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Чит-файл для Life & Death

Life & Death

 За игрой пока никто не наблюдает. Первым будете?

Выдержка из Энциклопедии игр

Разработчик:The Software Toolworks
Издатель:The Software Toolworks
Модель распространения:розничная продажа
Жанры:Logic / Simulator

Даты выхода игры

вышла в 1988 г.

Solution [ENG]

Информация актуальна для
Part 1

 So  you've  spent  half your life  hacking  at Orcs, obliterating alien
hordes, and dragging leisure-suited misfits around the world. Now you're
looking to do something useful for humanity. Well, your timing is great.
Toolworks  General  is  looking for a  few  good  surgeons to assume the
burden  of  a  few appendectomies,  infections,  and vascular grafts. No
problem at all!

 When  you start the game, you'll need  to sign in on the receptionist's
clipboard. She'll welcome you and prompt you to go to the classroom, but
let's not do that yet. Using whichever input device you have (a mouse is
ideal  for this game), set your  difficulty level to Novice until you've
successfully  completed both operations. Erase the  scrawl in the box at
the bottom of the option screen by clicking on the small Erase checkbox;
then  draw your own initials in the space provided. You can turn off the
sound at this point, but don't unless you absolutely have to: The sounds
of the EKG and of the clamps closing are extremely useful.

 Click  outside  the box to signify  you're done setting parameters. Now
you're ready to hand-pick your surgical staff and start seeing patients.
Since  your  first operation will be  an appendectomy, let's go into the
Staff   room  and  choose   knowledgeable  and  cooperative  assistants.
Otherwise they'll be of no help at all in the OR (Operating Room).

 Look  over  the six files by first  clicking on the filing cabinet, and
then  on each name (NOT in the  small check-box). You'll get a photo and
brief  description of each staff member. Gregory Danielson is a must for
appendectomies; click on his check-box. But that means that you will NOT
want  Beverly  Kabes on your staff,  nor  will you want Laurelee Menzies
(whose  area  of expertise is irrelevant  to this operation). Kim Brewer
would  be a good choice if you're looking for a general nurse to assist;
if  you have trouble keeping your eye on the EKG, then pick Ken Shepherd
instead  of  Kim. If you're  anticipating  trouble with incisions, David
Manglier  would  also  be a decent  alternative.  My  personal picks are
Danielson and Brewer.

 Click  on  the  door  of  the Staff  room  to  leave  and head into the
Classroom.  Watch the blackboard and listen closely; the advice is basic
(most can be found in the manual). When class is over, click on the door
and the receptionist will tell you where your patient is.

 In  the  patient's room, there's no need  to look at the clipboard yet.
The  patients'  complaints all sound the  same, and your main diagnostic
tool  is to palpate the abdomen, so click on the abdomen of whoever's in
bed.  Click  all around the area; be  sure to get each quadrant at least
once  or  you'll be reprimanded further on  down  the line. In this, the
first half of the game, here are the guidelines for diagnosing: If there
is no pain response anywhere on the abdomen, that signals intestinal gas
and  should be OBSERVED. If there is pain response all over the abdomen,
that signals an infection and should be MEDICATED. If there is pain only
in  some  parts  of the abdomen,  that  could  be either appendicitis or
kidney  stones; you MUST take an X-RAY (even  if the pain is only on the
patient's  left side and thus unlikely to be appendicitis). If there are
kidney  stones, they'll appear as a clump  of small white dots ABOVE the
pelvis  (surrounded by black). If such stones appear, your action should
be REFERRAL (since urology is not the field you're in). If no stones are
present, that's appendicitis! Click on OPERATE on the clipboard and exit
the patient's room. If you've just booted up, you'll be advised to check
in  on  the  phone (the copy protection).  Do  that  if you need to; the
receptionist  should then inform you that they're waiting for you in OR.
Head for the OR and here we go!

Part 2

 On  the  upper  right is the section  of  the patient's body with which
you'll  be working. Beneath the body is a message box (it may not appear
instantly)  where words of encouragement,  advice, and scorn will appear
from  your two assistants. Next to it is a small bottle representing the
current  fluid connected to the patient's IV. At the left is the EKG and
the  anesthetic  machinery,  and below that  are  a tray and two drawers
(currently  closed) with all the instruments you'll need to operate. You
can  see that the anesthetic is OFF  and the breathing and heartbeat are
regular.  You'll  want to learn to keep  your ears tuned to that EKG; if
the  pitch changes or if the constant beeping stops, you'll have to turn
your  attention to the problem. Although you have assistants who will be
commenting along the way, I'm going to assume you're in this alone.

