EMERGENCY ROOM
FILE INFORMATION
FILENAME(S): EMERGENCY ROOM
FILE TYPE(S): PRG
FILE SIZE: 36.5K
FIRST SEEN: 2025-10-19 22:49:44
APPEARS ON: 1 disk(s)
FILE HASH
554499d879143492c6d1e5514d4f48f96636861264a96a369d15090c6a7abcbe
FOUND ON DISKS (1 DISKS)
| DISK TITLE | FILENAME | FILE TYPE | COLLECTION | TRACK | SECTOR | ACTIONS |
|---|---|---|---|---|---|---|
| LOADSTAR GAMES | EMERGENCY ROOM | PRG | Radd Maxx | 21 | 1 | DOWNLOAD FILE |
FILE CONTENT & ANALYSIS
> DETECTED: COMMODORE BASIC PROGRAM (LOAD ADDRESS $0801)
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00001880: 4C 53 22 3A 99 00 B4 20 46 23 99 22 9C 2D 2D 2D |LS":... F#.".---|
00001890: 41 20 48 41 4E 44 59 20 50 4F 43 4B 45 54 20 52 |A HANDY POCKET R|
000018A0: 45 46 45 52 45 4E 43 45 20 4D 41 4E 55 41 4C 20 |EFERENCE MANUAL |
000018B0: 46 4F 52 22 00 FC 20 50 23 99 22 54 48 45 20 42 |FOR".. P#."THE B|
000018C0: 55 53 59 20 49 4E 54 45 52 4E 20 46 41 43 49 4E |USY INTERN FACIN|
000018D0: 47 20 54 48 45 20 52 49 47 4F 55 52 53 20 41 4E |G THE RIGOURS AN|
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000018F0: 54 48 45 20 45 52 2D 2D 2D 22 3A 99 00 25 21 5A |THE ER---":..%!Z|
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00001910: 50 48 59 53 49 43 41 4C 20 44 49 41 47 4E 4F 53 |PHYSICAL DIAGNOS|
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00001930: 4C 20 53 49 47 4E 53 20 43 4F 4E 53 49 53 54 20 |L SIGNS CONSIST |
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00001950: 45 22 00 79 21 6E 23 99 22 28 42 50 29 2C 20 48 |E".y!n#."(BP), H|
00001960: 45 41 52 54 20 52 41 54 45 20 4F 52 20 50 55 4C |EART RATE OR PUL|
00001970: 53 45 20 28 48 52 29 2C 22 00 B4 21 78 23 99 22 |SE (HR),"..!x#."|
00001980: 52 45 53 50 49 52 41 54 4F 52 59 20 52 41 54 45 |RESPIRATORY RATE|
00001990: 20 28 52 52 29 2C 20 41 4E 44 20 54 45 4D 50 45 | (RR), AND TEMPE|
000019A0: 52 41 54 55 52 45 22 3A 99 22 28 54 45 4D 50 29 |RATURE":."(TEMP)|
000019B0: 2E 22 3A 99 00 F0 21 82 23 99 22 4E 4F 52 4D 41 |.":...!.#."NORMA|
000019C0: 4C 20 52 41 4E 47 45 53 20 41 52 45 20 41 53 20 |L RANGES ARE AS |
000019D0: 46 4F 4C 4C 4F 57 53 3A 22 3A 99 22 42 50 2D 2D |FOLLOWS:":."BP--|
000019E0: 39 30 2F 35 30 20 54 4F 20 31 34 30 2F 39 30 22 |90/50 TO 140/90"|
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00001A20: 99 22 54 45 4D 50 2D 2D 39 37 20 54 4F 20 31 30 |."TEMP--97 TO 10|
00001A30: 30 22 00 5D 22 96 23 99 3A 99 22 53 49 47 4E 49 |0".]".#.:."SIGNI|
00001A40: 46 49 43 41 4E 54 20 44 45 56 49 41 54 49 4F 4E |FICANT DEVIATION|
00001A50: 53 20 46 52 4F 4D 20 54 48 45 53 45 22 00 89 22 |S FROM THESE".."|
00001A60: 9B 23 99 22 4C 49 4D 49 54 53 20 55 53 55 41 4C |.#."LIMITS USUAL|
00001A70: 4C 59 20 4D 45 41 4E 20 54 52 4F 55 42 4C 45 2E |LY MEAN TROUBLE.|
00001A80: 22 3A 99 3A 8D 35 30 30 30 00 CD 22 A0 23 99 22 |":.:.5000..".#."|
00001A90: 45 58 41 4D 49 4E 41 54 49 4F 4E 20 4F 46 20 54 |EXAMINATION OF T|
00001AA0: 48 45 20 48 45 41 44 20 53 48 4F 55 4C 44 20 49 |HE HEAD SHOULD I|
00001AB0: 4E 43 4C 55 44 45 20 20 43 48 45 43 4B 49 4E 47 |NCLUDE CHECKING|
00001AC0: 20 54 48 45 20 45 59 45 53 2E 22 3A 99 00 13 23 | THE EYES.":...#|
00001AD0: AA 23 99 22 53 4D 41 4C 4C 20 4F 52 20 50 49 4E |.#."SMALL OR PIN|
00001AE0: 50 4F 49 4E 54 20 50 55 50 49 4C 53 20 43 41 4E |POINT PUPILS CAN|
00001AF0: 20 4F 43 43 55 52 20 57 49 54 48 20 4E 41 52 43 | OCCUR WITH NARC|
00001B00: 4F 54 49 43 20 49 4E 54 4F 58 49 43 41 54 49 4F |OTIC INTOXICATIO|
00001B10: 4E 2E 22 00 5E 23 B4 23 99 22 45 4E 4C 41 52 47 |N.".^#.#."ENLARG|
00001B20: 45 44 20 50 55 50 49 4C 53 20 43 41 4E 20 42 45 |ED PUPILS CAN BE|
00001B30: 20 44 55 45 20 54 4F 20 48 59 50 4F 58 49 41 20 | DUE TO HYPOXIA |
00001B40: 20 20 28 4C 4F 57 20 42 4C 4F 4F 44 20 4F 58 59 | (LOW BLOOD OXY|
00001B50: 47 45 4E 29 2C 20 4F 52 20 46 52 4F 4D 22 00 9D |GEN), OR FROM"..|
00001B60: 23 BE 23 99 22 49 4E 54 4F 58 49 43 41 54 49 4F |#.#."INTOXICATIO|
00001B70: 4E 20 57 49 54 48 20 50 43 50 20 28 41 20 43 4F |N WITH PCP (A CO|
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00008C70: 44 45 52 45 44 00 8C 94 3E 53 83 4F 4C 44 20 43 |DERED...>S.OLD C|
00008C80: 48 41 52 54 20 4F 52 44 45 52 45 44 00 D6 94 48 |HART ORDERED...H|
00008C90: 53 83 52 45 53 50 49 52 41 54 4F 52 20 57 4F 4E |S.RESPIRATOR WON|
00008CA0: 27 54 20 44 4F 20 59 4F 55 20 41 20 42 49 54 20 |'T DO YOU A BIT |
00008CB0: 4F 46 20 47 4F 4F 44 20 20 20 57 49 54 48 4F 55 |OF GOOD WITHOU|
00008CC0: 54 20 41 4E 20 45 4E 44 4F 54 52 41 43 48 45 41 |T AN ENDOTRACHEA|
00008CD0: 4C 20 54 55 42 45 00 EE 94 52 53 83 4D 4F 4E 49 |L TUBE...RS.MONI|
00008CE0: 54 4F 52 49 4E 47 20 4F 52 44 45 52 45 44 00 3A |TORING ORDERED.:|
00008CF0: 95 5C 53 83 30 2C 4C 41 42 20 49 53 20 4E 4F 52 |.\S.0,LAB IS NOR|
00008D00: 4D 41 4C 20 45 58 43 45 50 54 20 46 4F 52 20 4D |MAL EXCEPT FOR M|
00008D10: 49 4C 44 20 41 43 49 44 4F 53 49 53 20 20 41 4E |ILD ACIDOSIS AN|
00008D20: 44 20 41 20 56 45 52 59 20 4C 4F 57 20 47 4C 55 |D A VERY LOW GLU|
00008D30: 43 4F 53 45 20 4F 46 20 32 30 00 80 95 66 53 83 |COSE OF 20...fS.|
00008D40: 45 4B 47 20 53 48 4F 57 53 20 53 49 4E 55 53 20 |EKG SHOWS SINUS |
00008D50: 42 52 41 44 59 43 41 52 44 49 41 2C 58 2D 52 41 |BRADYCARDIA,X-RA|
00008D60: 59 53 20 4F 46 20 43 48 45 53 54 20 41 4E 44 20 |YS OF CHEST AND |
00008D70: 53 4B 55 4C 4C 20 41 52 45 20 4E 4F 52 4D 41 4C |SKULL ARE NORMAL|
00008D80: 00 CC 95 70 53 83 4F 4C 44 20 43 48 41 52 54 20 |...pS.OLD CHART |
00008D90: 52 45 56 45 41 4C 53 20 50 52 45 56 49 4F 55 53 |REVEALS PREVIOUS|
00008DA0: 20 54 52 45 41 54 4D 45 4E 54 20 20 20 20 46 4F | TREATMENT FO|
00008DB0: 52 20 50 4F 4F 52 4C 59 20 43 4F 4E 54 52 4F 4C |R POORLY CONTROL|
00008DC0: 4C 45 44 20 44 49 41 42 45 54 45 53 00 15 96 84 |LED DIABETES....|
00008DD0: 53 83 30 2C 22 50 41 54 49 45 4E 54 20 4D 55 4D |S.0,"PATIENT MUM|
00008DE0: 42 4C 45 53 20 53 4F 4D 45 54 48 49 4E 47 20 41 |BLES SOMETHING A|
00008DF0: 42 4F 55 54 20 42 45 49 4E 47 20 20 20 48 55 4E |BOUT BEING HUN|
00008E00: 47 52 59 2C 20 42 55 54 20 4C 49 54 54 4C 45 20 |GRY, BUT LITTLE |
00008E10: 45 4C 53 45 22 00 53 96 98 53 83 30 2C 44 4F 4E |ELSE".S..S.0,DON|
00008E20: 45 2C 44 4F 4E 45 2C 44 4F 4E 45 2C 44 4F 4E 45 |E,DONE,DONE,DONE|
00008E30: 2C 44 4F 4E 45 2C 53 48 45 20 53 54 4F 50 53 20 |,DONE,SHE STOPS |
00008E40: 42 52 45 41 54 48 49 4E 47 20 45 4E 54 49 52 45 |BREATHING ENTIRE|
