2nd Meeting with Deborah

On Monday 5th Febuary we met again with the doctor in CUH following a suggestion of hers that it might be more appropraite to set the game in an on call ward rather than an A&E as this experience would more accurately reflect the type of situation an intern doctor would be faced with and also meant that one person would be responsible for making all of the decisions which suited our game a lot more. This means adding a ward area to the in game hospital we have already designed and built as well as restructuring the procedure for dealing with a patient.

Below is a rough outline as to how we see this new procedure working :

The patient is a 45 year old male, one week post-op, somewhat overweight, driven in by a member of his family. (note that age and physical description of the patient has changed in order to achieve a more realistic case)

The nurse presents the player with the following information:
1. Lower abdominal pain
2. One week post appendicectomi
3. Feeling nauseous
4. Feeling unwell

The nurse may also provide the doctor with the patient's recent vitals and bloods, and if she doesn't the doctor(player) should ask for them:
1. Mild tachycardia
2. Heart rare : 105
3. Blood Pressure, stable, 135/85
4. No temperature

The player will then have the option to look over the patients notes and meds and these should be utilised in order to achieve a good outcome in the game.

If the player chooses these options he will be presented with the following information:

Meds:
On Tranadol (painkiller)

Past Medical History:
High cholesterol - on a high dose of medication for 1t (14mgs)
Past history of alcohol abuse
On a binge the night before
Was on a binge the night before the operation
Attributed some of the pain to the alcohol drank the night before
Smokes 10 - 15 cigarettes a day
Married, one child

Family History:
No major diseases
Uncle died suddenly in his 40s (maybe heart related)

It is now, and not before reviewing the patient's history and meds, that the player should talk to the patient and review his symptoms:
No headaches
Some dizziness
No urinary symptoms
Tachycardic

The player should note on examination:
Pale
Pain, mainly epigastric
Unwell
Sweating
Abdomen mildly distended, not very tender
Bowel signs are present
Respiratory system is clear
Chest is clear
Cardiovascular heart sounds 1 & 2, no murmurs


Following the examination the player will have to access the patient as being "well"(monitor for a while), "unwell" or "very unwell"(call arrest team).

The correct assessment for this scenario is "unwell".

Now the player will be presented with a number of options. Some of these options will have sub-options. The options are:

Get ECG (correct)
Don't get ECG
Get Bloods -> Now (correct) or In The Morning -> What types of bloods?
Get Chest X-Ray -> Normal or Errect
Get PFA
CT Abdomin

If the player makes the right choices he will get teh appropriate feedback. We will be able to return the results of the ECG by displaying a static image of the graph and by looking at this image the player should be able to identify the key information it represents.

The player will then be asked if they are concerned about the results. They can reply:
Yes (correct) or No

If they answer correctly they will be presented with a list of potential treatments for the patient such as:

Afib
ST Elevation Mi
Non ST Elevation Mi (correct)
Pericarditis

If the player chooses correctly the player will win the game but if the player chooses incorrectly the player will lose the game.

If will also be possible for the player to call for assistance at any point throughout the game although this will only be the correct action at key moments in the procedure's timeline.

This is just a rough outline of the things we may or may not include and we will be tightening the overall process as we move forward with the game.