 The  two  kinds  of  heart  problems  you'll  run  across  are  PVC and
Bradycardia.  With  PVC,  the EKG will drop  in  pitch and the line will
plummet  and  bounce back (see the manual  for  a picture). The cure for
this  is a quick injection of Lidocaine, already in a hypo in the bottom
drawer  (marked  with an "L"). PVC is  easy  to remember because it will
look like a "V" on the EKG. Bradycardia shows a relatively flat EKG, and
the  beep will stop altogether; this  requires an injection of Atropine,
marked with an "A" and sitting next to the Lidocaine. Think of "A" going
with  "B"  and  you can easily  recall  Atropine going with Bradycardia.
(These  sorts  of mnemonics are exactly  what help most medical students
get through school.)

 Once  in  a  while, the patient's  blood  pressure will drop. This will
happen  without  fail if you don't start  the patient on IV blood before
you  begin cutting. If the heart rate does drop, put blood in the IV and
quickly  clamp and cauterize all bleeders. But  if the rate drops to 50,
immediately  inject  the  patient with  Dopamine  (in the bottom drawer,
marked  "D"). You only have one hypo  of Dopamine and unlimited hypos of
Atropine and Dopamine.

 Since  the patient's still awake, you're  not likely to run into EITHER
problem!  So let's get down to some  hacking and slashing of an entirely
new kind.

 Open  the  bottom drawer (just click the  fingertips  on the end of the
drawer),  and open the top drawer. From the top drawer: Click on soap to
wash;  click  on  gloves. Click on the  large  bottle with the "A" on it
(it's  antiseptic).  Holding the button  down, move the antiseptic cloth
all  over the skin; try not to leave any unwiped areas. The area will be
shaded with black dots to show where you've wiped. Return the antiseptic
to  the  drawer, and pick up the  sterile drape (the folded cloth on the
left). The cursor will change to a square; place this square all the way
to  the upper left corner of the  abdominal window so that the corner of
the  square  fits neatly into the corner  of the window (don't leave any
visible  area in between) and click. You  should get a very thin, almost
unnoticeable  line around the abdomen -- virtually no drape at all. This
is  crucial  since you'll need every  available millimeter of space with
which  to operate. If the square cursor  vanishes and is replaced by the
hand, and the abdomen window flickers slightly, you've done it right. (A
comment in the message box may confirm it.)

 Close  the  top drawer. Turn on the  gas.  Pick up the hypo labeled "B"
(the  antibiotics)  in the bottom drawer, and  move it over to the skin;
click  to  inject, and the hypo will  vanish.  Get a bottle of blood (it
LOOKS  like blood) from the drawer, and click it on the full bottle next
to  the  message window; that bottle  should  change to blood. This will
prevent  the  patient's  blood pressure from  dropping  as you make your
first incision. Close the bottom drawer, and pick up your scalpel.

 You'll  be making a McBurney's incision (page 92 of Lindstrom's notes).
From  your  point of view, you'll be  making a single, straight cut from
the upper left corner of the abdomen to the lower right corner. Make the
line as long as possible; this is also crucial because it determines the
size  of  the wound you're creating, and you  need a BIG wound to get at
the  appendix. So, start and end as close to the very corners as you can
(without  cutting the drape). Incision technique isn't easy; you'll need
to  learn  to  cut as straight  as  possible  while also cutting QUICKLY
(which  helps to keep the incision  neat). Practice is the only solution

 Make  that incision in the abdomen. Then  drop the scalpel, pick up the
forceps (lying horizontally above the scissors) and clamp a bleeder (the
widening  circles  of red that will  appear  along the incision). As you
clamp,  you  should  hear a "click"  and  you'll  probably get a comment
affirming  the action. Another forceps will have appeared; clamp all the
bleeders.  When  all  the bleeders have  stopped  spreading, pick up the
cauterizer  (looks  like a soldering iron on  the left edge of the tray)
and  click once LIGHTLY on each bleeder. You  may need to do this 2 or 3
times  on  each,  but eventually you'll  have  cauterized them all. Then
remove  each  clamp, one at a time,  and  using either sponge or suction
hose (S-shaped), remove the blood.

