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The hospitals here are all seeing big increases in ED traffic. Our run volume is going up, the EMS agency is going way up. They're at over 7k calls this year already. It's only gonna get worse.
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"I have a rash" is pretty low priority in an ER room. "I can't breathe" tend to work better. Now, ask yourself how many people in that ER had true life threatening problems and how many were there to try to score drugs, free minor medical care, or were just to stupid, cheap, or lazy to go to a urgent care facility for non life threatening problems. Every time I have walked into an ER, I'd say maybe 1 in 10 people had an issue where an ER visit was the correct thing to do, the rest had absolutely no immediate or urgent medical reason that couldn't be treated by a plain Dr office. View Quote View All Quotes View All Quotes Quoted:
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Would have died anyways in a third world country. Good thing there was at least a hospital. Wonder if there is more to the story? Probably. LOLWUT? What good is a hospital if they don't even make an attempt at fixing you up? I can die in a chair sitting at home, no need to go to the hospital for that. "I have a rash" is pretty low priority in an ER room. "I can't breathe" tend to work better. Now, ask yourself how many people in that ER had true life threatening problems and how many were there to try to score drugs, free minor medical care, or were just to stupid, cheap, or lazy to go to a urgent care facility for non life threatening problems. Every time I have walked into an ER, I'd say maybe 1 in 10 people had an issue where an ER visit was the correct thing to do, the rest had absolutely no immediate or urgent medical reason that couldn't be treated by a plain Dr office. Yes, but they have to pay for a Drs. visit. |
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So if I'm reading ARF correctly on this, it's probably better that the hospital didn't get around to him based on his looks?
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Last 2 times I went to the ER I had to get 15 stitches in my chin and had to do some ungodly things.
Both were admitted quickely and left as soon as I could sign my name releasing me. Might have helped that they were 3 years ago. |
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The ER I work is over 50 beds, and we are still loading patients up and down the hallway cause we are so inundated with crap like abdominal pain x 2 years and "my finger feels funny", while chest pains sit in the lobby untreated because the current system allows for it.
Ambulance abuse plays a huge role in it also. |
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Rash+ rapid death might be this: <a href="http://s487.photobucket.com/user/oscardeuce/media/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg.html" target="_blank">http://i487.photobucket.com/albums/rr232/oscardeuce/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg</a> Meningitis? That would have had a better prognosis, actually... what my erstwhile colleague is probably referring to is meningococcemia. At least with meningococcal meningitis, the infection is largely contained within the CNS. With fulminant meningococcemia, the infection is a body-wide gram-negative sepsis with the same bacteria (Neisseria Meningitidis). Meningococcal meningitis is a rapid killer... but meningococcemia is even faster... you're dead in a matter of hours. That and TTP are the only immediately-life-threatening "rashes" (and both would give you a similar rash, in fact) I can think of off the top of my head. And unfortunately for the deceased, a chief complaint of "rash" will get you a low-priority triage category... meaning you're going to wait for quite a while. In a busy urban trauma center, you might wait all day. And looking at the man's forearm in that second picture, I'm wondering if those aren't needle tracks. If they are, he could have sepsis and DIC (resulting in a rash) from any number of bugs... or even endocarditis on his heart valves. Drugs are bad... mmmmkay? |
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Something tells me the rash was only a symptom of a much more serious problem.
The big question is, is this malpractice through failure to give care when needed? Somewhere, a lawyer is asking that question and he's getting a stiffy over it. |
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Something tells me the rash was only a symptom of a much more serious problem. The big question is, is this malpractice through failure to give care when needed? Somewhere, a lawyer is asking that question and he's getting a stiffy over it. View Quote Something tells me that the rash had nothing to do with what killed him. |
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At my hospital, a ton of people come in complaining of chest pain. After the full negative workup, they then tell us about the small cut or persistent cough. They are abusing the system and end up getting rushed back and we can't ship em out for hours. The guy who actually needs ED care then has to wait for the FSA to clear out. I would imagine this has something to do with it.
People should use quick care more often. ED is for EMERGENCY |
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My first impression of this guy is he probably is not awake during normal orifice hours with a Doc, so he went to an ER...maybe he told the staff he had a more serious condition at the nurse's station but they went ahead and put him on the "pay no mind" list....we will get to the patient when we can. Dead men tell no tales. I cannot see anyone really at fault besides the patient, the ER is a place you should not go alone, and if you are alone it should be noted by the staff.
