Medical Mysteries: NYC Emergency Room
Medical Mysteries: NYC Emergency Room Rulebook
Table of Contents
Table of Contents
Getting Started
If this is your first game of Medical Mysteries, it's best that you follow Nurse Judy's tutorial. Follow her instructions, and she'll show you how we work here.
Open the tutorial envelope now and complete it.
Return here afterward to continue reading the rules and finish your tour.
Patient 1, Shyla Patel
Once you have completed the tutorial, you are ready to begin your shift. Select a patient. We recommend starting with Patient 1, Shyla Patel.
Do not open the other Patient envelopes.
- Make sure you have every item listed in the Patient envelope.
- Read the Admission Interview and the Electronic Medical Record to discover the patient's situation. Pay attention to small details.
- Familiarize yourself with the Knowledge Booklets (you'll find them in the envelope named CODEX — KNOWLEDGE — RULES). They provide essential details on the protocols, tests, pathologies, medications and specialists you have access to. There's no need to read them in full right away, since you can refer back to them at any time while playing Patients 1 through 4.
- It's time to act. Consult the patient's Status Card 1 (CS1).
Status Card (CS)
The patient's Status Card lists all the actions you can take. Some tests are listed on the back of the Status Card. As your shift progresses, your patient's state may change. When you are asked to take a new Status Card, discard the old one, then consult the new one to discover the patient's new state and the new options available to you.
The Status Card shows a State box, an Actions section, and a Tests section on the back. When your patient's condition changes and you take a new Status Card (e.g. CS1 replaced by CS2), it shows the patient's New State.
Actions
Each shift is divided into 4 periods of two hours. During each of these periods, you may take 3 actions from among those listed on the patient's Status Card. You can perform several types of actions:
- Question the patient: Often, talking with the patient is essential to understanding their situation.
- Run a test: Running tests will give you new information about your patient. Tests that reveal that everything is normal are also useful, for ruling out certain hypotheses.
- Prescribe a medication: Many pathologies can be treated by administering the right treatment to the patient.
- Apply a protocol: Certain situations may require a protocol, such as disinfecting a wound or performing a surgical procedure.
- Consult a specialist: Calling on an expert's opinion can often help clarify the patient's symptoms.
Patient Sheet — Record Your Actions
Whenever you choose an action, you must record it on the Patient Sheet. Each action chosen corresponds to a Code. Look up this code in the Codex. You will then often be asked to take one or more Hospitalization Cards, or to look up another Code in the Codex. Note that all of this counts as one single action: only the actions you choose from the patient's Status Card and record on the Patient Sheet count toward your 3 actions.
Example Patient Sheet, showing patient Luana Kapule: at 00:00, Admission interview, back pain, Code BPA; at 00:40, Nephrology consultation, Code NEP; at 01:20, Blood test (CBC), Code BLT. After every three actions the sheet marks a Summary — e.g. "Summary at 02:00. Follow the patient's state on the current Status Card (CS)." — repeating for the 04:00, 06:00, and 08:00 periods.
Summaries
When you have completed the 3 actions of a period, it's time to get a summary of your patient's state. Consult the Summaries section on the patient's Status Card.
The Summaries section lists a Code for each period's summary time (e.g. 02:00, 04:00, 06:00, 08:00) — look up the Code shown for the corresponding time.
Look up in the Codex the Code associated with the corresponding time.
TAM — Take Hospitalization Card 10.
Once the summary is complete, you are ready to take 3 new actions for the next period.
Exception in case of emergency: If you are handling an emergency at the moment you're due to get a summary, do NOT take this summary. Instead, perform your first action of the next period. Once the emergency is resolved, get the deferred summary from the emergency.
Surviving the Night
Your primary goal is to make sure your patient survives the night. To do this, take their symptoms into account and run tests until you're able to determine the correct diagnosis and the appropriate treatment. Once you've succeeded, you'll receive a Hospitalization Card indicating that your patient survived the night. Congratulations!