 Pick up the skin spreader (the butterfly-shaped mechanism at the bottom
of  the tray), and click it on the incision. The skin will peel away and
reveal a layer of subcutaneous fat. Congratulations! Get somebody in the
room to wipe your forehead.

 All  the while, of course, you'll be listening to the EKG and injecting
the proper fluid when necessary. Also keep your eye on that bottle; when
the  blood is about to run out (don't wait till the last moment), put in
a bottle of Glucose from the bottom drawer.

 Now do the same thing to the subcutaneous fat that you did to the skin;
incise  at the same angle, clamp bleeders, cauterize, remove clamps, and
wipe  clean. Again, be sure to go to the very corners for your incision,
but  be  careful  not  to cut _beyond_  the  corners  to the skin above.
Retract the fat to reveal the oblique muscle tissue.

 The  oblique  muscle  (and the transversus  muscle  below) has no blood
vessels  and  will  not  cause bleeders.  Cut  the  oblique muscle layer
exactly  as  in  the last two layers,  going  from  corner to corner and
making  a  straight,  neat incision. The  next  layer -- the transversus
muscle  --  is striated in the other  direction.  Don't cut at the usual
angle;  cut "with the grain" from upper right to lower left. Keep making
those  incisions  as long as  possible.  Retracting the transversus will
reveal  the peritoneum, through which you can vaguely see the end of the
large intestine (which covers the appendix).

 The  peritoneum  calls  for  very  delicate  incising.  Unless you have
version  1.03  of the program (or  better), forget what the manual tells
you  about incising the peritoneum and listen carefully. You're going to
cut  diagonally from upper left to lower right with the scissors. FIRST,
pick  the  spot  where you're going to  start  the incision. Pick up the
scalpel  and  click  once  just  at  that  point;  you're  scraping  the
peritoneum  but  not cutting it. Don't draw  a line, just click once and
let go. Put the scalpel down and get the forceps; clamp the forceps just
a  pixel or two below where you just scraped. With the forceps in place,
pick  up  the  scalpel again and click  once  more on the same point you
scraped;  a large black dot should  appear. Drop the scalpel, remove the
forceps,  pick  up  the scissors and  start  clicking. Make each click a
little farther down and to the right of the last, but not too far or the
program  will think you've started a new incision. Don't make your first
snip  right on the black dot; make it a bit further down/right. Continue
all the way to the lower right corner and use the skin retractor.

 Voila! There's that lovely large intestine, covered with infected fluid
(the  black  shading). From the bottom  drawer,  take the test tube, and
click  it on the abdomen to get a fluid sample. Close the drawer and get
the  suction tube; start to suction off the liquid, and it'll come right
up. Put down the hose.

 Click  the  fingertips at the bottom  of  the large intestine. Provided
you've  made  the  incisions long enough,  the  cecum  will flip up into
sight. If the incisions aren't as large as they need to be, you won't be
able  to get at this area, and you'll have to abandon the operation. But
let's hope for the best.

 Open  the top drawer and get the roll  of gauze. Click the gauze at the
base  of the cecum, and the  cecum becomes packed and immobilized. Close
the drawer. I assume you're still watching the IV and the EKG? Of course
you are.

 Once  again,  click the fingertips at the  base  of the cecum to expose
more  intestine. Click the fingertips at the base of this new intestine,
and  the  appendix  pops up, pointing to  the  right.  Take a clamp, the
L-shaped  object  in  the  center  of the  tray.  Clamp  the  tip of the
appendix,  all  the way to the right  and just above the bottom edge. If
you  clamp  in the wrong spot, the  appendix  may rupture; in that case,
take  the  drainer  from  the top drawer  (the  red  bulb) and drain the
appendix before continuing. If you've clamped the appendix correctly, it
will  be lifted and the underside  exposed. You're doing great if you're
still with me; put the game on pause and play some golf.

 You're  going  to nick the mesoappendix  membrane. Pick up the scalpel.
There's  a  red  line, or shadow,  running  the  length of the appendix.
You'll  nick  -- a quick click -- at  a  point slightly to the right and
about  a fifth of the way up that  red line. If you mess up, you'll know
it...and  they'll  show you in class  the proper place to nick. Assuming
you've clicked in the right place, you'll get another big black dot with
a  small  white  dot in the center.  Put  down  the scalpel and take the
needle  and  thread. Click once at the  center of that dot to suture the
mesoappendix artery.