00008E50: 4C 59 21 00 96 96 A2 53 83 30 2C 44 4F 4E 45 2C |LY!....S.0,DONE,|
00008E60: 57 48 45 52 45 3F 20 54 48 45 52 45 20 41 52 45 |WHERE? THERE ARE|
00008E70: 20 4E 4F 20 4C 41 43 45 52 41 54 49 4F 4E 53 20 | NO LACERATIONS |
00008E80: 20 20 20 20 20 20 20 20 57 4F 52 54 48 20 53 55 | WORTH SU|
00008E90: 54 55 52 49 4E 47 00 D9 96 AC 53 83 44 4F 4E 45 |TURING....S.DONE|
00008EA0: 2C 44 4F 4E 45 2D 2D 42 55 54 20 49 54 20 44 4F |,DONE--BUT IT DO|
00008EB0: 45 53 4E 27 54 20 48 45 4C 50 2C 44 4F 4E 45 2D |ESN'T HELP,DONE-|
00008EC0: 2D 42 55 54 20 49 54 20 44 4F 45 53 4E 27 54 20 |-BUT IT DOESN'T |
00008ED0: 48 45 4C 50 2C 44 4F 4E 45 00 1F 97 B6 53 83 30 |HELP,DONE....S.0|
00008EE0: 2C 30 2C 50 41 54 49 45 4E 54 20 49 53 20 55 4E |,0,PATIENT IS UN|
00008EF0: 41 42 4C 45 20 54 4F 20 53 57 41 4C 4C 4F 57 2D |ABLE TO SWALLOW-|
00008F00: 2D 20 20 20 20 20 20 20 20 20 20 53 48 45 20 41 |- SHE A|
00008F10: 53 50 49 52 41 54 45 53 20 49 50 45 43 41 43 00 |SPIRATES IPECAC.|
00008F20: 6A 97 C0 53 83 5A 5A 5A 41 50 21 21 21 20 20 20 |j..S.ZZZAP!!! |
00008F30: 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 | |
00008F40: 20 20 20 20 20 20 20 20 20 20 20 20 20 53 48 45 | SHE|
00008F50: 20 44 4F 45 53 4E 27 54 20 4C 4F 4F 4B 20 41 20 | DOESN'T LOOK A |
00008F60: 42 49 54 20 42 45 54 54 45 52 00 8B 97 CA 53 83 |BIT BETTER....S.|
00008F70: 48 45 52 20 43 4F 4C 4F 52 20 49 4D 50 52 4F 56 |HER COLOR IMPROV|
00008F80: 45 53 20 41 20 4C 49 54 54 4C 45 00 C4 97 D4 53 |ES A LITTLE....S|
00008F90: 83 44 4F 4E 45 2C 44 4F 4E 45 2C 30 2C 4E 4F 52 |.DONE,DONE,0,NOR|
00008FA0: 4D 41 4C 20 45 58 43 45 50 54 20 46 4F 52 20 53 |MAL EXCEPT FOR S|
00008FB0: 4C 49 47 48 54 4C 59 20 4C 41 52 47 45 20 50 55 |LIGHTLY LARGE PU|
00008FC0: 50 49 4C 53 00 0F 98 DE 53 83 48 45 52 20 48 45 |PILS....S.HER HE|
00008FD0: 41 52 54 20 53 4F 55 4E 44 53 20 41 52 45 20 53 |ART SOUNDS ARE S|
00008FE0: 4C 4F 57 20 41 4E 44 20 46 41 49 4E 54 20 20 20 |LOW AND FAINT |
00008FF0: 20 20 42 52 45 41 54 48 49 4E 47 20 49 53 20 53 | BREATHING IS S|
00009000: 4C 4F 57 20 41 4E 44 20 53 48 41 4C 4C 4F 57 00 |LOW AND SHALLOW.|
00009010: 35 98 E8 53 83 52 45 46 4C 45 58 45 53 20 41 52 |5..S.REFLEXES AR|
00009020: 45 20 53 4C 49 47 48 54 4C 59 20 48 59 50 4F 41 |E SLIGHTLY HYPOA|
00009030: 43 54 49 56 45 00 81 98 ED 53 83 53 48 45 20 48 |CTIVE....S.SHE H|
00009040: 41 53 20 41 20 4D 45 44 49 43 2D 41 4C 45 52 54 |AS A MEDIC-ALERT|
00009050: 20 42 52 41 43 45 4C 45 54 20 4C 49 53 54 49 4E | BRACELET LISTIN|
00009060: 47 20 20 4E 41 4D 45 20 41 4E 44 20 44 49 41 47 |G NAME AND DIAG|
00009070: 4E 4F 53 49 53 20 4F 46 20 44 49 41 42 45 54 45 |NOSIS OF DIABETE|
00009080: 53 00 A6 98 F2 53 83 53 48 45 20 49 53 20 43 4C |S....S.SHE IS CL|
00009090: 41 4D 4D 59 20 41 4E 44 20 50 41 4C 45 2C 4E 4F |AMMY AND PALE,NO|
000090A0: 52 4D 41 4C 2C 30 00 EF 98 FC 53 83 53 45 56 45 |RMAL,0....S.SEVE|
000090B0: 52 41 4C 20 53 45 43 55 52 49 54 59 20 47 55 41 |RAL SECURITY GUA|
000090C0: 52 44 53 20 41 52 52 49 56 45 20 41 4E 44 20 20 |RDS ARRIVE AND |
000090D0: 20 20 20 20 53 54 41 4E 44 20 41 52 4F 55 4E 44 | STAND AROUND|
000090E0: 20 43 52 41 43 4B 49 4E 47 20 4A 4F 4B 45 53 00 | CRACKING JOKES.|
000090F0: 2D 99 06 54 83 54 48 45 59 20 41 52 45 20 42 55 |-..T.THEY ARE BU|
00009100: 53 59 20 52 49 47 48 54 20 4E 4F 57 2D 2D 20 20 |SY RIGHT NOW-- |
00009110: 20 20 20 20 20 20 20 20 20 20 20 20 20 54 52 59 | TRY|
00009120: 20 41 47 41 49 4E 20 4C 41 54 45 52 21 00 79 99 | AGAIN LATER!.y.|
00009130: 10 54 83 50 53 59 43 48 20 52 45 53 49 44 45 4E |.T.PSYCH RESIDEN|
00009140: 54 20 53 55 47 47 45 53 54 53 20 59 4F 55 20 43 |T SUGGESTS YOU C|
00009150: 48 45 43 4B 20 46 4F 52 20 20 20 49 4E 53 55 4C |HECK FOR INSUL|
00009160: 49 4E 20 43 4F 4D 41 20 41 4E 44 20 43 41 4C 4C |IN COMA AND CALL|
00009170: 20 4D 45 44 49 43 49 4E 45 00 B0 99 1A 54 83 20 | MEDICINE....T. |
00009180: 53 48 4F 43 4B 45 44 20 52 45 4C 41 54 49 56 45 |SHOCKED RELATIVE|
00009190: 53 20 54 45 4C 4C 20 59 4F 55 20 41 42 4F 55 54 |S TELL YOU ABOUT|
000091A0: 20 48 45 52 20 20 20 20 44 49 41 42 45 54 45 53 | HER DIABETES|
000091B0: 00 D9 99 24 54 83 53 55 52 47 45 4F 4E 53 20 41 |...$T.SURGEONS A|
000091C0: 52 45 20 41 4C 4C 20 54 49 45 44 20 55 50 20 4A |RE ALL TIED UP J|
000091D0: 55 53 54 20 4E 4F 57 2C 30 00 06 9A 18 F6 99 22 |UST NOW,0......"|
000091E0: 93 11 11 11 4C 4F 41 44 22 C7 28 33 34 29 22 31 |....LOAD".(34)"1|
000091F0: 22 C7 28 33 34 29 22 2C 38 22 3A 99 22 11 11 11 |".(34)",8":."...|
00009200: 11 52 55 4E 13 22 00 23 9A 22 F6 97 36 33 31 2C |.RUN.".#."..631,|
00009210: 31 33 3A 97 36 33 32 2C 31 33 3A 97 31 39 38 2C |13:.632,13:.198,|
00009220: 32 3A 80 00 00 00 |2:.... |
.......***ER***.#....***10/31/84***.C...
.***BY DEAN ROBINSON, MD***.X.(.SC.53281
:BC.53280:.SC,1:.BC,2:.G(147)G(142):."."
...2.."....":..14)".*** .ER.! .***.":.".
.".K.<...18)"BY":.:..11)"DEAN ROBINSON,
MD"...F..:..17)"1984":."........":."WOUL
D YOU LIKE INSTRUCTIONS?"...P.."( Y/N )"
.,.Z..AN$:.AN$."".90.@.D..AN$."Y"..10000
.P.N..SC,1:.BC,2.F.H..***INITIALIZE***..
.R..G(147):."...":..11)"INITIALIZING DAT
A"......WT$(6,6,5).Z....P.0.5:.R.0.6:.C.
0.6:.WT$(R,C,P):.C,R,P:R.0:C.0:P.0...,.T
I$."020000":.500......***END***.-...."WO
ULD YOU LIKE TO CONTINUE?":."( Y/N )".B.
...AN$:.AN$."".420.S....AN$."Y".500.X...
.G(147):.BC,14:.SC,6:.".":.63000......**
*PATIENT SELECTION***......"...":."(PRES
S ANY KEY TO CONTINUE,".V...."OR 'Q' TO
QUIT)"......AN$:.AN$."".530......AN$."Q"
.400. .&.PT.P%:P%..(.(1).5).1:.P%.PT.550
.N.0.J.0:MN.0:K.0:TU.0:ID.0:CPR.0:BIC.0:
LID.0:SUC.0:DEM.0:RES.0:CT.0:NG.0:EX.0..
.:.EPI.0:IPE.0:C.0:WAR.0:LAV.0:GLU.0...D
.ET.TI:.***START ELAPSED TIME***...N..P%
.11000,12000,13000,14000,15000......***M
AIN LOOP***.......25);"TIME IS ";TI$....
..MN.1.1050.Q...."BP=";SBP;"/";DBP;"HR="
;HR;"RR=";RR;"TEMP=";TP:..A...R.0:C.0:P.
0.I.$..I$......I$."HELP"..10500:.1000...
3..I$."READ PEARLS"..9000:.1000.D.8..I$.
"QUIT".I$."EXIT".400...B..I$."START IV".
R.3:C.1:.1220...L..I$."TAKE HISTORY".R.1
:C.6:.1220.(.V.TFW$.H(I$,4):TSW$.I(I$,4)
.C.`..TFW$."GET ".R.1:.1160...J..R.6.."S
AY WHAT?":."TRY AGAIN, OR ASK FOR 'HELP'
!":.1000...T..TFW$.WT$(R,C,P).1160...~.R
.R.1:.1130......C.6.R.2.R.4:C.1......C.6
.."YOU CAN'T DO THAT!":."TRY AGAIN, OR A
SK FOR 'HELP'":.1000......TSW$.WT$(R,C,P
).1220.=....R.2.TSW$."RINE".C.7:.1220.`.
...R.3.TSW$."ATOR".R.0:C.5:.1220.....R.
