Editing 1619: Watson Medical Algorithm
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==Explanation== | ==Explanation== | ||
− | + | {{incomplete|much more on the different procedures etc.}} | |
− | In this comic, | + | IBM's {{w|Watson_(computer)|Watson}} is a natural language system designed to answer questions posed by humans. Recently, IBM has extended Watson to act as a {{w|clinical decision support system}}, using image analytics to aid physicians in medical decision making. In this comic, Randall shows a {{w|Flowchart|flowchart}} representing a possible algorithm for Watson, including bizarre techniques including surgical alteration of a patient to match a height and weight chart and squeezing the patient to remove yellow fluids. Like [[416: Zealous Autoconfig]], this comic pokes fun at a rigid, poorly-designed setup that ends up potentially doing more harm than good. |
− | Modern | + | Modern medicine involves both standard processes and clinical judgement based around years of advanced training. An algorithm like this would have to be incredibly complicated in order to simulate the clinical judgement of a good doctor. |
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− | + | The algorithm depicted treats a patient as more of a machine or mechanical system than a living being, especially through decisions such as: | |
− | + | * Injecting oxygen into patients with low oxygen saturation, rather than treating the root cause | |
+ | * Removing and inspecting a skeleton, then diagnosing the patient's condition with a bone count | ||
+ | * Dissecting a doctor "for parts" after consulting him or her for advice | ||
+ | * Removing extra limbs from a patient if the count is less than 100 | ||
+ | * Determining whether the "build environment" of the patient is sane. This is most probably a reference to the configure script used in the {{w|GNU_build_system|GNU build system}}, which emits "checking whether build environment is sane" as one of its status messages. | ||
+ | * Rinsing the whole patient with a saline solution | ||
+ | * Removing organs from a patient regardless of response to an organ donation request | ||
− | + | Other decisions appear to be entirely unrelated to the conditions upon which they are predicated: | |
− | + | * If the patient doesn't rate their pain on a scale from 0-10, sequence their genome, apply a {{w|tourniquet}}, and perform an {{w|autopsy}} | |
+ | * If the patient's phone's battery is low, defibrillate until the battery is charged, sync photos, then administer general anesthesia | ||
+ | * If the patient is successfully comforted after an oxygen injection, check their medical history and apply skin grafts | ||
+ | * If green fluid is released from the patient, begin to cauterize | ||
+ | * If the patient has 100+ limbs, check their Vitamin D level | ||
− | The title text implies that, if the patient is so lucky to ever reach one of the two places with the option "discharge patient" | + | The title text implies that, if the patient is so lucky to ever reach one of the two places with the option "discharge patient," a minor glitch will cause to program to go back to the ''hunt down and capture patient'' option which thus force the patient and the program to repeat the process again in an infinite cycle, that will only end once the patient give another rating of their pain level than on the 0-10 scale. Then the program will start to sequence their genome then apply a tourniquet and finally perform an autopsy, on what will in the end for certain be a deceased patient, but maybe not when the autopsy began. This will finally cause the patient to leave the cycle... as a corpse! |
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+ | This is one of many comics with [[:Category:Flowcharts|flowcharts]], amongst other a recent comic with that very name: [[1488: Flowcharts]]. | ||
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This is the second comic in a row about health issues with the last comic being [[1618: Cold Medicine]]. | This is the second comic in a row about health issues with the last comic being [[1618: Cold Medicine]]. | ||
− | == | + | The computer's behavior in this comic can be compared to the healthcare robot named Baymax in the movie {{w|Big Hero 6 (film)}} (2014). |
− | {| | + | |
+ | ==Transcript and Discussion of Medical Appropriateness== | ||
+ | {{incomplete transcript}} | ||
+ | {| border=1 | ||
| | <b >Step</b> | | | <b >Step</b> | ||
| | <b >Medically valid?</b> | | | <b >Medically valid?</b> | ||
| | <b >Conditions and following step</b> | | | <b >Conditions and following step</b> | ||
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Draw Blood | Draw Blood | ||
− | | | + | | background-color:green | |
Phlebotomy is a normal early step in the diagnostic process, but not as first and unconditional step | Phlebotomy is a normal early step in the diagnostic process, but not as first and unconditional step | ||
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Record patient’s name | Record patient’s name | ||
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Record patient’s name | Record patient’s name | ||
− | | | + | | background-color:green | |
− | + | ||
− | | | | + | OK |
+ | | | | ||
Measure Patient’s height and Weight | Measure Patient’s height and Weight | ||
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Measure Patient’s height and Weight | Measure Patient’s height and Weight | ||
