Karty
Retired Admin
The Medical Guide
Introduction
The largest issue when roleplaying in a medical capacity, namely with RCFD are those who do not know how to roleplay illness or injury. With this being said, no blame can be passed to them as medicine is hard to comprehend for most people given its dynamic and complicated nature. This guide serves to inform those who wish to roleplay injuries or those who get into an unexpected incident in which injuries should be roleplayed. The end goal is to keep it simple and user friendly. There will undoubtedly be much more to talk about than what I've put in this guide as I cannot possibly list every situation. I hope you enjoy and I'm open for any questions of the medical nature.
Vocabulary
There is a lot of vocabulary that comes with medicine. Although the person providing the roleplay should be using plain english, at times something can slip out and confuse the other party. This list is quite small and only deals with common words said.
- HR - Heart Rate
- RR - Respiratory Rate
- BP - Blood Pressure
- SpO2 - Oxygen Saturation
- BG - Blood Glucose
- CPR - Cardiopulmonary Resuscitation
- BVM - Bag Valve Mask
- IV - Intravenous
- ETT - Endotracheal Tube
Vital Signs
This is where most people roleplaying illness or injury go wrong. Your vital signs are a set of parameters that help the treating party make informed decisions based on what your body is doing. There are five main vital signs we look at on a regular basis.
Heart rate, also known as your pulse is quite simply how fast or slow your heart is beating. The normal range for an adult is between 60 and 100 beats per minute. This can change based on numerous factors including injury, illness, and preexisting conditions. A common assumption within the community is that during trauma your heart will be slower, this is typically not what will happen. When your body experiences trauma a number of things can happen. One of the first things will be shock, everyone has likely experienced shock at some point in their life. When you're in a state of shock your heart rate will increase as you enter a mode known as fight or flight. This state increases your pulse, blood pressure, and breathing rate. Another common misconception is that when losing blood your heart will slow down. Again, it is the opposite and in reality when you've lost a substantial amount of blood your pulse will increase dramatically. This is your body attempting to compensate for the blood loss.
Respiratory rate, this is how fast you're breathing. The normal range for an adult is between 12 and 16 breaths per minute. A stated before, during times of shock your breathing rate will likely increase. During trauma, especially that to the head, your respiratory rate may decrease.
Blood pressure, this is essentially the measurement of the pressure your blood is pumping at, sounds pretty simple. This is actually complicated to most people given the fact that it contains two numbers. In a blood pressure reading there is a top number and a bottom number. The top number is known as the systolic pressure. This is the force of blood against your artery walls as the heart beats. The bottom number is the diastolic pressure. This is the force of blood against your artery walls when your heart is in between beats. Many current roleplayers within the medical area believe that 120/80 is a good blood pressure. This is however wrong as in 2017 the guidelines were updated. This chart shows the updated values.
Oxygen saturation, this is how much oxygen is within your blood stream. The normal oxygen saturation is between 94 and 100 percent. Anything below 90 percent is known as hypoxia. Lung conditions such as asthma and chronic obstructive pulmonary disease can cause lower oxygen values. Trauma to the chest can cause damage to the ribs which in turn can injure the lungs, resulting in decreased capacity and breathing difficulty.
Temperature, this one is pretty simple. The normal temperature is typically between 97.6°F and 99.6°F. Anything over 100.4°F is a fever and anything over 103.1°F is a high fever. This is 36.4°C, 37.5°C, 38°C, and 39.5°C respectively. A low body temperature, also known as hypothermia occurs when the body temperature lowers below roughly 95°F or 35°C. Fevers are typically caused by infection within the body, though a high body temperature can also be caused by heat related illness such as heat exhaustion and heat stroke. Hypothermia is typically caused by being within a cold environment without the proper gear for too long. Many drowning cases in which the patient was in the water for some time can also cause hypothermia.
Trauma
Trauma accounts for almost all of the medical scenarios within RCRP. The most common types are vehicle collisions, stabbings, and gunshot wounds. This section could literally take me hours to write given the uncertainty of injury, but I'll keep it quite basic.