6.TSW$."RICS".C.7:.1220.....C.C.1:.1160.
..D.P.P%:.***BEGIN RESPONSE CONDITIONS**
*...N..SBP..60.HR.50.HR.200.RR..5.T1.TI:
.1270...X..4000......SUC.1.SUC.0......TI
.T1.10000.BIC.0.)....R.0.C.6.MN.1.R....R
.0.C.5.J(C).J(C).1:.J(C).1.T(C).TI......
R.0.C.5.J(C).1.."YOU HAVE ALREADY ORDERE
D THAT!":.1000......R.1.C.2.MN.1.1400...
...R.1.J(C).1.C.5.."YOU MUST ORDER THAT
FIRST":.1000...(..P%.2.RES..2.1340...2..
R.1.C.5..1030.;.<..R.3.C.1.K.1.."YOU ALR
EADY HAVE ONE GOING!":.1000.L.F..R.3.C.1
.K.1...P..K.1.R.2.."YOU MUST PLACE AN IV
FIRST TO GIVE THAT":.1000...Z..R..1.C.4
.TI.T(C).8000.1400...D.."SORRY, THAT WIL
L TAKE A FEW MINUTES TO GET BACK--- TRY
AGAIN LATER!"...N..1000...X..R..0.C..5.
TU.1.1430.]...."RESPIRATOR HOOKED UP AND
RUNNING AT 15 RESPIRATIONS/MIN.".R.
..RR.15:RP.1:.1000......R.3.C.4..3000...
..R..6.C..6.1520......TI.T1.1000.1500.A
....K.1.TU.1.1500......"CODE CALLED---":
.:."YOU'RE IN LUCK!":....H.."ANOTHER INT
ERN SHOWS UP AND OFFERS TO".Q.R.."PLACE
AN ET TUBE AND IV FOR YOU":K.1:TU.1:.100
0......"CODE CALLED--":."BUT NO ONE RESP
ONDS QUICKLY ENOUGH"......"TO DO YOU ANY
GOOD":.1000.K....R.4.C.1.DEM.1..6000:.1
000......CPR.0..6100......CPR.15.1570.+.
..."IT BECOMES OBVIOUS THAT FURTHER CPR"
:."IS USELESS-----".B....T.1.2000:.T:.40
70..."..R.1.C.2.HR.0.."EKG SHOWS VENTRIC
ULAR FIBRILLATION!":.1000...,..TU.1.."YO
U HAVE ONE IN PLACE ALREADY!":TU.1:.1000
...6..CT.1.."YOU HAVE ONE IN PLACE ALREA
DY!":CT.1:.1000.&.@..NG.1.."YOU HAVE ONE
IN PLACE ALREADY!":NG.1:.1000.C.J..SUC.
0.R.4.C.3.."ZZZAP!":."NO IMPROVEMENT AT
ALL!":.1000...T..R.2.C.7.SBP.SBP.10:DBP.
DBP.5:.HR.200.HR.HR.20.W.^..P%..4.R.6.C.
7.."SORRY, THEY ARE UNAVAILABLE JUST NOW
":.1000...H..R.1.C.6.TU.0.."NO WAY TO TA
LK WITH AN ET TUBE!":.1000.!....DEM.1.40
0.G....P%.11300,12300,13300,14300,15300.
]....SUC.2..8000:.400.Q....P%.2.DEM.1.40
0.{.L..1000...P..***INITIAL VITAL SIGNS*
**.T.Z..G(147):."BP=";SBP;"/";DBP;.1);"H
R=";HR;.1);"RR=";RR;.......1);"TEMP=";TP
:......."YOUR EFFICIENT TRIAGE NURSE HAS
".=...."ALREADY OBTAINED SOME VITAL SIGN
S.":..K...."SHE TURNS TO YOU FOR INSTRUC
TIONS---":..Q..........***TUBE PLACEMENT
SUBROUTINE***.Z.B..:."PLEASE INDICATE T
HE TYPE OF TUBE YOU ARE GOING TO PLAC
E"...L.."BY ENTERING THE APPROPRIATE .NU
MBER.:":..5.V.."1-NASOGASTRIC TUBE (TO P
UMP STOMACH)".S...."2-CHEST TUBE (TO REL
IEVE TENSION PNEUM0THORAX).....
."3-ENDOTRACHEAL TUBE (TO USE RESPIRATOR
)":.:.......AN$.....AN%.E(AN$)......AN%.
1.AN%.3..:."NOT A VALID CHOICE--TRY AGAI
N!":.3010.....C.C.(AN%.1):AN%.0. ....C.6
.TU.TU.1.1.&..C.5.CT.CT.1.B.0..C.4.NG.NG
.1.H.:...D. ..***CHECK FOR DEMISE***.V..
..TI.T1.4000........P%.4.......SBP.0:DBP
.0:HR.0:.RP.1.RR.0...H..G(147):."..."...
R..TI.T1.8000..".CARDIAC ARREST!!!.":.".
..":..&....TI.T1.14400..".YOUR PATIENT I
S KNOCKING ON DEATH'S DOOR.":..A....G(14
7)"....":."TIME HAS RUN OUT FOR THIS ONE
.":."..."......:."IT'S ON TO THE GREAT B
EYOND--":G%.G%.1:."...".U...."SCORE: INT
ERN=";I%;.3);"GRIM REAPER=";G%:DEM.1:.".
..":.......***SCREEN CHANGE***......".(P
RESS ANY KEY TO CONTINUE)".(....AN$:.AN$
."".5020.6....G(147):..P.P..***CPR SUBRO
UTINE***.U.Z..SBP..60.HR..50.RR..5.CPR.0
.6060......CPR.0.."CPR ALREADY UNDERWAY!
":......."CPR UNDERWAY---
YOU'VE BOUGHT SOME TIME!".....
T1.TI:CPR.1:..$...."YOUR NURSE WISELY TA
LKS YOU OUT OF THIS".Q...."SINCE IT REAL
LY ISN'T NECESSARY YET":..P.T..SBP..60.H
R..50.RR..5.6130.....CPR.CPR.1:T1.TI:..H
...."CONGRATULATIONS!":."VITAL SIGNS HAV
E IMPROVED TO THE POINT"......"THAT CPR
CAN BE STOPPED."......:."YOU AND YOUR HA
RDWORKING NURSE".8...."TAKE A BREATHER--
-":.:.T.1.800:.T.D...CPR.0:..I.X..***CAR
DIAC ARREST SUBROUTINE***.T.B..K.1.....L
..R.2.C.2.BIC.1...V..R.2.C.3.LID.1......
R.2.C.7.EPI.1......R..4.C..3...N....BIC.
1.7100......"ZZZAPP!":."..":."TOUGH LUCK
--":."THE PATIENT IS JUST TOO".;...."ACI
DOTIC TO BENEFIT FROM YOUR ATTEMPT".U...
."TO DEFIBRILLATE.":..J....LID.1.P%.5.71
50...F.."ZZZAPP!":."..":."HEART RHYTHM R
ETURNS TO NORMAL BRIEFLY,"...P..T.1.1800
:.T...Z.."BUT SOON DISAPPEARS AGAIN.":..
.....EPI.1.TI.T1.10000.7200. ...."ZZZAPP
!":."..":."NO DICE---":..N...."THE OLD T
ICKER JUST ISN'T COOPERATING!".}...."YOU
R NURSE SUGGESTS REPEATING THE SHOCK"...
..."AFTER GIVING SOME EPINEPHRINE.":..Y.
.SBP.100:DBP.70:HR.70:RR.15:."...":.".Z
ZZAPP!!!"...*.."..":.".LIVING BETTER ELE
CTRICALLY!".&.4..P%.3.RR.35:HR.120:.RP.0
.RR.15.8.>.."..":SUC.1:..D.@..***SUCCESS
FUL CONCLUSION SUBROUTINE***...J.."...":
."YOU HAVE SNATCHED ANOTHER FROM THE"...
T.."CLUTCHES OF THE GRIM REAPER!"...^.."
..":."GIVE YOURSELF A PAT ON THE BACK---
-":.".."...H.I%.I%.1.1 R.."SCORE: INTERN
=";I%;.3);"GRIM REAPER=";G%:.:.:..L (#.*
**CLINICAL PEARLS***.E 2#.G(147):.BC,11:
.SC,1.. <#.:..12)".CLINICAL PEARLS":...
F#.".---A HANDY POCKET REFERENCE MANUAL
FOR".. P#."THE BUSY INTERN FACING THE RI
GOURS AND MYSTERIES OF THE ER---":..%!Z
#.".CHAPTER 1 PHYSICAL DIAGNOSIS":..R!
D#."VITAL SIGNS CONSIST OF BLOOD PRESSUR
E".Y!N#."(BP), HEART RATE OR PULSE (HR),
"..!X#."RESPIRATORY RATE (RR), AND TEMPE
RATURE":."(TEMP).":...!.#."NORMAL RANGES
ARE AS FOLLOWS:":."BP--90/50 TO 140/90"
.2".#."HR--55 TO 100/MIN.":."RR--10 TO 2
0/MIN.":."TEMP--97 TO 100".]".#.:."SIGNI
FICANT DEVIATIONS FROM THESE"..".#."LIMI
TS USUALLY MEAN TROUBLE.":.:.5000.M" #."
EXAMINATION OF THE HEAD SHOULD INCLUDE
CHECKING THE EYES.":...#.#."SMALL OR PIN
POINT PUPILS CAN OCCUR WITH NARCOTIC INT
OXICATION.".^#.#."ENLARGED PUPILS CAN BE
DUE TO HYPOXIA (LOW BLOOD OXYGEN), OR
FROM"..#.#."INTOXICATION WITH PCP (A CO
MMON STREET DRUG OF ABUSE)."..#H#."JERK
Y EYE MOVEMENTS CAN ALSO OCCUR WITH PCP
INTOXICATION.":..$$R#."NORMALLY, LUNGS A
RE CLEAR WHEN YOU LISTEN TO THE CHE
ST.".N$.#."NO BREATH SOUNDS ARE A BAD SI
GN.":...$.#."REFLEXES ARE REDUCED OR HYP
OACTIVE WITH SEVERE HYPOXIA OR NARCOTICS
.".O$.#."THEY CAN BE HYPERACTIVE WITH PC
P.":."..":.5000..%.#."HYPOXIA PRODUCES A
DUSKY SKIN COLOR. CLAMMY SKIN OFTEN
COMES FROM".`%.$."SHOCK OR LOW BLOOD GLU
COSE (AS IN INSULIN REACTIONS).":.
..%.$."ABDOMINAL SOUNDS MAY BE HYPOACTIV
E WITH"..%.$."PCP INTOXICATION.":.".....
.":.5000..%"$."CHAPTER 2 LAB TESTS":.:.
"ACIDOSIS CAN RESULT FROM PROLONGED".(&,
$."HYPOXIA OR METABOLIC DERANGEMENTS.":.