Extra-Hour Actions
You have eight hours to help your patient survive the night. However, some cases can be particularly complicated. If your shift is coming to an end and you need more time, you may keep taking as many additional actions as necessary. However, you will lose 5 points from your final score for each action taken during Extra Hours. For tests performed after 08:00, use the Code for the 06:00–07:59 period.
Death
As the doctor, you decide what actions to take and in what order. The patient's life is literally in your hands. Be careful. Make the wrong decision, or take too long to diagnose the cause of their condition, and your patient might not have a very happy ending…
Final Report
Once your patient has survived the night, fill out the Final Report on the back of the Patient Sheet. You'll need to list the cause of each of the patient's symptoms, indicate which treatments you prescribed, and your recommendations to the patient before discharging them from the hospital. Be sure to write everything down before reading the Epilogue.
Example Final Report, for patient Luana Kapule:
Causes — What are the causes of the patient's symptoms? "Luana has gallstones, which caused inflammation of the gallbladder."
Treatments — What treatments did you administer to treat the patient's symptoms? "Nephrology consultation / Blood test (CBC) / Ultrasound / Surgery: Cholecystectomy."
Recommendations — What recommendations do you prescribe to prevent future symptoms or complications, based on the Codex, tests, diagnosis, and pathology? "Prescription of pain relievers."
Once the Final Report is complete, read the patient's Epilogue.
Important: It's possible for your patient to survive the night without you having understood their pathology. If that's the case, you may continue running tests and prescribing treatments until you're sure you can complete the Final Report. A good doctor doesn't settle for treating the symptoms: they uncover the cause!
Epilogue
Once you've finished writing your Final Report, it's time to read the Epilogue. It describes the key details of the patient's case and gives you your final score.
I'm Stuck! What Should I Do?
Your goal is to make sure your patient survives the night. To do this, you will need to:
- Examine the data: Read the patient's Admission Interview, their Electronic Medical Record (front and back), and all the Hospitalization Cards in your possession. Draw up a list of symptoms.
- Prioritize symptoms: Determine which symptoms are the most serious or potentially life-threatening, and treat them first.
- Evaluate hypotheses: Consult the Knowledge Booklets to consider the different pathologies your patient might have. Sometimes, the information you need is spread across different categories.
- Gather new data: Run tests, question the patient, or consult a specialist to obtain information that could be useful.
- Refine the diagnosis: Choose tests that help confirm or rule out hypotheses.
- Prescribe a treatment: Once you've determined a likely diagnosis, consult the Knowledge Booklets to find out which treatments to prescribe.
- Check your list: Make sure you've treated all of your patient's symptoms. Remember that even the smallest details can be important.
Still stuck:
- Carefully reread all the documents in your possession.
- Consult a specialist. Help from your colleagues, even if it costs an action, can definitely help point you in the right direction.
- Check that you haven't forgotten to get a summary.
- Check that you're using the correct Status Card.
- Check that you've looked up the correct Codes for each action and collected all the appropriate Hospitalization Cards.
- Using the Patient Sheet, check all previously performed actions.
Disclaimer
Although based on facts, Medical Mysteries does not claim to offer any medical advice whatsoever. This game offers a simplified medical diagnosis to let players step into the shoes of an ER doctor. This game pays tribute to healthcare professionals, but does not replace them in any way. Medicine is complex, and doctors, nurses, and other healthcare professionals spend years learning how to treat people. If you have any questions, consult your doctor.
Credits
This game was developed in-house by the Identity Games team.
- Authors: Nicholas Cravotta and Rebecca Bleau
- Graphic design: Henno Drop
- Medical consultants: Judy Griffin, Mat "Le Méchant Renard"
Credits for the French edition (IELLO): Project manager — Guillaume Dejonghe; Translation — MeepleRules.fr; Proofreading — Maëva Debieu Rosas; Graphic design — Claire Wach.