 Get the scalpel. To sever and remove the artery and membrane, you click
once  directly  on that long red shadow,  a pixel or so below the bottom
edge  of  the clamp. The clamp appears  spread; use the lower of the two
clamp  ends  as  a reference point. Click  just  below that end, and the
membrane  vanishes.  Now  get another clamp  and  clamp the base of that
long,  red  shadow; Danielson should confirm  that the LOWER clamp is in
place.  Get  another clamp and clamp at  about the middle of the shadow;
Danielson  will remark that the HIGHER clamp is in place. Get the needle
and  thread,  click  once  between the  two  clamps,  and a small "purse
string"  suture should appear. Click the  scalpel just above the suture,
and  off  it goes. The appendix is  gone. All the clamps except one will
vanish.  Remove that clamp and click the fingers on the cecum to tuck in
the  wound. A small hole appears on  the cecum; click the needle on that
once to make a Z-string suture across the hole. Put away the needle, and
click  the fingertips on the base of the cecum. That'll instantly remove
the gauze and tuck everything back into place. You're ready to close!

 To close each layer, pick up the skin retractor. Move it all the way to
the  right  of  the window; it will  be  almost entirely off the screen.
Click it once and the peritoneum closes. Put down the retractor, pick up
the needle, and place sutures along the closed incision. They don't have
to be touching, but they should be fairly close together. You'll need to
make a lot of them.

 Once  you've  finished suturing the  peritoneum,  take the spreader and
click  it  all  the  way  on  the  right  as  you  did  just before. The
transversus  muscle layer closes; suture it  the same way. Now close and
suture  the  oblique muscle layer and  the subcutaneous fat layer. Close
the  skin  layer, but don't suture it.  Secure it with the X-shaped skin
clips  in  the  upper  left corner of  the  tray.  Put them close enough
together to touch. Turn off the gas, and let the patient go to Recovery.
Congratulations! This was the hard part.

 When the program evaluates the surgery, you'll be told to go to Medical
School if your performance was not perfect. If it was perfect, you'll be
congratulated  for having performed an  appendectomy and sent to medical
school  anyway! But now you'll be promoted  to deal with a different set
of problems, and appendectomies will become a thing of the past.

Part 3

 Your  new crop of patients will  have one of three possible conditions:
arthritis,  immature  aneurysms, and mature  aneurysms. The diagnosis is
just  nearly  as  straightforward as in  the  previous part of the game.
Carefully  palpate  all areas of each  patient's  abdomen. Be certain to
palpate  several times just below the navel. If the patient has pain all
over  the abdomen, take an X-RAY. You'll probably find that the spine is
practically  a  solid white mass;  this indicates arthritis and requires
MEDICATION.  If  the patient's response  topalpation  under the navel is
"That  feels like a lump" or some  mention of a lump, that's probably an
aneurysm. Do an ULTRASOUND SCAN to determine its size. If it's less than
"5  cm"  in  diameter (use the ruler  up  above  the ultrascan screen to
judge), it's immature and should not be operated upon. Check OBSERVE. If
the  aneurysm is 5 cm or larger (as it probably will be), you'll have to

 Before  you go into the OR, though, you'll want to readjust your staff.
Be  sure to include Laurelee Menzies,  the resident expert on aneurysms.
Your  other  assistant  should be either  Kim  Brewer, Bev Kabes, or Ken
Shepherd.  Head into the. You'll note a  few new items on the trays, but
don't be intimidated. Next to conquering the appendix, this one's almost
a cakewalk.

 Open  the bottom and top drawers. Use  the soap and the gloves (in that
order please!). Apply the antiseptic (this time you have a whole abdomen
to work with). Put on the drape, and as before, you're going to leave as
much room to operate with as possible. Close the top drawer, turn on the
gas, inject with the "B" hypo (there's a new one marked "H" for Heparin,
which  you'll need in a bit). Hang a  bottle of blood on the IV and pick
up your scalpel.

 This  time  you  won't  be  making  any  McBurney's  incisions. Cutting
smoothly, incise the abdomen straight down the middle from as far on top
to  as close to the bottom as  you can without touching the drape. There
shouldn't  be  much drape there, anyway...only a  line or two on top and
bottom.  Work  quickly to clamp all  the  bleeders with the forceps. The
cauterizer  is  gone; we now have a  ligator -- a pretzel-shaped loop on
the  tray.  Pick  it up and center  it  over each bleeder; click once to
ligate each bleeder. When you've gotten them all, remove the forceps and
wipe  the area clean. Separate the skin  with the skin retractor. Do the
same  with  the rippling subcutaneous fat  layer. Always be vigilant for
problems  with  the  EKG;  act  quickly  with  Atropine,  Lidocaine, and
Dopamine when necessary.

