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Post by dwindsweptwayne on Aug 9, 2012 20:39:29 GMT -5
8/9
This is an expanded, formal chart for Phillip Mason, who was logged into the clinic after an explosion at the helipad.
Pt is 35 year old caucasian male, approx. 5'10, weight WNL for height.
On 8/8, patient was in the direct line of force from an explosion. The resultant impact caused a blunt-force cardiac arrest. CPR was performed at the scene by Anthony. Patient was transported, and required cardiac conversion by external electrical stimulation.
Patient was placed on IV fluids and cardiac monitoring.
Approximately 4 hrs post trauma, patient lost breath sounds on the right side. Auscultation and auditory examination by stethoscope revealed potential collapsed lung. A chest tube was inserted, at which time the area drained approximately 90ml of fluid and blood. The chest tube was left in place.
Approximately 3 pm ET, the left lung was determined to have collapsed. A second chest tube was inserted, and approximately 220ml of fluid drained from the lung.
Both chest tubes are currently draining at a rate of approximately 5-8ml per hour. The IV has been slowed to 15ml per hour to prevent excess fluid buildup in the lungs and subsequent "drowning" due to the hematomas of the lungs.
At approximately 7pm ET on 8/9, echocardiogram revealed a massive cardiac tamponade, with a minimum volume of 300ml, and a potential maximum volume over 600ml. Pericardiocentisis was performed, resulting in 470 ml of mixed fluid and dark blood.
*Note from Darlene -- I know there's significance to the blood around the heart being so dark... but I'm going to have to research it -- I can't pull it off the top of my head right now.
At 8:38pm, heart rate was 92bpm, Blood pressure is 90/60, patient is still unconscious, cyanotic, and in acute respiratory distress.
12:05 ET
Repeat Ultrasound found an anomaly in the aorta. Diagnosis: DeBakey II, Stanford A proximal aortic dissection, leaking into the pericardium.
Surgery was initiated a 11:18 pm ET by Rebekkah Johnson, with Darlene Wayne at Scrub and Josie circulating.
at12:02, the aortic dissection was exposed, with a 7 cm long dissection of the proximal arch. There was pronounced distention and a visible pulsing of the distended aortic tissue.
Attempts to suture the dissection resulted in rupture of the aorta and tearing of the over-stretched pericardium. Blood loss was approximately 2 liters in less than 30 seconds.
Patient went into immediate cardiac arrest, and was unable to be revived.
Time of death 12:05am August 10
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Post by dwindsweptwayne on Aug 12, 2012 14:33:15 GMT -5
8/11 This is a NO-TOUCH "autopsy" based on information acquired through observation of the patient and review of the patient's personal diary. In this document, the reviewer will attempt to explain the patient's acquisition of Rager virus, subsequent behaviors, and eventual demise for the understanding and posterity of New Haven, and to address the future health needs of the Community. Lawrence picked up the "cold" that was going around New Haven. For most individuals, this cold has been nothing more than an annoyance. However, in reviewing Lawrence's journal, there are distinct symptoms that, if they had become public, might have been caught much sooner. We would still not have been able to do anything to prevent Lawrence's death, but the deaths of both Elizabeth and Stewart Horner might have been prevented. In one of the early journal entries, right after the fever associated with the cold virus, Lawrence mentions red and black spots before his eyes, and later, he mentions a red wash on his vision. For anyone who dealt with the H5N1 "Rager" variant, this symptom would be immediately recognizable as a "key" symptom for Rager infection. Also of critical note, pending a policy decision from Jackson as the New Haven leader, is the fact that this previous March, Lawrence, along with several other teens, was injected by the PTB with the experimental variant of the Rager virus that was discussed in earlier documents relating to Lucius Hasting's recovery of the individuals in the New Orleans installation group. None of the other teens survived the injection process, however, Lawrence did NOT show primary illness from the injection, and was considered "immune". He did not report his injection -- we only found note of it in his diary. Therefore, in order to insure the health of our population, a notice should be sent out informing our people that, if they WERE injected, we need to know, in order to determine how to manage the situation with minimal loss of life within our Community. Lawrence's transition from initial illness with the 'cold' to full Rager status took approximately 7 days, which is consistent with the OLD conversion period for Rager virus, which may indicate that this latent form of Rager virus has a shortened conversion period compared to the "initial infection Rager II" variant we've been noticing over the past few months. HOWEVER, IN CONVERSION, Lawrence was still able to plot, think, reason, plan, and implement plans. Until the very end, he was able to think and make use of a 'decision tree' -- his actions were NEVER mindless, even with the full force of the Rage activity conversion in place. This is a NEW variant, with a time differential that may be caused by latent viral activity, even though no symptoms are showing. Of further concern - Will individuals in deteriorating health states who have either been exposed and not picked up the disease or who have been injected (including things like aging, etc.) result in ongoing conversions to Rager state and incipient zombification at death? Recommendations: - All individuals coming into New Haven should be screened for signs of recent injections, and should be asked directly whether they have had any immunizations or treatments, particularly if those immunizations or treatments were part of a local health department, military, or other government "immunization/cure" recruitment.
