[Roleplaying] The sick, The Injured and The Hypochondriac.

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Chris Murphy
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Trauma Care Air Ambulance
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The Sick, The Injured and The Hypochondriac
Roleplaying Illness, Injury and assumed medical conditions.​

So, you've decided that your character suffers from an illness or medical condition? Great!
Next question, how do you reflect that in your roleplay.​
This guide will touch on a few common medical conditions, and how they may effect you or your character. In doing this, I'll give a brief overview of the condition, as well as signs and symptoms (Signs - What can be seen, Symptoms - What the patient reports feeling). For those who want a little more info, I'll also post a more in depth overview of the condition in a spoiler.​
I'll cover the following conditions:
Asthma
Acute Myocardial Infarction - Heart Attack
Cerebrovascular Accident - Stroke
Diabetes - both Type 1 and 2

As well as some mental health conditions, including acute psychosis, hallucinations and delusions.

I'll also look at some of the common traumatic incidents that occur and what I would expect, if treating these patients IRL.​

This guide will not tell you HOW to RP the condition, it will, however, arm you with the knowledge to do it your way​

Asthma
Asthma is very common inflammatory disease of the airways that effects nearly 19 million Americans. Generally people can live healthy, normal lives with asthma. Acute exacerbation of asthma, or more commonly known as asthma attacks can stop a person in their tracks. Lets have a think about what might occur in an asthma attack: We've recognized that it is an inflammatory disease of the airways, but what does this mean?
Essentially, with the right conditions, a persons airways become irritated and swell up, decreasing the amount of pipe to breath through. This results in obvious difficulty breathing.
Here is an example for you to consider: When you blow up a balloon, you blow at a certain pressure, but if you try to blow up a water balloon you require much more pressure. why? because there is more resistance and less room for the air to get through.
What is asthma?Ultimately there is much speculation about the origin of asthma and what exactly causes it. We do know that the triggers for an exacerbation are different for every one, and that some people are more sensitive than others. Asthma is a life long diseases, there is a common misconception that asthma is grown out of, but that is not the case.
What happens in an asthma attack? Essentially, the whole process of an Asthma attack is an immune response and in some ways can be likened to an allergy. When a person with asthma is exposed to a trigger or stimuli a reaction in the airway begins. The airways are irritated intially, causing smooth muscle in the airways to spasm and contract. The body recognizes the trigger as an invading pathogen, that must be destroyed. The local cells pick up the pathogen and begin attempting to kill the pathogen. The result is inflammation. The body then stimulates cells in the bronchi (branches of the airway at the end of the trachea) to produce mucus, in an effort to eject the pathogen.
The result of this is constricted, swollen airways, and excessive thick, sticky mucus.
So, if we take constricted airways, add on swelling and throw in some mucus, there is a significantly smaller space for air to move, creating difficulty in taking in enough oxygen.

Here is a pretty picture I drew:
Signs and Symptoms of Asthma Attack
Mild Asthma Attack
  • Some shortness of breath
    Heaviness on chest
    Slight pain when breathing
    Heart rate might be increased slightly (normal for Adult is 60-100beats/minute)
    Respiratory rate will be increased a little (normal for Adult is 12-20breaths/minute)
Moderate Asthma Attack
  • Shortness of breath
    Heaviness on chest
    Slight pain when breathing
    Difficulty completing long sentences
    There may be a slight wheeze
    There would be some increase in work of breathing - i.e. the patient will breath heavily
    Heart rate would be increased (normal for Adult is 60-100beats/minute)
    Respiratory rate will be increased (normal for Adult is 12-20breaths/minute)
Severe Asthma Attack
  • Extreme shortness of breath
    Extremely heavy feeling on chest
    Pain when breathing
    Difficulty completing sentences of any length - usually one word to two word answers
    Audible wheeze
    There would be increase in work of breathing - i.e. the patient will breath very heavily
    Heart rate would be increased (normal for Adult is 60-100beats/minute)
    Respiratory rate will be increased (normal for Adult is 12-20breaths/minute)

