Guide to Medical

This is an advanced guide for following extremely realistic roleplay. Don't follow this if you're not one after detail.

Medical is a demanding job for Doctors and the Chief Medical Officer to perform, and as a result, the proper procedures should be followed when treating patients.

This guide will show the recommended procedures to follow when performing medical duties.

Terminology

Medical terms every good Doctor must know.

Vitals

• HR: Heart rate. The measure, in bpm, of a patient's heart activity. 60-100 bpm at rest is considered normal.
• BP: Blood pressure. The pressure of a patient's blood vessels (measured in mmHg [mm of mercury] above surrounding atmospheric pressure [101kPa]). Measured with a systolic (maximum) and diastolic (minimum) measurement. 120/80 mmHg is considered normal.
• Resuscitation: The act of reviving a patient from a state of near-death through defibrillation, CPR, or other means.
• CPR: Cardiopulmonary resuscitation. The act of pumping the chest of a critical patient with both hands or through a machine to attempt to make blood flow around the body. CPR should be performed at 100 bpm (100 compressions per minute).

CA AND HEART ATTACK ARE BEING REVAMPED

• Bradycardia: A slow heart rate, generally considered to be lower than 60bpm for non-pediatric patients.
• Tachycardia: A fast heart rate, generally considered to be higher than 100bpm for non-pediatric patients.
• Hypotension: A low blood pressure, generally considered to be less than 90/60.
• Hypertension: A high blood pressure, generally considered to be over 130/80.

Equipment

• ECG: Electrocardiogram. Graphing system used to visually see the heart rhythm of a patient to diagnose heart conditions such as an arrhythmia.
• EEG: Electroencephalogram. A device used to measure the brain activity of a patient.
• Defibrillator/Defib: A set of two pads used to deliver an electric shock to a patient to stabilize certain heart conditions such as a heart arrhythmia. The act of using a defibrillator is called Defibrillation.
• IV: Intravenous (fluid). A method of medication or blood injection by injecting a persistent injection port into a vein on a person's body (forearm, neck, chest, extremities), and then administering medicine by connecting the port via a tube to an external bag holding the fluid.

Triage

Triaging is the process of basing incoming patients' care priority based on the extent of their injuries or ailments, including their condition and their physical and mental state.

Doctors should look for the following and determine a patient's condition accordingly:

	Red	Orange	Yellow	Green
Airways	Obstructed	Threatened	Clear	Clear
HR/Heart Rate (bpm)	>130 bpm	121-130 bpm	111-120 bpm	50-110 bpm
GCS*	< 8	9-13	14	15
Traumatic Bleeding	Hemmorhage	Major	Minor	None
Procedure	Resuscitation**	Urgent	Less urgent	Not urgent

*GCS stands for the Glasgow Coma Scale. See below for the Glasgow Coma Scale chart.

A patient should also be prioritized based on the extent of their visual injuries--someone with bullet wounds should be prioritized over someone with a light cut or bruise.

Once patients have been appropriately prioritized, proceed to Treatment.

Glasgow Coma Scale (GCS)

The Glasgow Coma Scale (GCS) is a measure of the awareness level of a patient from a scale of 3-15: 14-15 being peak consciousness (normal, everyday function) to 3 (comatose). A number should be assigned accordingly based on how conscious the patient is when responding to stimuli such as bright lights in the eyes, or pain.

Scans and Diagnosis

Scanning a patient to find a potential diagnosis (and subsequent treatment) can be done through invasive and non-invasive methods.

• A Body scan involves the usage of the scanner inside the medical bay to perform a body scan of the patient. Useful for finding internal ailments. The scanner has two modes:
  • A CT/CAT scan uses x-ray viewing.
  • An MRI uses a magnetic field.
• A blood test can be performed to look for diseases, pathogens or toxins in the blood.
• Sonography, also known as ultrasound, can be used to find minor problems, determine blood flow, or perform a prerequisite scan before using a body scan.
• Monitoring a patient's ECG can give insight into any cardiac conditions they may have.

Trauma Treatment

Trauma is defined as the presence of vascular injuries to the body. Treating trauma can range from simple gauze and wound management to surgery.

Wound Treatment and Dressing

Steps to close and seal a wound.

1. Wash or sterilize your hands before attempting to touch compromised skin.
2. If the wound is bleeding, apply pressure using a clean, dry gauze pad until bleeding subsides.
3. Clean the wound with soap and warm, running water. If water is not available, use a non-sting disinfectant. Do not use alcohol.
4. Dry the area using dry gauze pads. Dab the pads on the wound; do not rub or wipe.
5. Dress the wound using gauze roll and medical tape. Do not apply adhesive directly to the wound.

Emergency wound treatment: The following procedure should be used if a wound is profusely bleeding, has not stopped bleeding or is larger than 2 cm in diameter or length in any dimension.

1. Thoroughly apply iodine around the wound, never on it.
2. If the wound is in an extremity (such as the limb), if the bleeding is arterial tightly wrap a tourniquet cuff or rope around the portion of the limb closer to the body to limit blood flow to the wound and create a tourniquet.
3. Use a sterile gauze roll and medical tape or large bandages to wrap the wound tightly to apply pressure.
4. After bleeding has subsided, use medical staples or stitches to force the wound to seal.
5. Apply a bandage over the wound to prevent infection.
6. Treat for shock if present (see below).

Bone breakage

Bone breakage can be defined as the fracture, splintering, or shattering of a bone.

1. Perform wound treatment and dressing if there is an open wound.
2. Immobilize the injured area by applying a splint above and below the injured areas.
3. Apply cold gel packs to the injured area to minimize swelling.
4. Treat with anesthetic or painkillers to minimize pain and risk of shock.
5. Treat for shock if present (see below).