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OK | OK | ||
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Consult Standard height/weight chart | Consult Standard height/weight chart | ||
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Consult Standard height/weight chart | Consult Standard height/weight chart | ||
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OK | OK | ||
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Surgically adjust patient to match | Surgically adjust patient to match | ||
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Surgically adjust patient to match | Surgically adjust patient to match | ||
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− | May be considered ethically dubious unless there are [http://www.gosh.nhs.uk/medical-information/procedures-and-treatments/limb-length-difference-and-limb-lengthening sound medical reasons] for doing so. Could be an allusion to | + | May be considered ethically dubious unless there are [http://www.gosh.nhs.uk/medical-information/procedures-and-treatments/limb-length-difference-and-limb-lengthening sound medical reasons] for doing so. Could be an allusion to [https://en.wikipedia.org/wiki/Procrustes Procrustes]. |
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Is patient coughing up blood? | Is patient coughing up blood? | ||
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− | | width="33%" rowspan=2 | | + | | width="33%" rowspan=2 | |
Is patient coughing up blood? | Is patient coughing up blood? | ||
− | | width="33%" rowspan=2 | | + | | width="33%" rowspan=2 | |
OK, coughing up blood is generally a sign that there is something wrong. Typical causes are respiratory tract infections (e.g. tuberculosis), lung trauma or pulmonary embolism. | OK, coughing up blood is generally a sign that there is something wrong. Typical causes are respiratory tract infections (e.g. tuberculosis), lung trauma or pulmonary embolism. | ||
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Yes: Gather blood and return it to body | Yes: Gather blood and return it to body | ||
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No: Is patient still here? | No: Is patient still here? | ||
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− | | width="33%" rowspan=2 | | + | | width="33%" rowspan=2 | |
Is patient still here? | Is patient still here? | ||
− | | width="33%" rowspan=2 | | + | | width="33%" rowspan=2 | |
− | Not usually considered a step, but missing patients are a problem in some fields, psychiatry or intensive care for example. | + | Not usually considered a step, but missing patients are a problem in some fields, psychiatry or intensive care for example. |
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Yes: Record pulse rate | Yes: Record pulse rate | ||
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No: Hunt down and capture patient | No: Hunt down and capture patient | ||
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Hunt down and capture patient | Hunt down and capture patient | ||
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− | Valid if patient should not have left the bed/unit, but the wording is possibly dubious. | + | Valid if patient should not have left the bed/unit, but the wording is possibly dubious. |
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Is patient still here? | Is patient still here? | ||
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Gather blood and return it to body | Gather blood and return it to body | ||
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Dangerous idea in this case due to likelihood of contamination, although if safely done autotransfusion is an accepted medical technique to ensure a matching blood supply prior to a major operation, or to enhance stamina (blood doping) | Dangerous idea in this case due to likelihood of contamination, although if safely done autotransfusion is an accepted medical technique to ensure a matching blood supply prior to a major operation, or to enhance stamina (blood doping) | ||
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Record pulse rate | Record pulse rate | ||
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Record pulse rate | Record pulse rate | ||
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OK, but maybe a little late. | OK, but maybe a little late. | ||
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Is patient screaming? | Is patient screaming? | ||
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− | | width="33%" rowspan=2 | | + | | width="33%" rowspan=2 | |
− | Is patient screaming? | + | Is patient screaming? |
− | | width="33%" rowspan=2 | | + | | width="33%" rowspan=2 | |
− | Very important question, indicating patient is conscious, in pain, and aware pain is bad. First attenders can use it in classifying priorities (quiet patients may be more severely injured). Generally useful in assessing nerve damage, pain relief, etc. | + | Very important question, indicating patient is conscious, in pain, and aware pain is bad. First attenders can use it in classifying priorities (quiet patients may be more severely injured). Generally useful in assessing nerve damage, pain relief, etc. |
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− | Yes: Ignore | + | Yes: Ignore |
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No: Check blood O<sub>2</sub> saturation | No: Check blood O<sub>2</sub> saturation | ||
