Rush M.D.: ICU Rulebook

Table of Contents

Table of Contents

• Components
• Symbols
  • Exam Types
  • Condition
  • Procedures
  • Other Symbols
• Component Anatomy
  • ICU Patient Cards
  • Diagnosis Cards
  • Electrocardiogram (ECG) Cards
• Game Boards
  • Intensive Care Unit (ICU) Board
  • Labs B & Diagnostic Imaging B Board
• 3D Cardboard Components
• How to Play with the Expansion
• Setup
• How to Play
  • Action Phase
    • Admission
    • Labs B & Diagnostic Imaging B
  • Intensive Care Unit (ICU)
  • Patient Evaluation Phase

Components

150 Cards:

• 36 (Hospitalized) ICU Patient Cards
• 8 Objective Cards
• 24 Urinalysis Diagnosis Cards
• 24 Allergy Test Diagnosis Cards
• 24 Ultrasound Diagnosis Cards
• 24 CT Scan Diagnosis Cards
• 10 Electrocardiogram (ECG) Cards

2 Game Boards

7 3D Cardboard Components (these need to be assembled):

• 1 CT Scanner
• 2 ICU Beds
• 4 IV Poles

13 Wooden Tokens:

• 4 Defibrillation Tokens
• 9 Allergy Test Tokens

50 Cardboard Tokens:

• 15 Urinalysis Tokens
• 20 Pump Infused Drug (PID) Tokens
• 8 Electrocardiogram (ECG) Tokens
• 6 Stability Tokens
• 1 Allergy Test Tile

1 Defibrillation Die

1 Ultrasound Token

1 Rulebook

Symbols

Below is a list of the symbols used in Rush M.D. - ICU.

Exam Types

Based on their Signs, Patients need to undergo different Exams before any further actions regarding their medical care (e.g., proper Treatment) can be determined.

• Urinalysis
• Allergy Test
• Ultrasound
• CT Scan

Condition

Patients' Condition can be prevented from worsening by performing all the necessary Procedures to stabilize them.

• Stabilized

Procedures

These symbols describe Procedures performed within the Intensive Care Unit (ICU).

• Defibrillation
• Electrocardiogram (ECG)
• Pump Infused Drugs (PIDs)

Other Symbols

Various other symbols used in Rush M.D. - ICU.

• Abnormal Cardiac Rhythm
• Normal Cardiac Rhythm

Component Anatomy

ICU Patient Cards

The ICU Patient Cards are labelled in the rulebook's card anatomy diagram as follows: Patient's Condition; Signs; Symptoms (Defibrillation, Pump Infused Drugs (PIDs), Electrocardiogram (ECG)); Treatment Reward; Required Exams; ICU Patient Indicator; Set Indicator; Contagious; and Surgery Folder.

Diagnosis Cards

Each Diagnosis card shows its Card Type, its Treatment Effectiveness, its Treatment Reward and its Treatment. The card types are Urinalysis Diagnosis, Allergy Test Diagnosis, Ultrasound Diagnosis and CT Scan Diagnosis.

Electrocardiogram (ECG) Cards

The ECG Cards have a Front Side and a Back Side. The Back Side shows the ECG Pattern to be recreated in the exact order. The Front Side shows the ECG Pattern used to verify the correct order of the ECG tokens, along with the Card Type.

Game Boards

Rush M.D. - ICU comes with 2 additional game boards that you can include in your games and represent the Hospital's Intensive Care Unit (ICU) and an expansion of the existing Laboratory & Diagnostic Department (Labs B & Diagnostic Imaging B). Each game board features a number of additional Action slots on which players can place Hourglasses to perform new Actions. Based on your player count and table space, you can set up these new game boards, along with the rest of them, in any way you prefer to maximize your gameplay potential.

Intensive Care Unit (ICU) Board

The ICU board features the following: the Department Name; a Slot for ICU Patient's Bed; Placeholders for ICU Patients' Electrocardiogram (ECG) Cards; and a Doctor Action Slot.

Labs B & Diagnostic Imaging B Board

The Labs B & Diagnostic Imaging B board features the following: the Exam Types; the Sign related to each Exam; a Doctor Action Slot; Slots for Patients' Beds; Placeholders for Diagnosis Cards; and a Tweezers Reminder.

3D Cardboard Components

The 3D cardboard components are the ICU Bed, the CT Scanner and the IV Pole. Instructions on how to assemble these components can be found on the publisher's website: www.artipiagames.com

How to Play with the Expansion

This expansion not only introduces the ICU but also brings 4 new Exams (Urinalysis, Allergy Test, Ultrasound and CT Scan) for you to perform on your Patients, using a Doctor Hourglass on the corresponding areas on the Labs B & Diagnostic Imaging B game board.

For a smoother learning curve we suggest that you play with the new Exams after you have familiarized yourself with all the Procedures and the new Actions related with the ICU. However, if you want a bigger challenge right from the start, feel free to include everything right away.

If you do not include the new Exams in your game, skip steps 2-4 from the Setup.