Acute Myocardial Infarction - Heart Attack
An Acute Myocardial Infarction (AMI) is a heart attack that is caused by an obstruction in one or more of the coronary arteries which surround and supply the heart with oxygen rich blood - the result of this lack of blood causes a section of heart muscle to die causing extreme pain and impaired ability to pump blood.
What is an AMIAn AMI occurs when there is an obstruction in the coronary arteries. The usual cause of obstruction of is an emboli - an emboli is what we colloquially call a 'clot on the trot'. This clot comes from a thrombus - which is a build in the lumen (inside) of a blood vessel. Generally this clot is made from fatty plaque. What happens in an AMI When there is a build up of plaque in a blood vessel, there is increased turbulence. This Turbulence can cause part of the clot to flick off, travel to the smaller coronary arteries and become lodged. This then stops the blood and subsequently oxygen reaching any of the myocardium (Heart Muscle). Like all muscle, Myocardium needs oxygen to live - this lack of oxygen causes the heart muscle to die - the byproduct of this is called Creatin Kinase (CK) which causes the pain. The lack of oxygen decreases the muscles ability to contract, and subsequently pump enough to distribute blood around the rest of the body. An AMI left untreated will progress to cardiac arrest and death.
Signs and Symptoms of AMI
  • shortness of breath
    Severe, Sharp, Heavy feeling chest pain
    Tingling or altered sensation in the left, jaw or back
    Heart rate increased (normal for Adult is 60-100beats/minute)
    Respiratory rate increased (normal for Adult is 12-20breaths/minute)

Cerebro-Vascular Accident - Stroke
A CVA or stroke occurs when there is a disruption to the supply of blood to the brain. This can be because of a clot, so there is no blood traveling past the point of clot, or a bleed in this case the blood is moving out of the blood vessels before reaching a destination. Majority of strokes are the former - caused by a clot.
What is a CVA When blood supply is interrupted to a part of the brain, there is a decrease in function or sensation that originates from that area. Ischaemic CVA Occurs when blood supply is ceased by usually by a clot; this can be further classified into thromobotic, eombolic, hypovolaemic and Central Venous Thrombous. Ultimately, these all result in an occlusion in a blood vessel that, similar to an AMI causes tissue death, and loss of function, the difference lays in the origin of the decreased O2 and blood supply.
  • Thrombotic: The clot forms where it lays
    Embolic: Like with an AMI, the clot occurs elsewhere and lodges in a cerebral blood vessel
    Hypovolaemic: there is decreased blood supply to the brain due to general decreased blood volume
    Central Venous Thrombus: A clot forms in the area that removes oxygenated blood from the brain
Haemorrhagic CVA Occur when there is a bleed into the brain - generally because of a rupture in a cerebral artery - this decreases blood flow beyond that point. There are multiple potential reasons for the rupture, from aneyurism to traumatic injury.
Whilst the treatment of these types of clots is different to that of ischaemic, the signs and symptoms are somewhat the same

Signs and Symptoms CVA
  • Remember: FAST!
    Poor muscle tone to one side of face (Facial Droop)
    Hemiplegia - Single sided weakness
    Slurred speech
    Inabilty to keep eye open
    Inability to walk straight, properly or at all
    Disorientation
    Poor word association e.g. using inappropriate words or phrases - "It's forecast to rain on Watermelon. We need to remember to take our cats!" But note, the patient will generally have no knowledge of making a mistake with their sentence.