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− | + | | width="33%" rowspan=2 ` | | |
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− | | width="33%" rowspan=2 ` | | ||
Check blood O<sub>2</sub> saturation | Check blood O<sub>2</sub> saturation | ||
− | | width="33%" rowspan=2 | | + | | width="33%" rowspan=2 | |
Only really indicated if the patient is in danger of hypoxia. Generally normal people should have a SpO2 of 98-100%, but in chronic lung disease this can fall as low to 80%, and in premature babies a SpO2 of 90% is usually targeted to avoid problems with retinopathy. If the SpO2 were to fall as low as 50%, the patient would definitely be dead or unconscious. | Only really indicated if the patient is in danger of hypoxia. Generally normal people should have a SpO2 of 98-100%, but in chronic lung disease this can fall as low to 80%, and in premature babies a SpO2 of 90% is usually targeted to avoid problems with retinopathy. If the SpO2 were to fall as low as 50%, the patient would definitely be dead or unconscious. | ||
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>50%: Remove and inspect skeleton | >50%: Remove and inspect skeleton | ||
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<50%: Inject oxygen | <50%: Inject oxygen | ||
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− | | width="33%" rowspan=2 | | + | | width="33%" rowspan=2 | |
Remove and inspect skeleton | Remove and inspect skeleton | ||
− | | width="33%" rowspan=2 | | + | | width="33%" rowspan=2 | |
Fatal if patient is still alive when beginning. Also not a valid medical procedure in any way as it is impossible to remove most of the long bones of the body without destroying all surrounding tissue. | Fatal if patient is still alive when beginning. Also not a valid medical procedure in any way as it is impossible to remove most of the long bones of the body without destroying all surrounding tissue. | ||
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Too many bones: Is fluid coming out of patient? | Too many bones: Is fluid coming out of patient? | ||
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Too few bones: Request consult with human doctor | Too few bones: Request consult with human doctor | ||
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Request consult with human doctor | Request consult with human doctor | ||
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− | Medically valid in the context of obtaining an opinion from a doctor in a different speciality who is better suited to treating the patient. | + | Medically valid in the context of obtaining an opinion from a doctor in a different speciality who is better suited to treating the patient. |
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Dissect doctor for parts | Dissect doctor for parts | ||
− | |- | + | |- |
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Dissect doctor for parts | Dissect doctor for parts | ||
− | | | <b >This may be considered ethically dubious. | + | | | <b >This may be considered ethically dubious.<span > </span></b>Possible reference to the Doctor Who episode “{{w|The girl in the fireplace}}” |
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− | Discharge patient | + | Discharge patient |
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Acceptable, but patient would generally be dead by then. | Acceptable, but patient would generally be dead by then. | ||
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+ | Discharge patient | ||
+ | | | | ||
+ | | | | ||
END STATE (before you read the title text) | END STATE (before you read the title text) | ||
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Is fluid coming out of patient | Is fluid coming out of patient | ||
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− | Unintended fluid release is always a problem. How significant a problem depends on where the fluid came from and if it is supposed to be coming from there. Red generally is due to blood, yellow is due to pus/tissue fluid/lymph and green signifies bacterial infection or bile salts (biliverdin). Could also relate to normal fluids being lost (e.g. urine, saliva, sweat) | + | Unintended fluid release is always a problem. How significant a problem depends on where the fluid came from and if it is supposed to be coming from there. Red generally is due to blood, yellow is due to pus/tissue fluid/lymph and green signifies bacterial infection or bile salts (biliverdin). Could also relate to normal fluids being lost (e.g. urine, saliva, sweat) |
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Squeeze patient | Squeeze patient | ||
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Could be in the medical context is in providing external ventilation (see iron lung) or other means of removing fluid (e.g. squeezing pus from a boil). | Could be in the medical context is in providing external ventilation (see iron lung) or other means of removing fluid (e.g. squeezing pus from a boil). | ||
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Is fluid coming out of patient | Is fluid coming out of patient | ||
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What color? | What color? | ||
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− | Never underestimate the number of different types of fluid the body can produce. | + | Never underestimate the number of different types of fluid the body can produce. |
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Activate sprinklers | Activate sprinklers | ||
