testing (Urine, Sputum, Fecal)​
Intern or higher​
Specimens are taken to test for different things, such as glucose in urine to indicate diabetes or blood in stool to indicate obstruction or cancer. Infections can also be found via measuring white blood cells.Urine - Ask patient to urinate into bottle, take bottle and place small amount on test stripe, interpret results.
Sputum - Ask patient to produce and cough into pot, send to lab for interpretation.
Fecal - Ask patient to produce specimen and place into pot, send to lab for interpretation.
Wound Care and ANNT​
Nurse or higher​
To clean a wound from debris and reduce risk of infection, promoting healing (proliferation)

Anti-septic non-touch technique: Tending to wounds aseptically to prevent infection, used in surgery and complex wounds.
Collect dressings, saline and gauze, waste bag, suture kit (if required), wound disinfectant (if required).

Clean the wound with saline and disinfectant if required, stitch wound using appropriate stitch method and dress wound. Consider followup appointment for re-dressing if required.
Blood Tests & Cultures​
Nurse or higher​
Many different indications for blood tests and cultures, from checking inflammatory markers and infections to diagnosing diseases such as diabetes and kidney/liver function. (See Here for more information)Collect needle cannula, tourniquet, collection pot, PPE and wipes, first clean site and choose appropriate vein, apply tourniquet to raise vein and insert cannula and collection pot attached, withdraw blood as required and send to lab for analysis.
Intravenous Cannulation​
Nurse or higher​
To provide intravenous fluids or to take blood over longer stay in clinic.Collect cannula needle, feeding tube and, tourniquet and wipe. Clean area and select vein, attach tournquet and insert needle, withdraw needle so only tube remains in vein, attach with a dressing.
Intravenous Medication​
Nurse or higher​
For fast medication administration and/or fluid and electrolyte replenishment.Withdraw medication and inject into bag of saline, check dosage and attach to IV stand, attach delivery port to cannula and start the drip.
Ultrasound​
Nurse or higher​
Used for investigations such as pregnancy and bladder function.Apply a small amount of ultrasound gel to area and apply the scanner, scan until image can be seen on screen.
D-Dimer Test​
Doctor or higher​
Tests for amount of blood clotting agent is in the blood, used to diagnose clot-related stroke and other thrombocyte related conditionsSame as blood test, withdraw sample and send to lab for anaylsis.
X-Ray Scan​
Doctor or higher​
To check bone integrity and check for fractures / dislocationOperate Xray scanner, place over intended area and interpret results.
Computerized Tomography (CT)
Scan​
Doctor or higher​
To check internal structures such as organs and interstitial spaces (aside from bones), can be used to check for conditions such as internal trauma, hemorrhagic stroke and structural damage.Operate CT Scan, place patient into scanner and record result, interpret findings.
For Xenian-Based procedures, please Click Here
Coming Soon...
If you would like to know more about pharmacology, please refer to this document:

Disclaimer - This is an archive for clinical practice, for specific Civil Medical Union legislation, please access the following document:

Click Here for Handbook

Credit:
@Lost Coast Chanties - Format (Heavily inspired by The Digital Library Archive)

The many websites, text books, lectures and teaching that went into this​
 
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Once upon a time there was a man who got blasted in the face by a shotgun point blank.

To save himself he used a bandage
 
Some of this information isn't actually correct, benzodiazepam (medication for seizure) is more preventative medication than a symptom relief. Generally all you can do in a seizure scenario is avoid the patient from injuring themselves and ensuring the airways are clear.
 
Anyhow, less NITPICKING and time to suggest!

Maybe malnutrition could be added for ration consumers. give them scurvy, yaar!
 
In 1984 George Orwell wrote his famous book, 1984 in which the world we see around is today is eerily more and more portrayed by said book. That being said


I hate medical roleplay.
 
Some of this information isn't actually correct, benzodiazepam (medication for seizure) is more preventative medication than a symptom relief. Generally all you can do in a seizure scenario is avoid the patient from injuring themselves and ensuring the airways are clear.
Well, actually, benzodiazepines such as diazapam and midazolam are used for symptom control. They are administered buccally or rectally as a muscle relaxant as prolonged seizures put a lot of strain on the heart which can result in a cardiac arrest. You are right about preventative medications, such as Sodium valproate and Gabapentin which reduce abnormal brain activity in people who are at more risk of having a seizure such as diagnosed epilepsy and some learning disability disorders. But thank you for your input!

Edit: I wanted to add that this is true of the United Kingdom, I am not aware of practices in other countries but benzos aren't generally used as prophylaxis medication here.
 
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This is well wrote out, I like it. Maybe add some information about radiation poisoning too? Since we've had mini-events where radiation is a issue.

Could also be good to write up some simple 'stages' of common illnesses/diseases, detailing symptoms from acute to chronic phases, for people who want to RP them out but don't want to make themselves look silly by missing some key symptoms.
 
This reminds me of the so-called “medical professionals” of the CMRU kicking me out because they were too incompetent to diagnose my character having absence seizures.
 
This reminds me of the so-called “medical professionals” of the CMRU kicking me out because they were too incompetent to diagnose my character having absence seizures.
after twenty seconds of research, I declare this a...


BAIT POST!
 
also i have a question are you an actual doctor or did you just do some reasearch on some websites
 
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