Vehicle collisions are the most commonly responded to calls and the mechanism of injury is quite dynamic. As a general rule of thumb, the faster the vehicles were travelling, the more severe the injuries will be. The most common injuries from traffic accidents are whiplash, concussions/traumatic brain injuries, bone injuries, and internal injury. As stated above, if you decide to roleplay internal bleeding then your blood pressure will drop while your pulse rises. If you roleplay broken ribs and that causes a collapsed lung, then your oxygen saturation will drop and it will be harder to breathe.
Vehicle collisions versus pedestrians or those on motorbikes are extremely dangerous and often deadly. Being on foot or on a motorbike offer you much less protection than a vehicle. Speed plays a big factor in this, when a vehicle is travelling at just 30 miles per hour, there is roughly a 45 percent chance of significant injury or death to the pedestrian. Obviously this increases with speed, therefore getting up after being struck by a vehicle doing 50 seems unlikely.
Stabbings and penetrating trauma are significant injuries that can often result in death. Generally the type and severity of injury is determined by where the knife or bullet ended up. In many cases people like to say that someone cannot survive a knife to the neck, this is simply not true and it depends on where the knife hits, though that's not to say it's likely to live either. If the knife were to sever the carotid artery, it is likely the patient would die from severe bleeding. If the patient were to survive then they could still face life threatening complications such as stroke and pulmonary embolism. According to a medical journal, the death rate for patients with penetrating trauma which impacted the carotid artery, the death rate was 21.5 percent. Of those who survived, 15.1 percent had a stroke. Other places that can easily cause death if stabbed or shot include the lungs, heart, liver, spleen, and femoral artery. The chest, abdomen, and legs respectively. Many people survive gunshot wounds and stabbings if appropriate medical treatment is rendered in a short amount of time.
Resuscitation
For our final topic we talk about resuscitation. Again, this one could be a very long one but I'll keep it brief. Resuscitation, in this case for simplicity, is the attempt to regain a pulse in a patient whom has none.
There are numerous reasons to go into cardiac arrest, the most common in RCRP are blood loss as a result of trauma. When you're in cardiac arrest your heart is either in a rhythm that can be shocked or one that cannot be shocked. For simplicity, this should be kept to two common rhythms. Asystole and ventricular fibrillation (VF). Asystole is the classic flat-line you think of or see in movies. During asystole there is no electrical activity in the heart. VF is a rhythm where there is electrical activity but it is disorganized and not pumping blood around the body. If VF is left untreated it will eventually turn into asystole and even with treatment it is unlikely to resuscitate the person.
During resuscitation some main things are done, the first is that CPR is started. This pumps blood around your body by compressing the heart manually. CPR can often break ribs in older patients and it is actually quite violent to witness. Your airway is also secured, this is usually done with what is known as intubation. Intubation is inserting a tube into your airway to manually breathe for you. The third thing will be giving medications, this is done through an IV line or an IO port. The most common medications given are epinephrine and amiodarone. Epinephrine works with CPR to help restart the heart, this can be given during both asystole and VF. Amiodarone is given during VF to help stop the disorganized rhythm, it cannot be given with asystole.
Defibrillation is done when the heart can be shocked. This sends an electric shock through your body which is intended to restart the heart. Sometimes it takes numerous shocks to restart the heart and sometimes it may not work at all. Here is an example of a defibrillation for VF.
It should be known that many people who go into cardiac arrest will not survive. The data varies but roughly 40 percent of patients can be resuscitated and brought to the hospital. However many go back into cardiac arrest and only about 15 percent of people who have a cardiac arrest will live long enough to be discharged from the hospital.
Conclusion
Thank you for reading this and I hope it served as informative to those who don't know much about medical roleplay. Keep in mind this was very basic and barely scratched the surface but it should suffice for mose situations you'll find your character in. At a later date I may add onto this but I feel as if this is a good start.