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− | Not medically valid. Presumably a reference to how much cleaning up will be required by this stage | + | Not medically valid. Presumably a reference to how much cleaning up will be required by this stage. |
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Subdue patient | Subdue patient | ||
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Subdue patient | Subdue patient | ||
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− | Potentially very important if patient is behaving dangerously to themselves and others around them (due to mental health issues e.g. psychosis or drugs) and/or is moving too much to be given treatment | + | Potentially very important if patient is behaving dangerously to themselves and others around them (due to mental health issues e.g. psychosis or drugs) and/or is moving too much to be given treatment. |
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Apply cream | Apply cream | ||
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Apply cream | Apply cream | ||
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Medically valid as a form of barrier dressing to improve wound healing. | Medically valid as a form of barrier dressing to improve wound healing. | ||
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Ask patient to rate pain level | Ask patient to rate pain level | ||
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Ask patient to rate pain level | Ask patient to rate pain level | ||
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Useful in the sense that it provides the doctor with the means to ensure that the patient is receiving adequate analgesia during conditions of chronic and acute pain. | Useful in the sense that it provides the doctor with the means to ensure that the patient is receiving adequate analgesia during conditions of chronic and acute pain. | ||
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Massage scalp | Massage scalp | ||
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This would belong more to the domain of palliative care and reflexology rather than being an accepted medical treatment. | This would belong more to the domain of palliative care and reflexology rather than being an accepted medical treatment. | ||
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Patient is healthy | Patient is healthy | ||
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Patient is healthy | Patient is healthy | ||
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A subjective assessment of the health patient is often helpful in ruling out certain diagnoses. For example, one is less likely to suspect cancer in a fit, healthy 30 year old than a thin, lethargic 50 year old. | A subjective assessment of the health patient is often helpful in ruling out certain diagnoses. For example, one is less likely to suspect cancer in a fit, healthy 30 year old than a thin, lethargic 50 year old. | ||
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Admit for observation | Admit for observation | ||
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Admit for observation | Admit for observation | ||
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Useful in the context of 'watchful waiting', in which the doctor may be unsure if the patient actually has a condition that they suspect that the patient has. By keeping the patient on the ward for a few days, the clinician can monitor the progression of symptoms and rapidly initiate adequate treatment if medically warranted. | Useful in the context of 'watchful waiting', in which the doctor may be unsure if the patient actually has a condition that they suspect that the patient has. By keeping the patient on the ward for a few days, the clinician can monitor the progression of symptoms and rapidly initiate adequate treatment if medically warranted. | ||
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Laser eye removal | Laser eye removal | ||
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− | This is not a standard medical procedure | + | This is not a standard medical procedure. This could be a pun on laser eye surgery where a laser is used to correct visual problems (e.g. short-sightedness), or laser hair and tattoo removal. |
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Admit for observation | Admit for observation | ||
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Sequence genome | Sequence genome | ||
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− | Useful in the association of extremely rare point mutations with an organic illness. See for instance the Genome 10K Project or the Cancer Genome Atlas. Or in diagnosing extremely rare mutations that are not picked up by most commercial DNA screening tests (e.g. kidney failure due to INF2 mutation). | + | Useful in the association of extremely rare point mutations with an organic illness. See for instance the Genome 10K Project or the Cancer Genome Atlas. Or in diagnosing extremely rare mutations that are not picked up by most commercial DNA screening tests (e.g. kidney failure due to INF2 mutation). |
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Apply tourniquet | Apply tourniquet | ||
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Apply tourniquet | Apply tourniquet | ||