- All illnesses, no matter how minor, must be monitored to assure that no incipient "rager trait" symptoms are developing in the individual.
- All deceased individuals must be cremated. No bodies should be allowed to be buried or otherwise disposed of on New Haven lands.
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Post by Selsie Turner on Aug 14, 2012 1:17:34 GMT -5
8/13
Dr. Guage "Vertigo" Cashin was brought to Darlene's clinic late this evening following a motorcycle wreck. Patient presents with a compound fracture of left arm (not specified in the scripts, so we'll go with the non-dominant arm), bone protruding just beneath the elbow. Multiple contusions and road rash abrasions on right arm and side, along with sixth and seventh ribs fractured, no lung punctures or internal damage.
With Darlene Wayne still under the weather, Dr. Noisewater was called from his house to provide primary care, medic Samuel Chase and veterinarian Rocky Johnson assisting.
Patient initially refused medical treatment until Selsie Turner pointed out his compound fracture. He promptly fell unconscious from shock and was immediately transported to the clinic, where he was stripped and cleaned up, abrasions swabbed with antibiotic solution and ribs wrapped, and placed on IV to replace lost fluids. The same sterile procedures as were given to Sophie DuBois' compound fracture were observed here. The bone has been re-set, an "open" cast applied to allow the wound to breathe and be treated in the event of infection, and the patient is in traction.
Colin Street donated the morphine in his pack to assist with Dr. Guage's pain management, in addition to the supplies the Clinic has on hand.
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Post by vertigo on Aug 14, 2012 10:13:05 GMT -5
Guage's Injuries.
6th - 7th Ribs fractured with no internal damage (Left side) Dislocated (now fixed)Left shoulder Fractured Radius left arm, through skin Concussion Road Rash along left side
** A post was made about how he wrapped his strap of his G36 assault rifle around his right arm, where his right arm was not injured, his right hand his 'business' hand **
Once Guage came to the next morning he instructed that he has a stockpile of equipment both from his initial Combat Medical supplies, his personal Dr.s Trauma kit. As well as the ambulance he and Cas brought in last night.
The Ambulance is overstocked with morphine, Antibiotics, pain killers, bandages and other first aid equipment. Along with the following items.
Ventilation and airway equipment Defibrillator Immobilization devices Infection Control Burn Kit Cardiac Monitor Portable Ultrasound Pre-loaded Syringes Glucometer and strips Respirator Surgical kit EKG Monitor GE DASH Patient Monitors X2 Blood pressure monitor Patient carrying Devices Stethoscope
These items are not a part of Guage's personal medical devices and tools.
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Post by vertigo on Aug 14, 2012 12:46:47 GMT -5
For the most part how Guage would want the equipment done would be for the betterment of the group. Having seen a pregnant woman he knew bringing in the ultrasound equipment could be invaluable and his training would allow him to use and diagnose any problems. (will make for some fun RP)
The accident was only last night and he is probably pretty heavily medicated right now. The ambulance needs to be heavily disinfected in the driver seat and cleaned... He will allow anyone to use the items he brought back....
However his personal items (which are stored on my own personal sheet for him) he is keeping to himself for now... He has only been in New Haven for a little while and trust only goes so far.
I want to roleplay out most of the scenes regarding Guage but I am open and willing to do an ongoing thread with respects to 'downtime'
..... on another note , I am enjoying this room so far, my first RP in 7+ years.
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Post by dwindsweptwayne on Oct 12, 2012 23:14:34 GMT -5
Chrisette came in for a pregnancy test today. The pregnancy test was positive, so we did a prenatal exam.
LMP: August 19
Slightly longer than usual luteal phase and cycle.
EDD: May 26.
Currently: ~7 wks, 5 days
Chris is severely underweight. She's on a strict diet, and I've informed the kitchen staff to increase her portions accordingly, especially fats and protein.