 Now  you're  down to the muscle  layer,  the rectus abdominus. This one
won't  bleed.  Cut down the linea alba,  the  thick white portion at the
center.   Spread   using  the  retractor.   You'll  be  looking  at  the
preperitoneum,  which is incised the same  way the peritoneum was: Click
with the scalpel to scrape, elevate just below with forceps, click again
with  scalpel  to nick a hole, remove  forceps and snip all the way down
with  the scissors. Be cautious not to make your snips so far apart that
you  appear  to  be making a  separate  incision; this will puncture the
intestines. But do try to make the incision straight...neatness counts.
 After  snipping  the preperitoneum, spread  it.  Using your fingertips,
click  on the bottom of the chest to push the intestines out of the way.
In the top drawer you'll see a small bag (called the gut bag). Click the
bag on the intestines at the top of the screen to keep them clean, tidy,
and out of the way. Underneath the intestines is the postperitoneum, and
underneath  that, the murky shape of the aneurysm. Scrape, elevate, nick
and  snip the postperitoneum exactly as  you did with the preperitoneum.
Spread  it  and there's the aneurysm,  the swelling just above where the
two iliac arteries merge.

 In the bottom drawer, take the Heparin and inject it before proceeding.
This prevents embolisms in 100% of my cases so far! I wouldn't know what
to  do if there WAS an embolism. Click the fingertips at the base of the
aneurysm  and  rubber tubing will appear  in  place. The aneurysm is now
immobilized and ready for action!

 Take  a clamp (NOT a hemostat) and  clamp either of the iliac arteries,
then  clamp  the  other  one.  Put  another  clamp  on  the small vessel
(mesenteric  artery)  extending from the center  of  the aorta, close to
where  they come together. Then put a  clamp at the top of the aneurysm,
right  where it comes into view. Work  quickly at this point; you've cut
off the blood supply to the legs!

 Take  the  scalpel and nick the  mesenteric artery just above the clamp
(not between the clamp and the aorta). A bleeder will appear; ligate it.
You're  going to incise the aorta with the scalpel. Don't start right at
the  top!  Start  about a quarter of  the  way  down the aneurysm or the
incision  will be too long, and you'll have to abort the operation. Make
the incision straight and clean; don't bring it quite all the way to the
bottom.  Use the skin retractor to expose the clot. Remove the clot with
your  fingertips; take the Y-shaped dacron  graft from the bottom drawer
and put it in place.

 The  graft has to be sutured into  place. Take the needle and put three
sutures  into each of the graft's  three ends (nine sutures altogether).
You should be able to see each of the three sutures connecting the graft
to the artery walls. Put down the needle.

 Before  you  can  complete the suturing,  you  have to close the artery
walls  around the graft. With your fingertips, click at the junctures of
the graft (the three ends) until the flaps of vessel tissue close around
them.  Then  take the needle up and  suture three times at each juncture
again, for a total of six sutures in each of the three branches. Pick up
the  retractor  and close the aorta  around the graft. Suture the aortal
incision with close stitches.

 The  next step is a test of your previous work. Remove one of the iliac
clamps.  Then  remove  the next. Finally  remove  the  clamp at the top,
re-establishing  the  flow  of blood through  the  aorta. If no bleeders
appear, you've made it! If bleeders do appear, replace the three clamps,
starting with the two iliac clamps. Resuture the incision and try again.

 Once  the aorta is repaired, remove  the rubber tubing. Then un-retract
the  postperitoneum.  Suture  it.  Remove the  gut  bag  and replace the
intestines.  Un-retract the preperitoneum and  suture it. Un-retract the
next two layers (chest muscle and subcutaneous fat). After un-retracting
the  skin,  close it with skin clips  instead  of stitches. Turn off the
gas, and pick up your diploma in the Chief of Surgery's office.

 You  retire wealthy, and your name  will vanish from the receptionist's
clipboard.  Should you want to relive  past glories, head into the Staff
room  and click on the file cabinet. Again, hearty congratulations: I'll
catch you on the back 9!

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