.C&6$."LOW GLUCOSE MAY BE DUE TO AN INSU
LIN REACTION.":...&@$."A COMMON CAUSE
OF ANEMIA IS BLOOD LOSS.":..Y&J$."THE E
LECTROCARDIOGRAM (EKG) CAN SHOW A NUM
BER OF THINGS:":...'T$."*NORMAL SINUS RH
YTHM IS THE HEALTHY FINDING.":..?'^
$."*SINUS TACHYCARDIA IS AN ABNORMALLY".
Z'H$." FAST RATE, OFTEN DUE TO DRUGS, AN
XIETY OR TRAUMA."..'M$.:.5000.R'R$."*VE
NTRICULAR RHYTHM IS BAD NEWS, SINCE IT
PRODUCES A PROFOUND DROP"..'|$." IN BLO
OD PRESSURE.":...(.$."*THE WORST IS VENT
RICULAR FIBRILLATION".A(.$." WHICH RESUL
TS IN NO BLOOD PRESSURE WHATSOEVER!
":."...."..(.$.5000:."CHAPTER 3 PHARMA
COLOGY":...(.$."GLOCOSE IS A SUGAR SOLUT
ION USEFUL IN"..(.$."PROVIDING CALORIES
OR REVERSING INSULIN COMA.":..0)
.$."BICARBONATE (BICARB) HELPS REVERSE
ACIDOSIS.":..[).$."LIDOCAINE TREATS
AN IRREGULAR HEART"..)B$."RHYTHM, SUCH A
S VENTRICULAR TACHYCARDIA OR FIBRILLATIO
N.":..M)L$."NARCAN REVERSES NARCOTIC INT
OXICATION.":...)V$."HALDOL IS A POWERFUL
SEDATIVE, USEFUL"..*.$."TO CALM AGITATE
D PATIENTS.":..`*.$."EPINEPHRINE (ADRENA
LIN) IS A CARDIAC STIMULANT.":.:.5000
..*.$."CHAPTER 4 OTHER TREATMENT MODAL
ITIES":...*.$."THE RESPIRATOR BREATHES F
OR PATIENTS"..*.$."WHO HAVE LOST THEIR R
ESPIRATORY DRIVE.":..-+.%."GIVING FLUIDS
CAN COMPENSATE FOR BLOOD LOSS OR LOW B
P.":..Y+.%."PLACING A TUBE CAN ALLOW YOU
TO USE THE RESPIRATOR, PUMP THE STOMACH
"..+.%."OR RELIEVE A COLLAPSED LUNG (TEN
SION PNEUMOTHORAX).":...+&%."CARDIOPU
LMONARY RESUCITATION (CPR)".(,0%."KEEPS
THE PATIENT ALIVE WHILE YOU TRY TO REV
IVE HIM.":."...".],:%.5000:."GIVING SHOC
K OR DEFIBRILLATION CAN STOP"..,D%."ABNO
RMAL VENTRICULAR RHYTHMS.":..H,N%."SUCTI
ON CLEARS THE BREATHING PASSAGES OF FO
REIGN MATERIAL."..,X%.".......":.5000:..
.,.'.***INSTRUCTIONS***..-.'.G(147):.BC,
11:.SC,4.,-$'..12)"INSTRUCTIONS":.:..Y-.
'."THE FOLLOWING IS A MEDICAL SIMULATION
"..-8'."GAME, BASED ON REAL SITUATIONS S
EEN"..-B'."ALMOST DAILY IN THE EMERGENCY
ROOM".V-L'."OF ANY MAJOR MEDICAL CENTER
.":.:....V'."IN THIS SCENARIO YOU ARE AN
INTERN,".(.`'."REALLY WET BEHIND THE EA
RS, BUT".O.J'."NEVERTHELESS OBLIGATED TO
TREAT".X.T'."WHOMEVER LANDS UPON YOUR D
OORSTEP". .~'."IN THE WEE HOURS OF THE M
ORNING."....'.".....":.5000....'."YOU DO
THIS BY TYPING IN INSTRUCTIONS"../.'."S
IMILAR IN MANY RESPECTS TO THE".0/.'."ST
ANDARD ADVENTURE GAME FORMAT.":..[/.'."F
OR EXAMPLE, YOU MAY WANT TO 'CHECK"../.'
."HISTORY', 'EXAMINE CHEST', 'GIVE"../D'
."GLUCOSE', ETC. ":..E/N'."FOR A LIST OF
AVAILABLE COMMANDS,"../X'."TYPE 'HELP'
AT ANY PROMPT.":...0.'."TO EXIT, JUST TY
PE 'EXIT' OR 'QUIT'.":..B0.'."YOU CAN TH
EN STOP ENTIRELY BY ENTERING '
N' ----OR CHOOSE"..0.'."ANOTHER PATIENT
BY ENTERING 'Y' AT THE CONTINUE
PROMPT."..0.(."..":.5000..0.(."JUST AS
IN REAL LIFE MEDICINE, TIME"..1.(."IS OF
THE ESSENCE IN CERTAIN SITUATIONS.".=1.
(."IF YOU WAIT TOO LONG, UNFORTUNATE".L1
((."THINGS MIGHT HAPPEN TO YOUR PATIENTS
!":...12(."YOUR GOAL IS NOT NECESSARILY
TO"..1<(."CURE --- JUST STABILIZE THE PA
TIENT"..1F(."ENOUGH TO GET HIM OR HER OU
T OF THE"..2P(."ER AND ONTO ANOTHER SERV
ICE.":..:2Z(."YOU DO THIS BY 'CALL'ING I
N ANOTHER".D2D(."SPECIALIST TO TAKE OVER
(IF ONE IS".~2N(."AVAILABLE).":."..."..
2X(."GOOD LUCK!":."..". 2.(.5000..2.(...
2.).***HELP MENU***.Z2.).G(147):.BC,4:.S
C,12:T3.TI..2.)..15)".HELP MENU.":."..."
.%3")."COMMANDS USUALLY CONSIST OF TWO W
ORDS".R3,)."(ALTHOUGH YOU CAN USE MORE O
R LESS IF".36)."YOU REALLY WANT TO), EN
TERED IN UPPER"..3@)."CASE ONLY.":.:."TH
E AVAILABLE ACTIONS INCLUDE:":...3J)."1)
.ORDER":..3)".EXAMPLES OF THINGS YOU CAN
ORDER:"..4O)..3)".LAB, X-RAYS, EKG, RES
PIRATOR,".;4Q)..3)"OLD CHART, MONITORING
":..V4T).".2).CHECK":..3)".EXAMPLES OF T
HINGS YOU CAN CHECK:.". 4^)..3)"VITAL SI
GNS, HISTORY, LAB, EKG,".D4H)..3)"X-RAYS
, OLD CHART":.:.5000..4R).".3).GIVE":..3
)".EXAMPLES OF THINGS YOU CAN GIVE:.".+5
|)..3)"GLUCOSE, BICARB, LIDOCAINE, NARCA
N,".S5.)..3)"FLUIDS, HALDOL, EPINEPHRINE
":...5.).".4).ADMINISTER.":..3)"EXAMPLES
OF THINGS YOU ADMINISTER:".C5.)..3)".CP
R, IPECAC, SHOCK (DEFIBRILLATION),"..5.)
..3)"OXYGEN, SUCTION, REASSURANCE":..'6.
).".5).PLACE.":..3)"EXAMPLES OF THINGS Y
OU CAN PLACE:.".V6.)..3)"IV, SUTURES, CH
EST TUBE, RESPIRATOR,"..6B)..3)"NASOGAST
RIC TUBE, ENDOTRACHEAL TUBE,"..6G)..3)"R
ESTRAINTS":."...":.5000..6L).".6).EXAMIN
E.":..3)"EXAMPLES OF THINGS YOU CAN EXAM
INE:"..7Q)..3)".HEAD, CHEST, SKIN, ABDOM
EN,".-7V)..3)"REFLEXES, BELONGINGS":..F7
.).".7).CALL.":..3)"EXAMPLES OF THINGS Y
OU CAN CALL:."..7.)..3)"CODE 99, MEDICIN
E, SURGERY,SECURITY,".N7.)..3)"PSYCHIATR
Y, PEDIATRICS, RELATIVES":."...":.5000..
7.).".SOME PROCEDURAL TIPS:":...8.).".1)
-.WHEN YOU ASK FOR 'HELP', THE".Q8.)..3)
"CLOCK STOPS TEMPORARILY":..3)"---SO ASK
AWAY!":..Z8.)..3)"HOWEVER, YOU READ THE
CLINICAL"..8.)..3)"PEARLS ON YOUR OWN T
IME, SO WATCH IT!".T8.).".2)-.CERTAIN OF
THE THINGS YOU CAN"..9.)..3)"'ORDER' (L
IKE 'LAB','EKG','X-RAYS',".-9.*..3)"'CHA
RT') TAKE SEVERAL MINUTES TO".]9.*..3)"P
ERFORM BEFORE YOU CAN GET RESULTS.":...9
.*..3)"SO GO ON ABOUT YOUR BUSINESS AND"
..9.*..3)"'CHECK' THE RESULTS LATER.":..
.9.*.".3)-.ORDERING 'MONITORING' WILL GI
VE YOU"..:.*..3)"A RUNNING TALLY OF VITA
L SIGNS.":.:.5000.F:.*."...":.".4)-.IF Y
OUR PATIENT'S VITAL FUNCTIONS".T:.*..3)"
DETERIORATE TOO FAR, HE OR SHE WILL". :&
*..3)"HAVE A .CARDIAC ARREST!. YOU THEN"
.M:0*..3)"HAVE LESS THAN 3 MINUTES TO RE
VIVE"..::*..3)"THEM BEFORE IT'S GRIM REA
PER TIME.":..&;D*.".5)-.YOU HAVE A POCKE
T MANUAL THAT".C;N*..3)"CAN GIVE YOU SOM
E CLINICAL TIPS":..3)"OR 'PEARLS'."..;X*
..3)"YOU CAN READ IT BY ENTERING"..;B*..
3)"'READ PEARLS' AT ANY PROMPT.":...;L*.
".6)-.WHEN ALL ELSE FAILS, TRY 'CALL'ING
A"."<V*..3)"CODE 99 ---WHO KNOWS?":..3)
"YOU MIGHT GET SOME HELP!".2<.*."..":.50
00.P<.*.BC,2:.SC,1:T1.T1.(TI.T3).V<.*..L
<.*.***PATIENT #1***..<.+.G(147):."...":
."YOU HEAR AN AMBULANCE SCREECH TO"..<.+
."A HALT OUTSIDE THE MAIN ENTRANCE DOORS
":."TO THE ER.":...=.+."A FEW SECONDS LA
TER TWO PARAMEDICS".4= +."BURST IN, WHEE
LING A STRETCHER.":..]=*+."ON THE STRETC
HER IS A MIDDLE-AGED"..=4+."WHITE MALE D
RESSED IN A JOGGING SUIT.":...=>+."HE DO
ESN'T LOOK AT ALL WELL.":."...":.5000..=
H+."...":."ONE OF THE PARAMEDICS TELLS Y
OU THAT"..>R+."THEY WERE CALLED BY SOMEO
NE WHO".A>\+."FOUND HIM COLLAPSED ON THE
SIDE OF".O>F+."A PATH IN A NEARBY PARK
MINUTES AGO.":...>P+."WHEN THEY ARRIVED,
HE WAS SEMI-"..>Z+."CONSCIOUS AND UNABL
E TO TELL THEM"..>.+."WHAT HAD HAPPENED.