Pelvis looks good, measurements look fine.
CBC: red count is low Urine: WNL, no white cells, no blood, no protein/glucose
Return to Clinic: November 12
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Post by Sophie on Nov 2, 2012 17:48:35 GMT -5
Rebekkah Johnson
Injured on 10/28 by Defiance during storm preparations. He caught her left shin with his hoof and avulsed a 2” x 5” flap.
Seen in the clinic on 11/1. Wound was numbed, cleaned, and debrided. Colin Street removed the flap of skin, coated in antibiotic ointment and bandaged it with orders to change the bandages daily. He also recommended daily antibiotics for the next week. Additionally, she was given IM Ampicillin and Tetnus Antitoxin.
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Post by Sophie on Nov 7, 2012 15:52:53 GMT -5
Ben, last name unknown.
Newcomer to New Haven. On 11/6/2012 he began to exhibit symptoms of possible early Rage Virus infection. Ben has been confined where he cannot hurt anyone and Sophie has taken blood.
It will take approximately 2-3 days to determine if he has been infected.
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Post by dwindsweptwayne on Nov 23, 2012 11:35:22 GMT -5
Izabella Maria Edwards was born on 11/21 by emergency c-section after her mother, Josie Edwards, experienced an acute placental abruption with hemorrhage. Izabella was only at 32 weeks gestation at the time of surgery. She is breathing on her own, but breath sounds are irregular and there is crackling and rales in the right lung. She is on supplemental oxygen for 30 minutes every 2 hrs by pediatric mask, at 2 lpm. Hematocrit is low, which is to be expected. Suck reflex is weak. She is being managed by "kangaroo parenting" -- skin to skin supported in a special wrap, no diaper -- just absorbent padding. Josie has been set up with a supplemental feeding system, and colostrum from the milk bank is being provided at 4-5 oz per day until Josie's milk comes in, then Josie will be encouraged to nurse Izabella on one side and pump on the other to provide milk for the supplemental nursing system. Izabella must be carried in the kangaroo system 100 percent of the time until she is about 1 month old. Survival for the first 7 days is around a 40% chance. After 7 days, that goes up to about 60% for a month, and then closer to 90% until she is about 6 months old. Because of the state of her prematurity, it will take her about 6 months to get past the risks of her birth. 1/23/2014 Izabella passed away this afternoon due to complications from immature lungs. Documentation is below www.aetherbound.com/virtualworlds/aftermath/roleplaylog/read.php?3,3
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Post by dwindsweptwayne on Nov 25, 2012 22:38:45 GMT -5
11/25/2014 Maya came to the clinic for a pregnancy test. She said that she'd had a couple of over the counter test positives, but we did the blood test anyway, since the otc tests may be compromised from age and poor environmental control during storage. The test was positive. I asked Maya to schedule a prenatal visit so we can get some baselines of her health and figure out how far she is along, and when she's due. She can have the appointment with me, or schedule with Rocky (who now has OB experience), Lilly (who is a GP and 3rd year surg resident), or Tobey (GYN surgical oncologist). (Link to roll: www.aetherbound.com/virtualworlds/aftermath/roleplaylog/list.php?3)12/16 TriageMaya was brought into the clinic today in critical condition, following a violent captive-event. Physical examination revealed - multiple contusions over her entire body;
- severe abrasions of wrists and ankles, as well as other moderately severe abrasions on torso and limbs;
- Lacerations to face
- Severe contusions of throat, and eye petichia consistent with strangulation injury
- Lacerations to torso (primarily back);
- GSW to RT bicep and LT hip: Both wounds through-and-through, with no bone involvement. Bullets do not appear to be soft-point or hollow-point, as wounds are nearly the same size on either side of the through-and-through.
- Evidence of 1st degree tearing around anal canal and into perineal area.
- Mild hypothermia (initial body temperature at 97.2)
- Dehydration
- Psychogenic shock (wounds were not sufficient to cause hypovolemic shock, though symptomology does not distinguish)
Treatment
Treatment was initiated to respond to issues in order of emergent nature.
1. IV was started with warmed Ringer's Lactate to restore blood pressure (shock), and to address both dehydration and hypothermia, which would aggravate shock condition.
2. Warmed and moisturized oxygen was started at 10 Lpm to address shock, and oxygen deprivation that may have resulted from strangulation injuries, as well as providing warmed air to assist with hypothermia.