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Something tells me that the rash had nothing to do with what killed him. View Quote Maybe... maybe not. I wonder if they found any stolen fentanyl patchs on him when they did his autopsy. Until we know a cause of death, it's all just speculation. And as for the "nobody checks on people" thing, that's ludicrous. This article at the NY Post says they called for him to come back several times from 10PM to 2AM (he checked into the ER around 10PM... so that's pretty fast, particularly for a "rash" complaint in an urban trauma center). He was apparently asleep, and didn't answer when they called for him... which isn't the hospital's fault. When you call a patient's name, you don't go through the entire waiting room, and kick every homeless person awake to see if they're "Mr. Jones." A security guard came through at 2AM to roust the homeless people who try to camp out in the hospital (they do it where I work too), and the guy was alive then. Security cameras show him still moving as late as 3:45AM. It was only when they came through at 6AM (again, to roust the homeless people) that they found him deceased. |
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That would have had a better prognosis, actually... what my erstwhile colleague is probably referring to is meningococcemia. At least with meningococcal meningitis, the infection is largely contained within the CNS. With fulminant meningococcemia, the infection is a body-wide gram-negative sepsis with the same bacteria (Neisseria Meningitidis). Meningococcal meningitis is a rapid killer... but meningococcemia is even faster... you're dead in a matter of hours. That and TTP are the only immediately-life-threatening "rashes" (and both would give you a similar rash, in fact) I can think of off the top of my head. And unfortunately for the deceased, a chief complaint of "rash" will get you a low-priority triage category... meaning you're going to wait for quite a while. In a busy urban trauma center, you might wait all day. And looking at the man's forearm in that second picture, I'm wondering if those aren't needle tracks. If they are, he could have sepsis and DIC (resulting in a rash) from any number of bugs... or even endocarditis on his heart valves. Drugs are bad... mmmmkay? View Quote View All Quotes View All Quotes Quoted:
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Rash+ rapid death might be this: <a href="http://s487.photobucket.com/user/oscardeuce/media/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg.html" target="_blank">http://i487.photobucket.com/albums/rr232/oscardeuce/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg</a> Meningitis? That would have had a better prognosis, actually... what my erstwhile colleague is probably referring to is meningococcemia. At least with meningococcal meningitis, the infection is largely contained within the CNS. With fulminant meningococcemia, the infection is a body-wide gram-negative sepsis with the same bacteria (Neisseria Meningitidis). Meningococcal meningitis is a rapid killer... but meningococcemia is even faster... you're dead in a matter of hours. That and TTP are the only immediately-life-threatening "rashes" (and both would give you a similar rash, in fact) I can think of off the top of my head. And unfortunately for the deceased, a chief complaint of "rash" will get you a low-priority triage category... meaning you're going to wait for quite a while. In a busy urban trauma center, you might wait all day. And looking at the man's forearm in that second picture, I'm wondering if those aren't needle tracks. If they are, he could have sepsis and DIC (resulting in a rash) from any number of bugs... or even endocarditis on his heart valves. Drugs are bad... mmmmkay? Wow GD be smart! A good triage nurse should have recognized this if this was the case. Some EDs have docs in triage for this reason. |
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I was on Vanco a few years ago and they had to up the dose to the max to get me in the range of effectiveness. At lower doses I was getting chills and sweats. I told the Dr but she dismissed it. About 4 doses into the heavy stuff I was extremely lethargic and broke out in a rash. My wife immediately hauled me to the ER. I was in a "room" within 10 mins.
I'm guessing it has to do with the urgency you express at triage. They did some blood work, gave my an IV of some sort and I went from feeling like I was going to die to about 75% that night. |
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I think that says more about those saying it than anything else. View Quote View All Quotes View All Quotes Quoted:
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So if I'm reading ARF correctly on this, it's probably better that the hospital didn't get around to him based on his looks? I think that says more about those saying it than anything else. Yup. |
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Meningitis doesn't usually appear with a rash. The complaints we see with meningitis are headache, fever, stiff neck. An ER can't even diagnose Meningitis until a spinal tap is done, which no triage nurse in America is doing.