":.:."HOWEVER, HE DID RESPOND A LITTLE".
5?.+."DURING TRANSFER TO THE AMBULANCE."
:."...":.5000.E?.+."...":."HE WAS BREATH
ING AND HAD A FAIRLY"..?.+."RAPID PULSE
AT THE SCENE.":."HIS BLOOD PRESSURE AT T
HE START"..?.+."OF THE SHORT TRIP TO THE
HOSPITAL":."WAS 90/50.":...@.+."SECONDS
BEFORE ARRIVAL, HE STARTED".O@.+."LOOKI
NG A LOT WORSE.":."...":."NOW IT'S IN YO
UR BALL PARK--".`@J+."...":.5000..@T+SBP
.60:DBP.0:HR.140:RR.5:TP.98.0..@.+.2000:
...@$,.**SUBROUTINE FOR PT#1***.A@.,.R.5
.C.4.ID.1..@8,.R.0.C.4.ID.1.."NO NAME AV
AILABLE TO ORDER CHART":..6AB,.R.6.C.4.I
D.1.."NO NUMBER AVAILABLE TO CALL RELATI
VES":..SAL,.R.2.C.6.RP.1.."GIVEN":..PAV,
.R.4.C.2.TU.1.."GIVEN":...A`,.R.2.C.6.RP
.1.RR.0..AJ,.R.4.C.2.TU.1.RR.0..AT,.SBP.
10.SBP.SBP.5.JA~,.DBP.10.DBP.DBP.5..A.,.
HR.10.HR.HR.10..A.,.7000..B.,.R.2.C.5.SB
P.SBP.10:DBP.DBP.5.FB.,.BIC.1.R.1.C.1.J.
1.."NORMAL, EXCEPT FOR ELEVATED CPK":..^
B.,.SUC.1.HR.100.11450..B.,.R.1.C.2.."EK
G SHOWS AN ABNORMAL VENTRICULAR RHYTHM":
...B.,.SUC..1.R..1.C..2.11460..B.,."NORM
AL RHYTHM, WITH SIGNS OF AN ACUT
E HEART ATTACK":...CD,.SUC.1.R.6.C.2..11
900:..*CN,.R..4.C..3.11520.MCX,.K.0.BIC.
1.LID.1.SUC.1.EPI.1...DC.-.R.2.C.7.."DON
E":..TC...WT$(R,C,P).ZCR....C|..G(147):.
"..."..C..."THE MEDICINE RESIDENT ARRIVE
S AND"..C..."CONGRATULATES YOU ON A JOB
WELL DONE,":.T.1.800:.T:...D..."AGREEING
WITH YOUR DIAGNOSIS".TD..."OF PROBABLE
ACUTE MYOCARDIAL INFARCTION.":.T.1.2400:
.T:...D..."YOUR PATIENT IS WHEELED OUT O
F THE ER"..D..."UP TO THE INTENSIVE CARE
UNIT IN".VDB.."FAIRLY GOOD SHAPE!":.T.1
.2400:.T:SUC.2..DV....D...***PATIENT #2*
**.&E...G(147):."...":."YOU HEAR A BIG R
UCKUS OUTSIDE".RE..."THE MAIN ENTRANCE D
OORS OF THE ER.":..~E..."A FEW SECONDS L
ATER TWELVE POLICEMEN"..E./."BURST IN, C
ARRYING A WILDLY GYRATING"..E./."YOUNG B
LACK MALE.":.:."IT TAKES THREE OF THEM T
O HOLD EACH"..F./."LIMB ---AND EVEN THEN
THEY HAVE TROUBLE.":..JF&/."HE DOES NOT
LOOK LIKE HE APPRECIATES".TF0/."THEIR E
FFORTS AT ALL.":."...":.5000..F:/."...":
."ONE OF THE POLICEMEN TELLS YOU THAT".S
FD/."THEY WERE CALLED BY AIRPORT PERSONN
EL"..GN/."WHO FOUND HIM TRYING TO DIRECT
TRAFFIC".!GX/."ON ONE OF THE RUNWAYS.":
..JGB/."WHEN THEY ARRIVED, HE WAS SINGIN
G".RGL/."SOME STRANGE DITTY AT THE TOP O
F". GV/."HIS LUNGS AND RUNNING AROUND IN
LITTLE".MG./."CIRCLES. HIS SONG HAD SOM
ETHING TO DO"..G./."DO WITH ANGELS DUSTI
NG OUT HIS"..H./."CRANIAL COBWEBS---":."
...":.5000.HH./."...":."HE WAS NOT EAGER
TO COME TO THE".YH./."HOSPITAL, BUT WAS
PERSUADED BY NUMBERS.":...H./."THE POLI
CEMEN HELPFULLY SUGGEST THAT".UH./."YOU
TRY TO BRING HIM BACK DOWN TO EARTH,"..H
F/.:."AND THEN THEY ALL SPLIT---"..IP/."
...":.5000.2IZ/SBP.160:DBP.100:HR.130:RR
.25:TP.101.\I./."YOUR PRUDENT NURSE HAS
ALREADY RUN"..I./."FOR COVER---":.:."NO
INITIAL VITAL SIGNS ARE AVAILABLE."..I./
...I.0.**SUBROUTINE FOR PT#2***.XI.0.RES
.1.R.3.C.3.RES.2..I.0.RES.1.12500..I*0.R
..0.C..4.12340.+J/0."HE PROMPTLY CHASES
THE TECHNICIAN OUT".ZJ20."OF THE ROOM BE
FORE IT CAN BE OBTAINED":..OJ40.R..0.C..
6.12350..J90."HE WILL HAVE NONE OF THAT,
AND DESTROYS THE EQUIPMENT":MN.0:..HJ>0
.R..1.C..5.12370..KH0."NO ONE IS FOOLHAR
DY ENOUGH TO GET NEAR HIM TO DO THIS":.
..KR0.R..3.C..1.12380.WKW0."HE TRIES TO
STRANGLE YOU WITH THE IV TUBING!".
.KZ0."BUT YOU MANAGE TO EVADE HIM---":K.
0:...K\0.R.3.C.2.."WHERE?--- NO LACERAT
IONS ARE VISIBLE":..PKF0.R..3.C..3.12420
..LP0."YOU TRY TO PLACE RESTRAINTS, BUT
HE RESTRAINS YOU INSTEAD!".%LZ0.:.12
800:..:L.0.R..3.C..3.12440.VL.0."HE IS T
OO BUSY TURNING OVER ALL OF THE STRETCH
ERS":...L.0.R..4.C..4.12460.NL.0."HE IS
TOO BUSY RUNNING AROUND IN LITTLE
CIRCLES---":...L.0.R..5.12480."M.0."YOU
THINK THE BETTER OF THIS AFTER HE TRI
ES TO BITE YOU!":..;M.0.RES.0.R.6.C.1.RE
S.1.MMT0.R.5.C.4.ID.1..M.0.R.0.C.4.ID.1.
."NO NAME AVAILABLE TO ORDER CHART":..BM
.0.R.6.C.4.ID.1.."NO NUMBER AVAILABLE TO
CALL RELATIVES":..XM.0.SBP.10.SBP.SBP.5
..M.0.DBP.10.DBP.DBP.2..N.1.HR.10.HR.HR.
3..N.1.RES.2.R.2.C.6.RES.3.RN.1.RES.3.R.
1.C.6.."HE JUST SNORES LOUDLY AT YOU---"
:..NN.1.RES.3.R.6.C.3..12900:...N$1.R.2.
C.7.."DONE":...N81.DBP.125.12700.HNB1."U
H OH---":.:."SUDDENLY HE GRABS HIS HEAD"
..NL1."AND COLLAPSES----":.:...OV1.:."DE
SPITE YOUR ATTEMPTS TO REVIVE HIM,".2O`1
."IT'S ALL OVER---":."...".]OJ1."HIS BLO
OD PRESSURE GOT SO HIGH THAT"..OT1."HE S
UFFERED A MASSIVE INTRACEREBRAL"..O~1."H
EMORRHAGE, AND THAT WAS THAT---".IO.1.T.
1.5000:.T:.4070:..YO.1.WT$(R,C,P)..O.1.R
.4.C.4.RES.2..12800:...O.1...P.2.**AMOK
SUBROUTINE***.:P.2."HE THEN RUNS COMPLET
ELY AMOK,".UP.2."WREACKING HAVOC UPON TH
E ER,":."UNTIL HE EVENTUALLY"..P.2.RES.0
.12870..P(2."RUNS OUT OF THE PLACE BACK
INTO THE CITY"..P22."WHERE HE IS SHOT DE
AD BY A POLICEMAN.":.T.1.3600:.T..P<2.40
70:..2QF2."IS SHOT DEAD BY A SECURITY GU
ARD.":.T.1.3600:.T.>QP2.4070:..AQD2.***P
T%2 SUCCESS SUBROUTINE***.TQN2.G(147):."
..."..QX2."THE PSYCHIATRY RESIDENT ARRIV
ES AND".LQ.2."CONGRATULATES YOU ON A JOB
WELL DONE,"..Q.2."AGREEING WITH YOUR DI
AGNOSIS OF"..R.2."PCP INTOXICATION.":.T.
1.3600:.T:..HR.2."YOUR PATIENT IS WHEELE
D OUT OF THE ER".IR.2."UP TO THE PSYCHIA
TRY UNIT"..R 2."SNORING HAPPILY-----":.T
.1.2400:.T:SUC.2..R.2...RH2.***PATIENT #
3***..RR2.G(147):."...":."THE ER DOORS A
BRUPTLY BURST OPEN,"..S.2."ADMITTING SEV
ERAL RATHER LARGE AND".@S.2."SEEDY-LOOKI
NG CHARACTERS BEARING A".NS.2."STRICKEN
COMRADE ON THEIR SHOULDERS.":...S.2."THE
Y DUMP HIM ON A NEARBY STRETCHER,".FS.3.
"GIVE HIM A DRINK FROM A LARGE BOTTLE"..
S.3."OF WHISKEY, AND THEN MILL AROUND".&
T.3."MAKING CRUDE COMMENTS TO THE NURSE.
":."...":.5000.XT"3."...":."ONE OF THEM
TELLS YOU THAT THEY ARE"..T,3."MEMBERS O
F THE LOCAL KNIFE AND GUN CLUB,"..T63."F
ORCED TO INTERRUPT THEIR EVENING"..T@3."