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Useful to stop acute bleeding from an injured extremity, but if it is drawn too tightly it can cause neuromuscular damage. | Useful to stop acute bleeding from an injured extremity, but if it is drawn too tightly it can cause neuromuscular damage. | ||
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Perform autopsy | Perform autopsy | ||
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Perform autopsy | Perform autopsy | ||
− | | | | + | | | Fatal if patient is still alive when beginning. |
| | END STATE (taking the title text into account, the only possible one) | | | END STATE (taking the title text into account, the only possible one) | ||
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Inject oxygen | Inject oxygen | ||
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− | May be fatal as injecting gases directly to the blood vessels can cause a serious embolism if it blocks blood flow to the brain or coronary arteries. However, if the oxygen is injected slowly into the venous circulation, it may be survivable as the bubbles may simply collect in the lungs where the oxygen is then slowly | + | May be fatal as injecting gases directly to the blood vessels can cause a serious embolism if it blocks blood flow to the brain or coronary arteries. However, if the oxygen is injected slowly into the venous circulation, it may be survivable as the bubbles may simply collect in the lungs where the oxygen is then slowly resorbed into the blood. |
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Comfort patient | Comfort patient | ||
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Comfort patient | Comfort patient | ||
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Psychological support to the patient and relatives is often useful after breaking news of a poor prognosis. It may also be useful in subduing the agitated or psychotic patient. | Psychological support to the patient and relatives is often useful after breaking news of a poor prognosis. It may also be useful in subduing the agitated or psychotic patient. | ||
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− | + | Subdue patient | |
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Review medical history | Review medical history | ||
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Important early step, rather too late and conditional. | Important early step, rather too late and conditional. | ||
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Skin grafts | Skin grafts | ||
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Skin grafts | Skin grafts | ||
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Only indicated if massive areas of the skin are damaged (typically due to burns) | Only indicated if massive areas of the skin are damaged (typically due to burns) | ||
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+ | |- | ||
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Count number of limbs | Count number of limbs | ||
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Not really relevant in medicine, but may be of use to know the reason behind any missing or extra limbs on seeing the patient though a through review of the medical history will render this point moot. Probably a little late to be noticing this now. | Not really relevant in medicine, but may be of use to know the reason behind any missing or extra limbs on seeing the patient though a through review of the medical history will render this point moot. Probably a little late to be noticing this now. | ||
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Remove extra limbs | Remove extra limbs | ||
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Medically indicated in cases of polymelia either due to cosmetic purposes or because the extra limbs pose a direct threat to the health of the baby. | Medically indicated in cases of polymelia either due to cosmetic purposes or because the extra limbs pose a direct threat to the health of the baby. | ||
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Subdue patient | Subdue patient | ||
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Measure vitamin D | Measure vitamin D | ||
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Valid in diagnosis of bone related issues, for example if multiple or comminuted fractures were being counted as additional limbs/bones. | Valid in diagnosis of bone related issues, for example if multiple or comminuted fractures were being counted as additional limbs/bones. | ||
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Check whether build environment is sane | Check whether build environment is sane | ||
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Could be technical reference to the installation of the algorithm in the robot, or could relate to the sanity of: | Could be technical reference to the installation of the algorithm in the robot, or could relate to the sanity of: | ||
− | *The robot doctor | + | * The robot doctor |
− | *The patient undergoing this procedure (before or after reaching this part of the process) | + | * The patient undergoing this procedure (before or after reaching this part of the process) |
− | * | + | * The person who programmed the robot to perform this flowchart |
− | * | + | * The person who allowed this state of affairs to occur (I'm looking at you [[Black-Hat]]) |
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NB: Whether the build environment is sane is irrelevant to the flowchart. | NB: Whether the build environment is sane is irrelevant to the flowchart. | ||