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Depends on the rash - purpuric rash, hell yes. View Quote View All Quotes View All Quotes Quoted:
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Is a rash something you go to the ER for? It's not for me. How about your primary care physician? I wonder what the Cause of death was. Posted Via AR15.Com Mobile Depends on the rash - purpuric rash, hell yes. Stolen from the Internet. "How long has the rash been present? Is it changing noticeably? Meningococcal septicaemia will be very recent in origin and changing almost visibly. Is the patient otherwise well? If a child has developed a purpuric, possibly meningococcal, rash but does not seem unwell, do not be lured into a false sense of security. That child may be moribund just 20 minutes later." I guess it isn't only children. |
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Is it more work or less work, for the ER staff, if your patient just dies in the waiting room? View Quote More. The administration is going to crawl up their asses with a microscope. It will take months for them to investigate this and settle with the family. An ER in New York City can have 100 people waiting to be seen. There's never enough staff, although there's usually a security guard or an orderly keeping an eye on the waiting area. The problem is that he went there with a condition that wasn't an emergency. That means they triaged him and decided that his rash could wait while they treated people who had difficulty breathing, chest pain, and other life threatening or potentially life threatening conditions. Given the long wait and the overload on the staff, they won't worry about it when the guy with the rash doesn't answer when they call for him. They'll assume he walked out. Then they go back to people who are bleeding or trying to scam opiates out of them. The news story says they checked on him more than once. I don't know about that, since they eventually found him dead. This has happened before, in New York City, so it's something the ER knew to expect. Not from this guy, but from people in general. The article quotes an anonymous hospital worker who says they found him, "...stiff, blue, and cold..." We don't know if this person was the chief of surgery or the SEIU wannabe who mops the floor. The statement is worthless until it is sourced. I hope that they were watching the waiting area and the person suddenly keeled over while they weren't looking, and the family is groping for dollars. It's possible that they're telling the truth, unfortunately. |
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Stolen from the Internet. "How long has the rash been present? Is it changing noticeably? Meningococcal septicaemia will be very recent in origin and changing almost visibly. Is the patient otherwise well? If a child has developed a purpuric, possibly meningococcal, rash but does not seem unwell, do not be lured into a false sense of security. That child may be moribund just 20 minutes later." I guess it isn't only children. View Quote When you see the petechial rash of Meningococcemia, you're actually looking at a picture of evolving DIC (Disseminated Intravascular Coagulation). DIC is what we call a consumptive coagulopathy, where the release of bacterial toxins causes the aggregation of platelets and abnormal bleeding. Those tiny little petechia that you're seeing in/under the skin are actually very small bruises/hemorrhages. In some patients, those will rapidly spread/increase-in-size until they form purpura: confluent purple bruises or hemorrhagic blisters. These patient's are SICK... and in many cases that rapid evolution of petechia-into-purpura is a pre-terminal event, even with antibiotics. What you're seeing in those cases is a patient's immune and hematologic systems rapidly circling the toilet bowl. By the time a person's sepsis has progressed to that degree, they're so far behind the eight-ball that many don't survive. |
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ERs are extremely overloaded right now. ..... Snip.... View Quote Been that way for years....I did my Medicine rotation my third year in Pod. School at the old Cook Co. Hospital...that was 2001...and they had full rooms, and the wipe off board had a space made between the rooms for the stretcher they would put there for the overflow patients...and even those were always full. Then the next year, went to the new hospital they opened...a lot of ER rooms....helped...but still had anywhere from 24hr to 48+ hour waits for the patients that were either not triaged or only had minor complaints.... This guy was probably triaged and said "I have a rash" so was put in the 'we'll get to him after the real emergencies' category.... AFARR |
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ERs are extremely overloaded right now. Ours apparently had three women miscarry in the waiting room in one weekend because they couldn't be seen. They are admitting patients to the hallway on the medical surgical floors just to get people out of the ER so they can see people. That's right, not even admitted to a room. To a hallway, where people and visitors are just all walking around. People are going to continue to die. EMTALA is the root cause. View Quote Which will be exacerbated 10 fold by Obamacare... |
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Been that way for years....I did my Medicine rotation my third year in Pod. School at the old Cook Co. Hospital...that was 2001...and they had full rooms, and the wipe off board had a space made between the rooms for the stretcher they would put there for the overflow patients...and even those were always full. Then the next year, went to the new hospital they opened...a lot of ER rooms....helped...but still had anywhere from 24hr to 48+ hour waits for the patients that were either not triaged or only had minor complaints.... This guy was probably triaged and said "I have a rash" so was put in the 'we'll get to him after the real emergencies' category.... AFARR View Quote View All Quotes View All Quotes Quoted:
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ERs are extremely overloaded right now. ..... Snip.... Been that way for years....I did my Medicine rotation my third year in Pod. School at the old Cook Co. Hospital...that was 2001...and they had full rooms, and the wipe off board had a space made between the rooms for the stretcher they would put there for the overflow patients...and even those were always full. Then the next year, went to the new hospital they opened...a lot of ER rooms....helped...but still had anywhere from 24hr to 48+ hour waits for the patients that were either not triaged or only had minor complaints.... This guy was probably triaged and said "I have a rash" so was put in the 'we'll get to him after the real emergencies' category.... AFARR If I were a betting man, that's where I'd put my money. And that's how business is SUPPOSED to be done; you treat the most-immediate life-threats first. The drug-seekers, colds-and-sniffles, and drama-queens can sit their butts down and wait, while we deal with the people who are obviously dying. Doing anything less (like catering to the drama-llamas) only encourages their crazy BS. This also goes for the pissed-off, selfish, manipulative, and solipsisitc idiots who call EMS from the hospital waiting room, in an attempt to get seen more quickly by coming in through the ambulance entrance. We have them wheel those people right back out into the waiting room. I can't see the triage nurse missing an obvious and evolving DIC (and the patient should have plenty of constitutional symptoms by that time, not just a "I have a rash, but otherwise I feel great!"). Then again, it's NYC in the middle of the winter... so who knows if the triage nurse actually had the patient take off his clothes so she could look at it. It may be that she simply took his word on the rash, and figured they'd look at it when they called him back. |
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GOVERNMENT OF MADAGASCAR CLOSES AIRPORTS TO PREVENT POSSIBLE INFECTIONS
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If I were a betting man, that's where I'd put my money. And that's how business is SUPPOSED to be done; you treat the most-immediate life-threats first. The drug-seekers, colds-and-sniffles, and drama-queens can sit their butts down and wait Snip... View Quote Unfortunately after a visit or two and some talking....the Drug Seekers, Colds and Sniffles and Drama-Queens learn to say "I have chest pain", "I can't breathe", etc. as they're triaged to move them up.... My ER rotation (1 month) during my first year residency was spent in about 50% in the Asthma room (yes, even as Podiatry resident...they stuck all the interns in there**) and most of the rest in the "Green" ER (minor stuff)...asthma's bad in the city, but a substantial percentage of the 'visitors' had no history of asthma, and once they'd get in there, suddenly, they'd have another issue (or be hungry....they actually stocked sammiches in the asthma room for patients...)...'my med needs refilled...I have this rash...my back hurts...etc'. AFARR (** the asthma room was the safest place to put the new people...like me and the MD/DO interns...the nurses there ran the show...'gee doctor, do you want to...' so I learned early on to listen to the experienced nurses and go with it for the most part. They did like us...Pod Residents and Students...for cutting and sewing though in the other part of the ER. By the time we've hit there, we've been doing it for a while in surgery rotations, so we can give the local, drain/remove, then sew if needed and the ER attending/Senior residents didn't have to stand over us...).... |
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I see you've never been to Woodhull Hospital. View Quote View All Quotes View All Quotes Quoted:
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And as for the "nobody checks on people" thing, that's ludicrous. I see you've never been to Woodhull Hospital. DITTO for KCH (Kings County Hospital in Flatbush, Brooklyn) in the 67. I had a foot post out front of there in the 90's, good times. In 2008 they had surveillance video of some EDP/kook stroking out in the waiting room. See Link link to CNN article and footage |
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When you see the petechial rash of Meningococcemia, you're actually looking at a picture of evolving DIC (Disseminated Intravascular Coagulation). DIC is what we call a consumptive coagulopathy, where the release of bacterial toxins causes the aggregation of platelets and abnormal bleeding. Those tiny little petechia that you're seeing in/under the skin are actually very small bruises/hemorrhages. In some patients, those will rapidly spread/increase-in-size until they form purpura: confluent purple bruises or hemorrhagic blisters. These patient's are SICK... and in many cases that rapid evolution of petechia-into-purpura is a pre-terminal event, even with antibiotics. What you're seeing in those cases is a patient's immune and hematologic systems rapidly circling the toilet bowl. By the time a person's sepsis has progressed to that degree, they're so far behind the eight-ball that many don't survive. View Quote View All Quotes View All Quotes Quoted:
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Stolen from the Internet. "How long has the rash been present? Is it changing noticeably? Meningococcal septicaemia will be very recent in origin and changing almost visibly. Is the patient otherwise well? If a child has developed a purpuric, possibly meningococcal, rash but does not seem unwell, do not be lured into a false sense of security. That child may be moribund just 20 minutes later." I guess it isn't only children. When you see the petechial rash of Meningococcemia, you're actually looking at a picture of evolving DIC (Disseminated Intravascular Coagulation). DIC is what we call a consumptive coagulopathy, where the release of bacterial toxins causes the aggregation of platelets and abnormal bleeding. Those tiny little petechia that you're seeing in/under the skin are actually very small bruises/hemorrhages. In some patients, those will rapidly spread/increase-in-size until they form purpura: confluent purple bruises or hemorrhagic blisters. These patient's are SICK... and in many cases that rapid evolution of petechia-into-purpura is a pre-terminal event, even with antibiotics. What you're seeing in those cases is a patient's immune and hematologic systems rapidly circling the toilet bowl. By the time a person's sepsis has progressed to that degree, they're so far behind the eight-ball that many don't survive. What's the other one called, where your entire circulatory system "freezes" solid into one giant clot? |
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Rash+ rapid death might be this: <a href="http://s487.photobucket.com/user/oscardeuce/media/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg.html" target="_blank">http://i487.photobucket.com/albums/rr232/oscardeuce/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg</a> Meningitis? anthrax |
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This guy is a junkie. Anyone who can't spot it in that first pic is an idiot.