Shock treatment

Treating a patient who begins to display rapid breathing, lightheadedness or otherwise beginning to feel faint or pass out, perform shock treatment immediately.

1. Lay the person down on a bed or couch or, if none is available, on a flat surface.
2. Elevate the patient's feet about 12 inches (30 cm) above their head unless the head, neck or spine is injured. Do not raise their head.
3. If the patient is at risk of vomiting, turn them to the side.
4. Administer oxygen and appropriate IV fluids (see section "IVs" below).

Medication

Medication for various types of injury can be applied, with varying side effects and overdose limits.

Name	Treatment for	Description	Side Effects	Overdose effects
Bicaridine	Trauma	Stimulates platelets in the bloodstream and encourages the body to allocate more resources to wound management. Greatly accelerates trauma healing.	Weakness, fever	Coma
Kelotane	Burns	Promotes the redevelopment of damaged tissue as well as stimulating the immune system to remove dead burn tissue. Greatly accelerates burn healing.	Lowered immune system, fever	Internal bleeding
Dylovene	Toxins	Contains a complex protein structure that attracts poisons or toxins capable of damaging biological tissue. Neutralizes toxins and can be safely purged via the liver. Has the side effect of encouraging expulsion of toxins via vomiting.	Vomiting, nausea	Poisonous in large doses
Inaprovaline	Stabilization	Raises heart rate, increases awareness, prevents patients in critical condition from having their heart stop beating. Mild painkiller.	Heart damage	Cardiac arrest
Peridaxon	Organ treatment	Promotes healing and revival of damaged or decaying organs at the cost of taking resources away from bodily function.	Weakness, lower organ efficiency	Coma
Dexalin	Oxygenation	A protein compound containing oxygen that can be safely metabolized by the body to deliver oxygen when the lungs or heart are compromised.	Hypotension	Oxygen toxicity syndrome
Cordrazine	Revival	A modified form of epinephrine that is specially used to treat cardiac arrest. Has a significantly reduced rate of brain damage when used compared to epinephrine.	Brain damage	Myocardial infarction
Alkysine	Brain	An experimental drug that forces the brain to make new neurons in place of damaged or deceased ones. Has several controversial side effects.	Short-term memory loss, disorientation	Amnesia, dementia

IVs

IVs (intravenous fluid) is a method of medication or blood injection by injecting a persistent injection port into a vein on a person's body (forearm, neck, chest, extremities), and then administering medicine by connecting the port via a tube to an external bag holding the fluid.

A list of common IV fluids can be found below, though medications and other fluids may be used depending on the situation.

Fluid	Composition	Usage
Saline-glucose solution (Saline)	0.9% NaCl dissolved in water	General nutrition and hydration
Ringer's Lactate (RL/RiLac)	NaCl, sodium lactate, KCl, CaCl in water	Replacing fluids and electrolytes in patients with low blood pressure or volume
Dextrose solution (D5W)	dextrose in water	Treats low blood sugar or water loss
Blood	blood	Injection of blood is used to treat transfusions
Carbopluoxicium	N/A	Used as an artificial oxidizer for a patient with compromised lungs

Disease Control

Disease control is the act of isolating a patient infected with a contagious pathogen such as a fungal, bacterial or viral infection.

Notes to treatment:

• If the pathogen is highly contagious, isolate the patient in one of two Quarantine chambers available in the medical bay.
• Avoid direct contact with a quarantined patient and always use proper hazmat gear.

Medication

Infections can potentially be mitigated through the usage of several available medicines.

Medicine name	Treats	Description	Taken by
Penicillin-10	bacterial infections	A modified, more potent strain of penicillin for more effective usage in treating infections.	Oral, injection
Kavananir	viral infections	An antiviral drug invented in the mid-21st century capable of treating most mild to moderate viral infections.	Injection
Imucondozone	immune booster	An immunotherapeutic drug used to boost the natural state of the immune system. Should be taken with supplemental nutrients to provide the necessary resources.	Oral, Injection
Bacteriophages	bacterial infections	An experimental treatment that uses viruses that only attack and infect bacteria. Useful for treating severe bacterial infections.	Injection
Fungicium-B	fungal infections	A medication containing a select amount of artificial and organic chemicals that specifically target and kill harmful fungi.	Oral

Surgery

Surgery should be performed when the aforementioned treatments are not enough or are ineffective, such as gunshot wounds or other severe traumatic injuries or disease.

Tools

The following is a list of equipment for surgery:

• Scalpel: Used for making incisions.
• Laser scalpel: Used for precise surgeries that only require a minimal entry point.
• Hemostat: Used for clamping arteries shut and additionally grabbing onto objects.
• Retractor: Used for keeping open an incision.
• Biodegradable thread & needle: Used to stitch an incision or wound closed.
• Cautery: Used to perform emergency wound closure.
• Disposals tray: Used to dispose of foreign or unwanted objects.
• Syringe: Used to inject precise amounts of medicine.

Machinery

The following machinery can be used and is often found in surgery:

• Anesthesia machine: Controls and regulates the flow of anesthesia to a patient undergoing surgery.
• Cardiopulmonary bypass machine: Usually used during cardiac surgery, it acts as an artificial heart that circulates blood and oxygen throughout the body.
• ECG: Used to show the heart rhythm of a patient. Used to diagnose heart arrhythmias.
• Ventilator: A machine used while a patient is under anesthesia or if a patient is incapable of breathing sufficiently on their own. This is used along with an endotracheal tube to intubate someone. It also helps for exhaling, removing CO² from the bloodstream.