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Rinse patient with saline solution | Rinse patient with saline solution | ||
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Rinse patient with saline solution | Rinse patient with saline solution | ||
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− | Tepid sponging may be indicated if the patient has a high fever. Could also refer to internally rinsing patient with saline solution i.e. providing intravenous sodium chloride to boost circulating volume or to perform peritoneal dialysis. | + | Tepid sponging may be indicated if the patient has a high fever. Could also refer to internally rinsing patient with saline solution i.e. providing intravenous sodium chloride to boost circulating volume or to perform peritoneal dialysis. |
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Is patient phone battery low? | Is patient phone battery low? | ||
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Invalid in medical terminology, could be a technological metaphor for the patient's consciousness or stamina. "Your life-force is running out" | Invalid in medical terminology, could be a technological metaphor for the patient's consciousness or stamina. "Your life-force is running out" | ||
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Defibrillate | Defibrillate | ||
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− | Indicated in cases where there is ventricular fibrillation, and to a lesser extent in | + | Indicated in cases where there is ventricular fibrillation, and to a lesser extent in atrial fibrillation (chemical cardioversion with adenosine is usually preferred) |
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Is patient phone battery low? | Is patient phone battery low? | ||
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Sync photos from camera | Sync photos from camera | ||
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Definitely invalid. Could refer to the robot attempting to backup photos from a camera before attempting to repair it/attempting to back-up patient's consciousness. | Definitely invalid. Could refer to the robot attempting to backup photos from a camera before attempting to repair it/attempting to back-up patient's consciousness. | ||
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Administer general anesthesia | Administer general anesthesia | ||
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Administer general anesthesia | Administer general anesthesia | ||
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− | Valid, but not at this stage. Only used when the procedure will invoke unnecessary distress or pain to the patient if they were to be awake beforehand | + | Valid, but not at this stage. Only used when the procedure will invoke unnecessary distress or pain to the patient if they were to be awake beforehand. |
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Discharge patient | Discharge patient | ||
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Blood loss? | Blood loss? | ||
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− | + | Useful. Patient may die if this clinical sign is missed. | |
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Patient address changed? | Patient address changed? | ||
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− | + | Useful to ensure that the organisation has current contact details for the patient in the event that they may need to contact the patient (e.g. to arrange further appointments) | |
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Request organ donation | Request organ donation | ||
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+ | Generally done prior to registering an individual for a driving licence or to a medical practice, or to the relatives of the deceased if consent had not been acquired beforehand. | ||
|Remove organs | |Remove organs | ||
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Remove organs | Remove organs | ||
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+ | The only organs which can be safely removed from a living person without resulting in serious, chronic medical issues are the kidneys/lungs (only one can be removed), spleen, part of the liver (as long as one lobe is left it can regrow to its original size) and colon (usually consisting of the appendix only). With some serious lifestyle modifications, the pancreas, pituitary gland, frontal lobe of brain, half of the brain, adrenal glands, bladder and most of the gut can be removed. The heart can be removed from the body and replaced with an artificial pump for a few months at the most. However, such organ removals are only indicated if there is a genuine clinical need to do so due to the non-negligible risk of death associated with these operations. | ||
| Discharge patient | | Discharge patient | ||
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Discharge patient | Discharge patient | ||
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− | + | | END STATE (before you read the title text) | |
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|} | |} | ||
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{{comic discussion}} | {{comic discussion}} | ||
+ | [[Category:Artificial Intelligence]] | ||
[[Category:Flowcharts]] | [[Category:Flowcharts]] | ||
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