Diabetes Mellitus
Whilst there are technically 3 kinds of Diabetes Mellitus, or Simply Diabetes, I will only discuss two here. Diabetes Mellitus is metabolic disease in which the pancreas does not produce enough, or any insulin. Insulin is a hormone that allows Glucose into cells. As mentioned there are 3 types - Type 1 (formerly known as Insulin Dependent Diabetes Mellitus (IDDM)), Type 2 (formerly known as Non-Insulin Dependent Diabetes Mellitus (NIDDM)) and Gestational Diabetes. I will only discuss Type 1 and Type 2 (T1DM and T2DM respectively).
T1DM is a complete inability to produce insulin at all - from diagnosis to death these people require artificial insulin to regulate their blood sugar levels and subsequently low cellular energy due to the inability to absorb and use the glucose in the blood. T1DM is generally diagnosed in early childhood at about 8 years old. T2DM on the other hand can be diagnosed at just about any age and is caused by cells inability to properly use the insulin excreted from the pancreas, and/or the pancreas' ability to produce sufficient levels of insulin. People with T2DM can control their blood sugars with a good diet and proper education, but do sometimes require oral hypoglycaemics (tablets used to aid in insulin use) or injected Insulin.
What is Diabetes Mellitus as aforementioned Diabetes Mellitus is a condition in which the body does not have enough, or know how to use it's insulin. What is Insulin? Insulin is a hormone excreted by the pancreas. It is required to allow the glucose into cells. Insulin is also responsible for regulating the conversion of Glycogen - a form of glucose that is stored in the liver back into usable Glucose when blood glucose/sugar levels are low. How do glucose levels affect the body? like anything, too little is not enough and too much is bad for us. Lets start low: Hypoglycaemia[/] i.e. Low blood Glucose/sugar occurs when there is not enough sugar in the blood stream to provide cells with energy. This can result in some minor results, such as tiredness or can progress into a coma - essentially, there isn't enough sugar to feed the cells, to provide them with the energy to continue to function - eventually the blood sugar will get so low that the neurons or brain cells will go 'silent' or not fire. Hypoglycaemia can be caused by either not enough input or too much insulin. Hyperglycaemia is far easier to reverse, and generally caused by low levels of insulin. ultimately if left untreated Hyperglycaemia can progress to either Diabetic Ketoacidosis (DKA) or HHNKS (HONKS). DKA occurs in people with T1DM only. It occurs because there is absolutely no insulin in the body to allow the use of glycogen, therefore cells begin to break down or metabolize fat - a byproduct of metabolizing fat is Ketones - The level of Ketones in the blood rises and throws the bodies electrolytes out of whack, causing a normally stable pH level to become acidic - causing a compensation response - to increase the O2 levels in the blood this is achieved by hyperventilating - Breathing too fast - eventually resulting in what's called Kussmauls Respiration (Deep, Labored, yet ineffective breaths) This can result in death. HHNKS or hyperosmolar hyperglycemic nonketotic syndrome, (formerly known as HONKS or hyperosmolar non-ketotic Syndrome - yeah. We'll stick with HONKS) is only seen in people living with T2DM. It occurs when there is an excess of Blood Glucose. There are no ketones present in the blood stream because there is still some insulin, which inhibits the bodies fat metabolism back up system, So, in an attempt to remove the high levels of Glucose, the body will increase urgency and frequency of urination, essentially trying excrete the glucose through urination. HONKS requires enormous levels of glucose - so eventually this process will lead to a higher concentration of glucose in the blood stream, and a viscous cycle begins - and usually results in death by dehydration.


Signs and Symptoms of Hyper/hypoglycaemia in Diabetes Mellitus
Hyperglycaemia (High Blood Sugar)
  • Hunger
    Thirst
    Need to urinate
    Fruity smell on breath
    Altered state of consciousness
    lethargy
    Sezuires
Hypoglycaemia (Low Blood Sugar)
Hunger
Thirst
Lethargy
Anxiety
Difficulty speaking/slurred speech
inability to walk straight
Staring 'glassy eyed' look
Nausea and vomiting
*Hypoglycaemic patients are often initially assumed to be under the influence of alcohol


Mental Health Conditions coming soon!
That's enough for tonight! If you have any particular conditions or diseases you'd like discussed, please post below or PM me.
I will continue tomorrow with the Mental Health conditions as promised.
until then, good luck, have fun and feel free to PM if you'd like clarification on anything!

C.M. (UB)BNsg, CCC(Paed), Dip HSc (Paramedics)
For Red County Roleplay 2013
 
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