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Rash+ rapid death might be this: <a href="http://s487.photobucket.com/user/oscardeuce/media/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg.html" target="_blank">http://i487.photobucket.com/albums/rr232/oscardeuce/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg</a> View Quote Braile? |
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Stop shouting, will you? And I'm unaware of such a condition. Nobody's blood just "freezes" into one giant clot. View Quote View All Quotes View All Quotes Quoted:
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What's the other one called, where your entire circulatory system "freezes" solid into one giant clot? Stop shouting, will you? And I'm unaware of such a condition. Nobody's blood just "freezes" into one giant clot. ALL CAPS is shouting. |
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DITTO for KCH (Kings County Hospital in Flatbush, Brooklyn) in the 67. I had a foot post out front of there in the 90's, good times. In 2008 they had surveillance video of some EDP/kook stroking out in the waiting room. See Link link to CNN article and footage View Quote View All Quotes View All Quotes Quoted:
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And as for the "nobody checks on people" thing, that's ludicrous. I see you've never been to Woodhull Hospital. DITTO for KCH (Kings County Hospital in Flatbush, Brooklyn) in the 67. I had a foot post out front of there in the 90's, good times. In 2008 they had surveillance video of some EDP/kook stroking out in the waiting room. See Link link to CNN article and footage KCH is wayyyy better than Woodhull especially if you need treatment for a GSW. Brookdale on the other hand....... |
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What's the other one called, where your entire circulatory system "freezes" solid into one giant clot? Stop shouting, will you? And I'm unaware of such a condition. Nobody's blood just "freezes" into one giant clot. ALL CAPS is shouting. I asked you nicely. *click* |
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GOVERNMENT OF MADAGASCAR CLOSES AIRPORTS TO PREVENT POSSIBLE INFECTIONS View Quote Okay, so it's been a while since I beat Pandemic 2 and got Kongregate's President Madagascar Assassin Badge, but I'll try to answer with what I remember. Be Infectious, but not Deadly You can alter your infectious disease at will. Because infected people never become uninfected, it's a totally valid strategy to infect as many people as possible and then mutate into a 100% mortality rate disease. Be Infectious, but Invisible You do have to be careful however, because even decidedly non-deadly diseases may spark airport / harbor closure, which may make Madagascar the human's best hideout. Don't go for the High Infection, High Visible symptoms, it's counteractive to your goal of INFECTING EVERY PATHETIC HUMAN ON EARTH. Remember - transmissions lead to closures! Be a Virus The benefits of fast mutation far outway the benefits of the other vectors. Start in Madagascar Or Canada, New Zealand, Cuba, Greenland, or West Europe. The point is, since these countries tend to be easiest to close, you may as well start there, to cut out on some headaches later. You can simply remake new games until you get one of these countries. And finally, a TLDR from the Kongregate comments: 1.Pick Virus. 2.Start in Canada, New Zealand, Cuba, Greenland, West Europe, or Madagascar. If you do not get there restart. 3.Sell the starting symptoms, and buy sneezing (unless it is what you started with, just keep it). 4.Buy 1-1-1-0 resistances but no transmissions (they trigger closures). 5.Once four countries are infected, sell sneezing to get rid of visibility. 6.Wait until all countries are infected. If Madagascar closes its shipyards/borders or is not infected in 30 days, restart. 7.Buy all four drug resistances AND sneezing, coughing, and vomiting. 8.After a few days, unlock tiers 2-3, (do not buy tier 4 ever!) keeping whatever symptoms it gives you. 9.Buy fever, fatigue, diarrhoea, pulmonary edema, and hypersensitivity. Then save for kidney failure and ataxia. |
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So if I'm reading ARF correctly on this, it's probably better that the hospital didn't get around to him based on his looks? I think that says more about those saying it than anything else. Yup. I think a lot of people are saying that a long term drug addict could easily have died from something other than "a rash". Also, many addicts are frequent flier drug seekers at ER's. It makes some sense to me that the staff would become somewhat skeptical of the severity of their conditions, especially in a very crowded ER. |
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