SOCIAL BY THE UNFORTUNATE ILLNESS OF"..T
J3."ONE OF THEIR MEMBERS.":..$UT3."HE SE
EMED TO HAVE DEVELOPED SOME".JU^3."SHORT
NESS OF BREATH, FOLLOWING".VUH3."A DIFFE
RENCE OF OPINION WITH ANOTHER"..UR3."MEM
BER, AND WAS THEREFORE BROUGHT".JU|3."FO
R MEDICAL ATTENTION.":."...":.5000..U.3.
"...":."THE PATIENT IS A YOUNG WHITE MAL
E".'V.3."WHO APPEARS TO BE HAVING CONSID
ERABLE".FV.3."RESPIRATORY DISTRESS.":..S
V.3."HIS COMRADES SUGGEST YOU DO SOMETHI
NG". V.3."QUICKLY, BEFORE THEY HAVE TO P
ERSUADE"..V.3."YOU MORE FORCEFULLY----".
PVB3."...":.5000..VL3SBP.110:DBP.60:HR.1
20:RR.45:TP.99:.2000:...W.3.**SUBROUTINE
FOR PT#3***.2W.3.SBP.10.SBP.SBP.5.HW.4.
DBP.10.DBP.DBP.5.`W.4.CT.1.HR.50.HR.HR.5
.XW.4.CT.1.RR.15.RR.RR.3..W&4.R.2.C.5.SB
P.SBP.10:DBP.DBP.5..W04.RR.60.RR.0.AW:4.
SBP.50.RR.0.13500..WD4.R.1.C.6.."TOUGH L
UCK! HE'S NOW UNCONSCIOUS--":..2XN4.R.3.
C.5.."DONE-- BUT HE'S STILL NOT BREATHIN
G!":CT.1:..BXX4.R.4.C.2.."HE IS UNABLE T
O SWALLOW IT---":..YX]4.TI.T1.10000..700
0. XB4.R.4.C.3.SBP.50.TI.T1..10000..7150
.ZXL4.R.4.C.4.."HE'S NOT BREATHING, SO I
T DOESN'T HELP!":...YV4.R.4.C.6.."REASSU
RE WHOM, YOURSELF?":."HE'S OUT COLD":..O
Y.4.R.5.C.1.."PUPILS ARE FIXED AND SLIGH
TLY DIALATED":..DY.4.R..5.C..2.13500..Y.
4."NO HEART OR BREATH SOUNDS HEARD---"..
Y.4."STAB WOUND PRESENT IN LEFT CHEST!":
..PY.4.R.2.C.6.RP.1.RR.0..YP4.R.2.C.6.RP
.1.."GIVEN":..%ZZ4.R.4.C.3.TU.0.SUC.1.."
ZZZAPP! ---NO IMPROVEMENT!":..YZ.4.CT.0.
R.6.C.5.SBP.80.DBP.40.RR.0.HR.50..13900:
...Z.4.R.4.C.3.RR.0.TI.T1.4000.."ZZZAPP!
--NO IMPROVEMENT!":...Z.4.R..4.C..3.135
90.CZ.5.LID.1.SUC.1.EPI.1....[.5.R.1.C.6
.TU.0.."HE CAN'T SPEAK WITH AN ET TUBE I
N HIM!":...[ 5.CT.0.13650.$[*5.RR.18.RR.
RR.3.8[45.HR.100.HR.HR.3.N[>5.SBP.90.SBP
.SBP.3.D[H5.DBP.60.DBP.DBP.3.V[R5.R.5.C.
2.EX.1..[\5.R.5.C.5.EX.1..[F5.R.3.C.2.EX
.1.."CHEST LACERATION SUTURED":..O[P5.R.
2.C.7.."DONE":...[.5.WT$(R,C,P)..[B6...[
L6.G(147):."...". \V6."THE SURGERY RESID
ENT ARRIVES AND".M\`6."CONGRATULATES YOU
ON A JOB WELL DONE,".Q\J6."AGREEING WIT
H YOUR DIAGNOSIS"..\T6."OF TENSION PNEUM
OTHORAX SECONDARY".E\~6."TO CHEST STAB W
OUND.":.T.1.2400:.T:...\.6."YOUR PATIENT
IS WHEELED OUT OF THE ER". ].6."UP TO T
HE SURGICAL INTENSIVE CARE UNIT".P].6."I
N FAIRLY GOOD SHAPE!":.T.1.2400:.T:SUC.2
.V].6..L].6.***PATIENT #4***..].6.G(147)
:."...":."JUST WHEN IT SEEMS THE COAST".
E]D6."MIGHT BE CLEARING FOR A WHILE,"..^
N6."THE ER PHONE RINGS.":.:."YOU PICK IT
UP, BUT HAVE TROUBLE".1^X6."MAKING OUT
WHAT'S BEING SAID DUE TO".O^.6."THE POOR
CONNECTION.":..Z^.6."THE CALLER IS A VE
RY DISMAYED WOMAN"..^.6."WHO IS EVENTUAL
LY ABLE TO TELL YOU".P^.6."THAT SHE JUST
FOUND HER TWO YEAR OLD"..^.7."IN THE BA
THROOM, HAPPILY EATING THE".4_.7."LAST P
ILL OF A FORMERLY FULL BOTTLE.":."...":.
5000.I_.7."...":."SHE HAS NO IDEA WHAT T
HE MEDICINE WAS,".._.7."SINCE IT BELONGE
D TO HER MOTHER-- AND".Z_.7."HE ALSO AT
E THE LABEL.":.:."SHE SAYS THAT HE SEEMS
TO BE OK"..`(7."THOUGH HE IS A LITTLE D
ROWSY.":..,`27."SHE PLANS TO RUSH HIM RI
GHT OVER TO".U`<7."YOUR NEARBY ER, BUT W
ANTS TO KNOW".|`F7."IF THERE IS ANYTHING
SHE SHOULD"..`P7."DO FOR HIM FIRST.":..
.`U7."ANY SUGGESTIONS?";I$..`Z7.I$."GIVE
IPECAC".I$."ADMINISTER IPECAC".IPE.1:."
...":.14200.3A_7.C.1.."SHE DIDN'T MAKE O
UT A WORD YOU SAID---":."..":.14250.WAD7
."SHE DIDN'T GET THAT DUE TO":."LOUSY CO
NNECTION--- TRY AGAIN!"..AN7.:C.C.1:.141
65.FAX7.5000:."...":."IT JUST SO HAPPENS
THAT SHE HAS SOME.":...A.7."SHE SAYS SH
E WILL GIVE HIM AN OUNCE AND".9B.7."A BI
G GLASS OF WATER AS YOU SUGGEST,":."AND
COME RIGHT OVER.".WB.7."...":.5000:."...
":."SEVERAL MINUTES LATER THE ER DOORS".
.B.7."FLY OPEN, ADMITTING A FRANTIC MOTH
ER":."BEARING HER SLEEPY,"..B 7."(BUT ST
ILL CATERWAULLING) TWO YEAR OLD.":..)C.7
."SHE SAYS HE VOMITED COPIOUSLY,":."---A
LL OVER THE CAR.".CC.7."...":.5000:SBP.9
0:DBP.50:HR.120:RR.45:TP.99:.2000:...C.7
.5000:."...":."SHE FINALLY GIVES UP AND
HANGS UP,".JC.7."AFTER SAYING THEY ARE O
N THEIR WAY OVER."..D.7."...":.5000:."..
.":."SEVERAL MINUTES LATER THE ER DOORS"
.4DC7."FLY OPEN, ADMITTING A FRANTIC MOT
HER".^DH7."BEARING HER SLEEPY TWO YEAR O
LD.":...DM7."SHE SAYS HE HAS BECOME INCR
EASINGLY"..DR7."LETHARGIC ON THE WAY OVE
R."..DW7."...":.5000:SBP.90:DBP.50:HR.12
0:RR.10:TP.99:.2000:...E.7.**SUBROUTINE
FOR PT#4***..E.7.IPE.1.RR.5.14500.OE.7.R
.1.C.1.."LAB SHOWS MILD HYPOXIA AND ACID
OSIS":...E.7.R.4.C.2.."YOUR NURSE SUGGES
TS GIVING NARCAN FIRST":..GE.8.R.4.C.4.R
P.0.."HE'S NOT BREATHING ENOUGH TO HELP
MUCH":...E.8.R.4.C.6.."SHE DOESN'T BELIE
VE YOU A BIT!":...F.8.R.5.C.1.."PUPILS A
RE PINPOINT AND NONREACTIVE":..BF"8.R.5.
C.2.RP.0.."BREATH SOUNDS ARE VERY FAINT"
:...F,8.R.5.C.5.RP.0.."HIS COLOR IS SLIG
HTLY GREY":...F68.R..2.C..4.14500.VF@8."
HE STARTS IMPROVE ALMOST IMMEDIATELY,"..
GJ8."BECOMING MORE ALERT, BREATHING FAST
ER".'GT8."AND DEEPER ON HIS OWN ----":..
8G^8.RP..1.14460.EGH8."HE NO LONGER NEED
S THE RESPIRATOR, SO"..GR8."YOU DISCONNE
CT IT AND PULL THE ET TUBE.":RP.0:TU.0.F
G|8IPE.1:RR.15:HR.100:SBP.100:DBP.70:...
G.8.R.2.C.5.SBP.SBP.10:DBP.DBP.5..H.8.R.
2.C.6.RP.1.."DONE":...H.8.R..3.C..6.RR.1
0.14530.LH.8."YOU RECONSIDER AND DECIDE
TO HOLD OFF"..H.8."ON THIS, SINCE HE'S B
REATHING PRETTY WELL ON HIS OWN":TU.0
:...HB8.R..3.C..4.14570.WHL8."YOU ARE AB
LE TO PLACE A NASOGASTRIC TUBE"..IQ8."(
WITH CONSIDERABLE DIFFICULTY )":..:IV8."
YOU LAVAGE, AND OBTAIN A FEW":."PILL FRA
GMENTS.":..AI.8."YOU THEN GIVE SOME CHAR
COAL AND"..I.8."MAGNESIUM CITRATE TO GET
RID":."OF THE REST.":.:LAV.1:...I.8.R.2
.C.7.."DONE":..SI.8.IPE.0.RR.0.RP.1.RR.R
R.1..I.8.WAR.0.RR.4.14650..J.9."YOUR PAT
IENT IS IN THE PROCESS OF".8J.9."HAVING
A RESPIRATORY ARREST!":..UJ.9."BETTER DO
SOMETHING FAST TO GET SOME":."AIR MOVIN
G!":...J&9."( YOUR EXPERIENCED NURSE SUG
GESTS".JJ09."EITHER CPR OR A RESRIRATOR
)":.:WAR.1..J:9.IPE.1.LAV.1.R.6.C.7..149
00:...KD9.R..6.C..7.14730.GKN9."YOU PAGE
THEM, BUT NO ONE CAN COME TO":."YOUR RE
SCUE JUST YET.".WKX9.:."THE RESIDENT DOE
S SUGGEST THAT YOU TRY"..KB9."GIVING SOM
E NARCAN IF HE SEEMS TO BE".NKL9."HAVING
RESPIRATORY DEPRESSION, THEN"..KV9."PUM
P HIS STOMACH TO GET RID OF". L.9."AS MU
CH OF THE POISON AS POSSIBLE.":..@L.9.TI
.T1.4000.CPR.14..14800:..RL.9.R.2.C.6.RR
.0.YL.9.IPE.1.SBP.SBP.3:DBP.DBP.2:HR.HR.