3. Evaluation of FHT and condition of fetus via ultrasound confirms that fetus is intact, FHT is present (162 BPM), and no signs of trauma to implantation.
4. Evaluation of head injury (laceration and blows to face) was addressed, with finding of moderate concussion.
5. Injuries to face were cleaned, to assure that no hidden bone fractures to face or skull were involved. Debridement of wounds was completed using 1% lidocaine (to minimize localized swelling commensurate to suturing) to numb area while wounds were opened, necrotic tissue from delayed care removed, and dirt and foreign material cleansed from wound site.
6. Suture of facial lacerations (brow and lip) were undertaken at this time, using 2-0 chromic gut (dissolvable) on tapered 3/8" circular needle for brow, and 1-0 PGA on 3/8" tapered circular for lip, and micro-placement of sutures at 3mm separation (using illuminated magnifier to assist) in order to minimize scar formation and allow for the possibility of delayed RTC for suture removal. (26 stitches to brow, 7 stitches to lip)
7. T-T GSW to LT hip was cleaned by flush and dip method. Wound was NOT sutured, and drain was placed, in order to minimize risk of infection being sutured into wound and wound healing over undiagnosed infection. This would require future surgical management, and the possibility of deep necrosis -- to be avoided at all costs.
8. T-T GSW to RT arm managed in same method as LT hip. Significant cavitation of arm muscle will bear watching, to assure that necrotic tissue is removed promptly and that wound heals from inside out.
9. Antibiotic treatment with broad spectrum antibiotics (250mg q12 Ceftraixone and 600mg q12 Ceftaroline fosamil over 60min) by IV started.
10. Lidocaine 2% was used to numb back, using local nerve block of posterior cutaneous nerve. Lacerations to back were cleaned, debrieded, and necrotic tissue from delayed treatment was removed. 4-0 PGA suture over 1/2" taper needle, with 6mm separation between sutures was used to suture back lacerations. (PGA absorbable suture was chosen due to possible delay in suture removal or failure to RTC for suture removal once patient is released from clinic). (47 stitches to 7 lacerations). Remaining lacerations were cleaned, treated with Silvadene and covered.
11. One peri-anal tear was sutured, using local 1% lidocaine to numb area.
12. Abrasions to wrists and ankles were cleaned, treated with Silvadene, and wrapped to prevent further damage. Dressings can be removed in 48 hrs and wounds left open to complete healing.
Maya was settled in one of the clinic overnight care beds. O2 will be continued for 24 hrs. Warmed infiltrates will be continued until body temperature is sustained at no less than 98.4F for 8 hrs, with hourly temperature monitoring for 12 hrs after termination of warmed infiltrates, to assure that body temperature remains stable.
Vitals other than temperature will be monitored every 60 minutes for the first 12 hrs, then every 4 hrs for the first 48 hrs. Evaluation of cognition will occur on the same schedule to assure no hidden brain injury is undetected.
Pt. may return home within 1 week, provided there is someone there to manage her care.
*NOTE: Per some of the findings of this physical exam, and the traumatic situation of the infliction of these injuries, as well as Maya's gestational situation, it is STRONGLY recommended that emotional/mental supportive care be integrated into her healing regimen. I will discuss this with the patient. We currently have a mental health professional on team, as well as a priest, Luc and myself, so I am profoundly hopeful that she will find someone with whom she can begin her non-physical healing, especially with her expecting a baby.
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Post by dwindsweptwayne on Dec 12, 2012 15:30:01 GMT -5
12/2
Ella was brought to the clinic with a body temperature of 95.7F (35.4C), severely hypothermic. In addition, Ella had multiple hematomas covering a significant portion of her body; evidence of brain injury including sluggish pupil response on one side and uneven pupils, and numerous blunt trauma injuries.
Emergent treatment was required to restore Ella's normal body temperature, and both warmed infusion of Ringer's Lactate and immersion in 103 degree water (continuously wood-heated Ofuro) until body temperature was restored to 98.2 degrees F (36.8C).
Upon completion of emergent treatment for hypothermia, Ella was examined to determine the extent of additional injuries. Head injury was confirmed as a moderate concussion. Additionally, a non-displaced fracture of the 4th right-side rib was discovered.
Ella remained in the clinic for 48 hrs to assure that the concussion was healing and that there were no signs of exacerbated brain injury including subdural hematoma or cerebral edema. As soon as pt. was stable, she was returned to her home to continue to recuperate.
