I wanted a way to simulate cardiac emergencies that are a staple of medical dramas, and reading through The Scut Monkey’s Handbook (Clinician’s Pocket Reference, 7th Edition), I found my answer in the rigid steps of the ACLS protocol. So:

MEDICAL HOSPITAL: CARDIAC ARREST

At each step in the protocol, the doctor announces the procedure and an assistant randomizes. A zero digit (or ten on a ten-sided die) indicates a successful return to a normal heart rhythm. The doctor can increase the odds of success by taking stress — one point of stress may be accrued per step, and increases the odds of success by 10%. Thus, if a doctor adds a point of stress, all further attempts will succeed on a nine or ten. If a doctor steadily adds stress, the chances of success increase accordingly. Only one point of stress may be added per step. After randomizing, the assistant reports the patient’s status to the doctor.

1. Check for pulse. If absent, initiate basic CPR. Check rhythm. If ventricular fibrillation or tachycardia is occurring, continue to perform basic CPR until a defibrillator is available. When available, apply paste and place paddles as directed on handles. Defibrillate at 200 joules. Clear!
If no conversion, continue.

2. Defibrillate at 300 joules. Clear!
If no conversion, continue.

3. Defibrillate at 360 joules, maximum output. Clear!
If no conversion, resume CPR and continue.

4. Establish an IV line and give epinephrine 1:10,000 solution 0.5-1.0 mg IV push. Intubate if possible. Defibrillate at 360 joules. Clear!
If no conversion, continue.

5. Give lidocaine 1 mg per kg of patient weight, IV push. Defibrillate at 360 joules. Clear!
If no conversion, continue.

6. Repeat lidocaine at 0.5 mg per kg of patient weight IV push. Defibrillate at 360 joules. Clear!
If no conversion, continue.

7. Give bretylium 5 mg per kg of patient weight, IV push. Consider bicarbonate or additional lidocaine bolus. Defibrillate at 360 joules. Clear!
If no conversion, patient dies.

So it’s a dumb little mini-game where the doctor must accrue stress to succeed, and the question is how much, and when. Meanwhile, you’ve got the defibrillator going, some drama at the table, I think it’ll be fun. Don’t use the above protocol to try and convert somebody for real, please.

Clear!
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2 thoughts on “Clear!

  • June 12, 2008 at 3:28 pm
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    what does stress do to the doctor who chooses to take it?

  • June 15, 2008 at 11:13 am
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    Sorry, I missed your comment. Stress puts limitation on a player’s actions each turn. The higher your stress, the fewer options you have. At the highest level, 9, you have one option for your scene: “A patient dies in your care”. At the lowest levels, you get many fun and character-building choices.

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