4..LF9.WT$(R,C,P):...LP9.G(147):."..."..
LZ9."FORTUNE SMILES UPON YOU":."( IN THE
NICK OF TIME AT THAT ),"..M.9."AS A PED
IATRIC RESIDENT HAS WANDERED BY!":..=M.9
."SEEING YOUR PREDICAMENT, SHE LENDS".HM
.9."A HAND--- AND TOGETHER YOU QUICKLY"
..M.:."PLACE THE CHILD ON A RESPIRATOR,
REVERSE".FM.:."THE EFFECTS OF THE OPIATE
HE TOOK WITH"..M.:."SOME NARCAN (TEMPOR
ARILY), AND PUMP"..N :."HIS STOMACH TO G
ET OUT THE UNABSORBED":."REMAINDER.":..F
N*:.T.1.4000:.T:."HE IS THEN WHEELED UP
TO PEDIATRICS"..N/:."IN GOOD SHAPE, FUSS
ING MIGHTILY---":.T.1.4000:.T:SUC.2:...N
4:.G(147):."..."..N>:."THE PEDIATRIC RES
IDENT ARRIVES AND"..OH:."CONGRATULATES Y
OU ON A JOB WELL DONE,".3OR:."AGREEING W
ITH YOUR DIAGNOSIS".]O\:."OF OPIATE OVER
DOSE.":.T.1.2400:.T:...OF:."YOUR PATIENT
IS WHEELED OUT OF THE ER"..OP:."UP TO T
HE PEDIATRIC WARD, PROTESTING"..OZ:."LOU
DLY, BUT IN VERY GOOD SHAPE!":.T.1.2400:
.T:SUC.2:...P.:.***PATIENT #5***.BP.:.G(
147):."...":."YOUR NURSE TAPS YOU ON THE
SHOULDER".QP.:."AND DIRECTS YOUR ATTENT
ION TO A CURIOUS"..P.:."CREW COMING DOWN
THE CORRIDOR.":..EP.:."A POLICEWOMAN AN
D A JAIL TRUSTEE ARE"..PJ:."ESCORTING ON
E PROFOUNDLY UNSTABLE"..QT:."FEMALE PRIS
ONER INTO THE ER,".;Q.:."ONE UNDER EACH
ARM.":."....":.5000.QQ.:."...":."THE TRU
STEE TELLS YOU SHE WAS DEPOSITED"..Q.:."
IN THE JAIL ABOUT AN HOUR AGO FOR DWI".J
Q.:."AFTER FLUNKING A FIELD SOBRIETY TES
T"..Q.;."ADMINISTERED BY THE ARRESTING O
FFICER".!R.;."WHOSE PATROL CAR SHE BROAD
SIDED.":..NR.;."SINCE HER ARRIVAL AT CIT
Y LOCKUP, SHE"..R$;."HAS REMAINED LETHAR
GIC AND MOSTLY INCOHERENT -----":.
..R.;."THEY DECIDED TO BRING HER TO YOU
AFTER"..R8;."SHE HAD A COUPLE OF BRIEF C
ONVULSIONS.":."...":.5000./SB;."...":."D
ESPITE HER APPEARING DRUNK AS A SKUNK,".
XSL;."THERE WERE NO SIGNS OF ALCOHOL IN"
..SV;."HER CAR, OR ON HER BREATH.":."...
"..S`;."SHE IS A WELL-DRESSED YOUNG BLAC
K WOMAN"..SJ;."WITH A GLAZED EXPRESSION,
WHO IS UNABLE"..TT;."TO WALK AND IS IND
EED INCOHERENT.":..8T~;."THEY DEPOSIT HE
R LIMPLY ON A STRETCHER".IT.;."AND LOOK
AT YOU EXPECTANTLY.":."...":.5000..T.;SB
P.100:DBP.60:HR.60:RR.10:TP.97..T.;.2000
:...TD;.***SUBROUTINE FOR PT#5***.KTN;.R
.5.C.4.ID.1..UX;.R.0.C.4.ID.1.."NO NAME
AVAILABLE TO ORDER CHART":..>U.;.R.6.C.4
.ID.1.."NO NAME AVAILABLE TO CALL RELATI
VES":..[U.;.R.2.C.6.RP.1.."GIVEN":..XU.;
.R.4.C.2.TU.1.."GIVEN":...U.<.R.2.C.6.GL
U.1.RP.1.RR.0..U.<.R.4.C.2.TU.1.GLU.1.RR
.0.HU.<.SBP.10.SBP.SBP.3..U.<.DBP.10.DBP
.DBP.2..U(<.HR.10.HR.HR.2..U2<.7000..V<<
.R.2.C.5.SBP.SBP.10:DBP.DBP.5.XVF<.BIC.1
.R.1.C.1.J.1.."NORMAL, EXCEPT FOR LOW GL
UCOSE":..MVZ<.R..4.C..3.15500..VD<.K.0.B
IC.1.LID.1.SUC.1.EPI.1....V.<.R.2.C.7.."
DONE":...V.<.R.1.C.6.TU.0.."SHE CAN'T SP
EAK WITH AN ET TUBE PLACED":...W <.R..2.
C..1.TI.T1.4000.GLU.1.15600.2W.<."SHE RE
SPONDS DRAMATICALLY, WITH".NW.<."IMPROVE
MENTS IN BREATHING, COLOR AND":."ALERTNE
SS.":..~W.<.TU.0.15590..WH<."SHE TELLS Y
OU SHE FEELS TERRIBLY".SWR<."HUNGRY AND
ANXIOUS. SHE ALSO CONFIRMS"..X.<."THAT S
HE IS A DIABETIC ON INSULIN ---AND
FORGOT TO EAT DINNER".LX.<GLU.1:SBP.120
:DBP.70:HR.100:RR.20:TP.98:..SX.<.R.6.C.
2.GLU.1.TI.T1.4000..15900:...X.<.GLU.1.1
5700..X.=.R.1.C.1.."GLUCOSE IS SLIGHTLY
LOW, OTHERWISE OK":...X.=.R.1.C.2.."EKG
SHOWS SINUS TACHYCARDIA":...Y.=.R.1.C.6.
."SHE TELLS YOU SHE HAS DIABETES":..SY"=
.R.4.C.2.."DONE--- AND SHE THROWS IT UP
PROMPTLY":..LY,=.R.5.C.1.."NORMAL":...Y6
=.R.5.C.2.."HEART RATE IS RAPID, LUNGS A
RE CLEAR":...Y@=.R.5.C.3.."NORMAL":...YJ
=.R.5.C.5.."CLAMMY, BUT NORMAL COLOR":..
.YO=.R.2.C.6.."GIVEN":...ZT=.WT$(R,C,P):
..$Z.>.G(147):."...".MZ&>."THE MEDICINE
RESIDENT ARRIVES AND"..Z0>."CONGRATULATE
S YOU ON A JOB WELL DONE,":.T.1.800:.T:.
..Z:>."AGREEING WITH YOUR DIAGNOSIS"..ZD
>."OF INSULIN INDUCED HYPOGLYCEMIA.":.T.
1.2400:.T:...{N>."YOUR PATIENT IS WHEELE
D OUT OF THE ER".?{X>."UP TO THE MEDICIN
E WARD, STUNNED BUT IN".L{B>."FAIRLY GOO
D SHAPE!":.T.1.2400:.T:SUC.2.R{V>...{ N.
***DATA***..{*N.ORDE," LAB"," EKG",RAYS,
HART,ATOR,RING.Z{4N.CHEC," LAB"," EKG",R
AYS,HART,IGNS,TORY..|>N.GIVE,COSE,CARB,A
INE,RCAN,UIDS,LDOL.$|HN.PLAC,E IV,URES,I
NTS,TUBE,O,O.N|RN.ADMI," CPR",ECAC,HOCK,
YGEN,TION,ANCE.V|\N.EXAM,HEAD,HEST,EXES,
INGS,SKIN,OMEN. |FN.CALL,RITY,CINE,ATRY,
IVES,GERY,"E 99".N|.N.0,LAB ORDERED,EKG
ORDERED,X-RAYS ORDERED..|.N.OLD CHART OR
DERED./}.N.RESPIRATOR WON'T DO YOU A BIT
OF GOOD WITHOUT AN ENDOTRACHEAL TUBE.
G}.N.MONITORING ORDERED..}.N.0,PATIENT I
S ACIDOTIC AND HAS AN ELEVAT
ED CPK.H}.N.EKG SHOWS VENTRICULAR TACHYC
ARDIA,X-RAYS OF CHEST ARE NORMAL..~.N.OL
D CHART REVEALS PREVIOUS TREATMENT FO
R ANGINA,0.?~.N.PATIENT IS OUT OF IT AND
IS UNABLE TO PROVIDE HISTORY._~.N.0,D
ONE,DONE,DONE,DONE,DONE..~.N.PATIENT HAS
STOPPED BREATHING ENTIRELY.E~JN.0,DONE,
WHERE? -THERE ARE NO VISIBLE LACERATIONS
,DONE..TN.DONE--BUT IT DOESN'T HELP,DON
E--BUT IT DOESN'T HELP,DONE.H.N.0,0,PAT
IENT IS UNABLE TO SWALLOW-- HE
ASPIRATES IPECAC...N.ZZZAP!!!
HE DOESN'T LOOK A
BIT BETTER...N.HIS COLOR IMPROVES A LIT
TLE...N.DONE,DONE,0,NORMAL EXCEPT FOR S
LIGHTLY LARGE PUPILS.4..N.HIS HEART SOUN
DS ARE RAPID AND FAINT NO BREATH SOUN
DS ARE HEARD...O.NORMAL,HE HAS ON A MED
IC-ALERT BRACELET THAT LISTS NAME AND
NUMBER....O.HE IS CLAMMY AND GREY,NORMA
L,0....O.SEVERAL SECURITY GUARDS ARRIVE
AND STAND AROUND LOOKING BORED.)..O
.THEY ARE BUSY RIGHT NOW--
TRY AGAIN LATER!.U..O.PSYCH RESIDENT TE
LLS YOU YOU'RE CRAZY-- PATIENT NEEDS MED
ICINE CONSULT....O. SHOCKED RELATIVES TE
LL YOU ABOUT HIS HEART CONDITION...$O
.SURGEONS ARE ALL TIED UP JUST NOW,0...L
O.0,LAB ORDERED,EKG ORDERED,X-RAYS ORDER
ED.!.VO.OLD CHART ORDERED.K.`O.RESPIRATO
R WON'T DO YOU A BIT OF GOOD WITHOUT A
N ENDOTRACHEAL TUBE...JO.MONITORING ORDE
RED.L.TO.0,LAB NORMAL EXCEPT FOR A SLIGH
TLY ELEVATED WHITE CELL COUNT...~
O.EKG SHOWS SINUS TACHYCARDIA,X-RAYS OF
CHEST ARE NORMAL.F..O.OLD CHART REVEALS
PREVIOUS TREATMENT FOR DRUG ABUSE,0..
