Design and Implementation of Rule-based Medical Models: An In Silico Patho-physiological Trauma Model for Hypovolemic Shock

摘要

Trauma from 'Dirty' Bomb blasts presents complex clinical problems to healthcare providers who must make critical emergency care decisions with incomplete information, usually limited initially only to cursory observations and vital signs. A set of simple, HFSM patho-physiological models of hypovolemic shock based upon blood volume deficits and remedial therapeutic actions has been created for 10 Virtual World scenarios used for training healthcare personnel in the diagnosis and management of 'dirty' bomb victims. Several general rules define the models:Virtual patients have individual characteristics of gender, age, health status.An Expanded Organ Injury Scale (EOIS) indicates in descriptive terms the type, severity, and location of the injury.Traumatic Hemorrhage Classes (THC) determine Blood Volume Deficit.EOIS/THC Score and Volume Deficit are tightly linked to the Hemorrhage Rate.Remedial actions include Wound care, Volume Replacement (0.9% saline, packed cells), and a Drug Formulary for Treating Hemorrhagic Shock.The above rules and their logical basis are derived from the literature on emergency medicine (trauma), with modifications for organ injury, and introducing progressive deterioration beyond the body's homeostatic capabilities, into failure of systems and organs, followed by death. The ten unique models and scenarios are designed to run simultaneously in a virtual emergency department to provide training experiences for healthcare personnel with trauma from a 'dirty' bomb blast event.