The fractured rib was wrapped, taped, and splinted using the "combined arm splinting" method. Patient was advised that she would need to restrict activity and maintain splinting for 4-6 weeks, in order to allow the rib to heal effectively and to prevent splintering that might do damage in or around the lungs.
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Post by dwindsweptwayne on Dec 25, 2012 7:54:37 GMT -5
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Post by dwindsweptwayne on Jan 9, 2013 15:28:37 GMT -5
January 9
Maya came in for a routine prenatal visit today.
LMP: September 14 (this would mean a conception date ~9/27)
EDD: June 20
Fundal Height: 16.2cm
FHR: 160 bpm
Gestational Age: 16 wks
Pulse: 76
B/P: 118/84
Temp: 98.8
Glucose: Neg
Ketones: Neg
Protein: Neg
INITIAL BLOODWORK:
HCT: 38%
HGB: 11ng/dL
WBC: 5500 cells/mL
PLA: 272,000/mmol
Viral Load: Negative
Rh: +
ABO: AB
Maya is a nullipara, 16 wks pregnant. Fundal height 16.2cm, which corresponds normally to estimated due date . Blood work looks good. Viral load and antibody titers for flu were negative.
I gave Maya recommendations on exercise, body-safety, nutrition and rest. For now, there are no limitations on her duty, although I am strongly recommending that she speak with a confidant of her choosing regarding her recent trauma, in order to assure that it will not affect her well-being as she goes through the emotional swings of pregnancy.
I did inform her that I will recommend light duty, beginning in her 28th week, and will recommend desk-duty beginning in her 32nd week, as routine cautions considering the very physical and highly demanding nature of her work.
I'll expect to see Maya in clinic again in a month for her next prenatal.
RTC: on or about February 9
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Post by dwindsweptwayne on Jan 15, 2013 20:12:14 GMT -5
LMP: December 6 (conceived 12/15 during assault by Tricckey Tatters)
EDD: September 7
Fundal Height: NA
FHR: NA
Gestational Age: 6 wks
Pulse: 76
B/P: 118/84
Temp: 98.8
Glucose: Neg
Ketones: Neg
Protein: Neg
INITIAL BLOODWORK:
HCT: 38%
HGB: 11ng/dL
WBC: 5500 cells/mL
PLA: 272,000/mmol
Viral Load: Negative
Rh: -
ABO: O
Tsuritsa is a nullipara, ~6 wks pregnant. Blood work looks good. Viral load and antibody titers for flu were negative. Tsuri has been experiencing some heightened sensitivity to smell, and nausea. Advised her to keep me appraised if she starts having actual vomiting.
I gave Tsuri recommendations on exercise, body-safety, nutrition and rest. I am strongly recommending that she speak with a confidant of her choosing regarding her recent trauma, in order to assure that it will not affect her well-being as she goes through the emotional swings of pregnancy.
I'll expect to see Tsuri in clinic again in a month for her next prenatal.
RTC: on or about February 6
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Post by dwindsweptwayne on Feb 10, 2013 14:54:53 GMT -5
February 10
Maya came in for a routine prenatal visit today.
LMP: September 14 (this would mean a conception date ~9/27)
EDD: June 20
Fundal Height: 19.2cm
FHR: 156 bpm
Gestational Age: 20 wks
Pulse: 76
B/P: 118/84
Temp: 98.2
URINE:
Glucose: Neg
Ketones: Neg
Protein: Neg
BLOODWORK:
HCT: 36%
HGB: 9 ng/dL
WBC: 5500 cells/mL
PLA: 272,000/mmol
Viral Load: Negative
Rh: +
ABO: AB
Maya is a nullipara, 20 wks pregnant. Fundal height 19.2cm, which is a little small for her due date . Blood work looks good. Viral load and antibody titers for flu were negative. Weight gain is negative -- as in, Maya has actually lost a couple of pounds since her last visit, and she indicated that she's having trouble sleeping -- midnight waking, delayed onset of sleep.
I've provided an herbal supplement to assist her in getting better sleep, and prescribed a diet that takes into account her activity level and metabolism, with a daily calorie requirement of around 3000 kcal/day. I've included a scrip to be given to the kitchen, to make sure that she doesn't have a problem obtaining travel variants of suitable foods for when she's on patrol.
I've informed her that if she does not show at least a 2 lb weight gain by the next visit, I will be compelled to put her on bed-rest to prevent intrauterine developmental issues with the baby.
I'll expect to see Maya in clinic again in a month for her next prenatal.
RTC: on or about March 9
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