..O.PATIENT LAUGHS UPROARIOUSLY AND RECI
TES THE PLEDGE OF ALLEGIANCE....O.0,DONE
,DONE,DONE,DONE,DONE.U..O.HE SMILES BROA
DLY AND GOES TO SLEEP....O.0,YOU ARE ABL
E TO START AN IV AFTER CONSIDERABL
E STRUGGLE.G..O.WHERE? THERE ARE NO VISI
BLE LACERATIONS...DO."IT TAKES YOU, THE
NURSE AND SEVEN SECURITY GUARDS DO
IT".M.NO.DONE--BUT ONLY AFTER A
PROTRACTED STRUGGLE...XO.DONE-
- BUT ALL IT DOES IS MAKE HIM TWICE
AS AGITATED.G..O.NO WAY-- HE BITES THE
ET TUBE INTO LITTLE PIECES....O.0,0
,HE PRETENDS TO SWALLOW THE IPECAC
THEN SPITS IT ON YOUR COAT.W..O.HE SCRE
AMS BLOODY MURDER-- INJURIN
G YOUR EARDRUMS. ..P.HE MANAGES TO GET O
UT A POCKET LIGHTER AND TRIES TO BLOW U
P THE ER.[..P.HE SIMPLY BITES THE SUCTIO
N TUBE INTO LITTLE PIECES....P.HE THRE
ATENS TO BLOW UP YOUR HOUSE WHEN HE
GETS OUT OF HERE....P.0,HIS EYE MOVEMEN
TS ARE JERKY AND HIS PUPILS ARE
ENLARGED...(P.HIS HEART SOUNDS ARE RAPID
AND STRONG BREATH SOUNDS ARE NORMAL.L
.2P.REFLEXES ARE HYPERACTIVE...<P."YOU F
IND A LIGHTER, WALLET WITH ID, A JOI
NT AND A VIAL OF POWDER"...FP.HE IS FLUS
HED BUT OTHERWISE NORMAL...PP.BOWEL SOUN
DS ARE HYPERACTIVE OTHERWISE
NORMAL ABDOMEN,0.T.ZP."A SECURITY GUARD
ARRIVES, LOOKS SHOCKED AND SENDS FOR REI
NFORCEMENTS"...DP.THEY ARE BUSY RIGHT NO
W-- TRY AGAIN LATER!.V.NP.
PSYCH RESIDENT IS BUSY RIGHT NOW---
HE SUGGESTS A SEDATIVE...XP. HIS RELATIV
ES TELL YOU ABOUT HIS ADDICTION T
O PCP.>..P.SURGEONS ARE ALL TIED UP JUST
NOW,0.L..P.0,LAB ORDERED,EKG ORDERED,X-
RAYS ORDERED....P.OLD CHART ORDERED.M..P
.RESPIRATOR WON'T DO YOU A BIT OF GOOD
WITHOUT AN ENDOTRACHEAL TUBE....P.MONIT
ORING ORDERED....Q.0,"HE IS SLIGHTLY ANE
MIC, ACIDOTIC AND HYPOXIC".?..Q.EKG
SHOWS SINUS TACHYCARDIA....Q.X-RAYS OF H
IS CHEST SHOW TENSION PNE
UMOTHORAX!.N..Q.OLD CHART REVEALS PREVIO
US TREATMENT VARIOUS INJURIES FROM FI
GHTS,0...,Q.HE SAYS HE WAS ON HIS WAY TO
CHURCH WHENSOMEONE HIT HIM IN THE CHEST
.8.6Q.0,DONE,DONE,DONE,DONE,DONE.D.@Q.PA
TIENT HAS STOPPED BREATHING ENTIRELY...J
Q.0,DONE,WHERE? -YOU HAVEN'T FOUND ANY
LACERATIONS,DONE...TQ.DONE--BUT
IT DOESN'T HELP,DONE--AND HE BREATHES A
LOT EASIER!,DONE.2.^Q.0,0,PATIENT MEREL
Y THROWS IT BACK UP ALL OVER YOU-
--.W.HQ.ZZZAPPP!
HE JUST CURSES YOU OUT!...RQ.HIS
COLOR IMPROVES A LITTLE...|Q.DONE,DONE,
0,NORMAL....Q.HEART SOUNDS RAPID- SMALL
STAB WOUND ANDNO BREATH SOUNDS IN LEFT C
HEST.H..Q.NORMAL,HE HAS NOTHING EXCEPT F
OR A KNIFE AND SOME BRASS KNUCKLES
....Q."HE IS CLAMMY AND GREY, AND HAS A
SMALL LACERATION ON HIS LEFT CHEST"....
Q.NORMAL,0....Q.SEVERAL SECURITY GUARDS
ARRIVE AND QUICKLY DEPART AGAIN.".B
Q.THEY ARE BUSY RIGHT NOW--
TRY AGAIN LATER!.M.LQ.PSYCH RESIDENT T
ELLS YOU YOU'RE CRAZY-- PATIENT NEEDS SU
RGERY CONSULT...VQ.HIS RELATIVES ARE ALL
AT THE SAME FIGHT HE CAME FROM.P..Q.SUR
GEONS ARE ALL TIED UP JUST NOW,0....R.0,
LAB ORDERED,EKG ORDERED,X-RAYS ORDERED..
..R.OLD CHART ORDERED._..R.RESPIRATOR WO
N'T DO YOU A BIT OF GOOD WITHOUT AN EN
DOTRACHEAL TUBE.W.&R.MONITORING ORDERED.
..0R.0,LAB IS NORMAL...:R.EKG SHOWS SINU
S TACHYCARDIA.O.?R.X-RAYS ARE COMPLETELY
NORMAL...DR.OLD CHART SHOWS NOTHING OTH
ER THAN ROUTINE CHECKUPS,0.K.XR.MOT
HER JUST REPEATS WHAT SHE TOLD YOU OVE
R THE PHONE.K.BR.0,DONE,DONE,DONE,DONE,D
ONE...LR.HE STOPS BREATHING ENTIRELY!.R.
VR.0,DONE,WHERE? -YOU HAVEN'T FOUND ANY
LACERATIONS,DONE....R.0,YOUR N
URSE WISELY TALKS YOU OUT OF THIS SINCE
IT'S NOT INDICATED.?..R.DONE--AFTER CONS
IDERABLE EFFORT....R.0,0,PATIENT MERELY
THROWS IT BACK UP ALL OVER YOU---
....R.YOUR NURSE WISELY SUGGESTS YOU SCR
AP THAT IDEA.X..R.HIS COLOR IMPROVES
A LITTLE.$..R.DONE,DONE,0,HIS PUPILS ARE
SOMEWHAT SMALL --OTHERWISE NO
RMAL.A..R."HEART SOUNDS ARE RAPID, BREAT
HING IS NICE AND DEEP"...FR.REFLEXES
ARE HYPOACTIVE,MOTHER BROUGHT THE EMPTY
UNMARKED PILL BOTTLE...PR."HIS COLOR IS
FAIRLY GOOD, NO BRUISES OR LACERATIO
NS ARE PRESENT".".ZR."NO BOWEL SOUNDS, O
THERWISE NORMAL",0.H..R.SEVERAL SECURITY
GUARDS ARRIVE AND LAUGH AT YOU OBN
OXIOUSLY....R.THEY ARE BUSY RIGHT NOW--
TRY AGAIN LATER!.S..R.PSYC
H RESIDENT TELLS YOU YOU'RE CRAZY--....S
."YOU REACH THE GRANDMOTHER, WHO TELLS Y
OUPILLS WERE MORPHINE SULFATE".G..S.SURG
EONS ARE ALL TIED UP JUST NOW,0.U.4S.0,L
AB ORDERED,EKG ORDERED,X-RAYS ORDERED...
>S.OLD CHART ORDERED.V.HS.RESPIRATOR WON
'T DO YOU A BIT OF GOOD WITHOUT AN END
OTRACHEAL TUBE...RS.MONITORING ORDERED.:
.\S.0,LAB IS NORMAL EXCEPT FOR MILD ACID
OSIS AND A VERY LOW GLUCOSE OF 20...FS.
EKG SHOWS SINUS BRADYCARDIA,X-RAYS OF CH
EST AND SKULL ARE NORMAL.L.PS.OLD CHART
REVEALS PREVIOUS TREATMENT FOR POORLY
CONTROLLED DIABETES....S.0,"PATIENT MUM
BLES SOMETHING ABOUT BEING HUNGRY, BUT
LITTLE ELSE".S..S.0,DONE,DONE,DONE,DONE
,DONE,SHE STOPS BREATHING ENTIRELY!....S
.0,DONE,WHERE? THERE ARE NO LACERATIONS
WORTH SUTURING.Y..S.DONE,DONE--B
UT IT DOESN'T HELP,DONE--BUT IT DOESN'T
HELP,DONE....S.0,0,PATIENT IS UNABLE TO
SWALLOW-- SHE ASPIRATES IPECAC.
J..S.ZZZAP!!!
SHE DOESN'T LOOK A BIT BETTER...JS.
HER COLOR IMPROVES A LITTLE.D.TS.DONE,DO
NE,0,NORMAL EXCEPT FOR SLIGHTLY LARGE PU
PILS....S.HER HEART SOUNDS ARE SLOW AND
FAINT BREATHING IS SLOW AND SHALLOW.
5..S.REFLEXES ARE SLIGHTLY HYPOACTIVE...
.S.SHE HAS A MEDIC-ALERT BRACELET LISTIN
G NAME AND DIAGNOSIS OF DIABETES....S.S
HE IS CLAMMY AND PALE,NORMAL,0....S.SEVE
RAL SECURITY GUARDS ARRIVE AND STAN
D AROUND CRACKING JOKES.-..T.THEY ARE BU
SY RIGHT NOW-- TRY AGAIN L
ATER!.Y..T.PSYCH RESIDENT SUGGESTS YOU C
HECK FOR INSULIN COMA AND CALL MEDICIN
E....T. SHOCKED RELATIVES TELL YOU ABOUT
HER DIABETES.Y.$T.SURGEONS ARE ALL T
IED UP JUST NOW,0......"....LOAD"G(34)"1
"G(34)",8":."....RUN.".#."..631,13:.632,
13:.198,2:....
> CLICK IMAGE PREVIEW FOR FULL MODAL