In order to integrate the new Exams into your game, based on your preferences and your potential table space limitations, you may do any of the following:

• New Department: If you choose to include only the Labs B & Diagnostic Imaging B game board, do not set up any of the components related to the Labs & Diagnostic Imaging game board and return them to the game box, as you are not going to use them.
• Reorganized Department: You may choose to include half of each of the two Labs & Diagnostic Imaging game boards in your game. Keep both game boards folded in half and choose which combination you want to use (Labs with Diagnostic Imaging B or Labs B with Diagnostic Imaging). Then, set up only the components related to the Exams you chose to use.
• Expanded Department: If you choose to include both Labs & Diagnostic Imaging game boards in your game (recommended for experienced players only), the following rules must apply:
  • For a Patient with a single Sign, you may perform either of the two available, related to that particular Sign, Exams (e.g., for a Patient with a Physical Sign you may freely choose between performing an X-RAY or an Ultrasound).
  • For a Patient with more than one Sign, regardless of whether they are of the same or of a different type, that Patient's Exams must not be performed all on the same game board (e.g., for a Patient with an Autoimmune and a Physical Sign, if you decide to perform an Allergy Test, you must then perform an X-RAY and not an Ultrasound). During the Patient Evaluation Phase, check if the Patient's Diagnosis cards are of Exams from both game boards and if they do not, lose 1 Medical Point for any such Patient.

Setup

In order to integrate the Rush M.D. - ICU expansion in your games, add the following steps during Setup:

• Place the ICU game board in the middle of the table, along with the rest of them, in any order/orientation you see fit.
• Place the Labs B & Diagnostic Imaging B game board in the middle of the table, along with the rest of them, in any order/orientation you see fit.
• Separate all Diagnosis cards based on the Exam they belong to, shuffle each type and place them in 4 face-down piles on the designated areas on the Labs B & Diagnostic Imaging B game board.
• Shuffle all Urinalysis tokens and place them face-down next to the Urinalysis area. Place the Allergy Test tile and all Allergy Test tokens next to the Allergy Test area. Place the Ultrasound token next to the Ultrasound area. Finally, assemble the CT Scanner and place it on the CT Scan area.
• Assemble the 2 ICU Beds and place them on the designated areas on the ICU game board.
• Shuffle all ICU Patient cards together with the rest of the Hospitalized Patient cards and place them in a face-down pile next to the Patient Admission area.
• Assemble the 4 IV Poles and place them next to the ICU game board.
• Sort the Electrocardiogram (ECG) tokens creating two sets of 4 (A, B, C and D) and place each set below the ICU game board, close to each ICU Bed.
• Shuffle all Electrocardiogram (ECG) cards and place them in a face-down pile on the designated area on the ICU game board.
• Place all Pump Infused Drug (PID) tokens, all Defibrillation tokens and the Defibrillation die next to the ICU game board.
• Sort all Objective cards and return those of the base game (i.e., the ones without the ICU Indicator on them) to the game box, as you are not going to use them. Then, choose an Objective card based on the number of players and the difficulty level you want to play (Easy, Normal, Hard, Very Hard).

Source note: the booklet marks its setup steps with icons rather than plain numbers, so the steps are listed here in printed order without numbers. The "skip steps 2-4" instruction in How to Play with the Expansion is kept as printed.

Source note: the booklet spells "Action" and "Exams" in a few places with Greek letters; they are rendered here with the Latin spelling.

How to Play

Action Phase

New Actions are now available during the Action Phase.

Admission

This is where new patients come in the hospital and you arrange for their treatment.

With the introduction of the ICU, you will also be admitting ICU Patients when drawing from the Hospitalized Patients deck.

Accept ICU Patient: Using a Doctor Hourglass, you may move one of the admitted ICU Patients to the ICU. To do so, pick up the chosen ICU Patient card and place it on any of the available Beds on the ICU game board.

IMPORTANT: Even though ICU Patients must first be accepted to the ICU and be stabilized before being transferred to a Ward, they are also considered, for all intents and purposes, to be Hospitalized Patients; following all the rules that concern Hospitalized Patients and counting toward the goals set by Objectives and Research Tasks referring to successfully treated and discharged Hospitalized Patients.

Labs B & Diagnostic Imaging B

Many patients need to go through exams to determine the cause of their symptoms and the proper treatment they should receive.

As with the Labs & Diagnostic Imaging game board of the base game, you may use your Doctor Hourglass to perform specific Exams on Hospitalized Patients, in order to find out how to properly treat them. Before performing one of those Actions, you must first move the Hospitalized Patient to be examined, along with the Ward Bed that the Patient is lying in, to the designated area of the corresponding Exam type.

The 4 types of Exam are the following: Urinalysis, Allergy Test, Ultrasound and CT Scan.

A Patient with an Infection Sign needs to have an Urinalysis Exam.

Urinalysis: With this Action you perform an Urinalysis Exam on the Patient placed in the Urinalysis area. To do so, look at the pair of letters shown on the back of the top card of the Urinalysis Diagnosis deck. One at a time, flip over the Urinalysis tokens until you reveal one that features both letters of this pair highlighted. Each token must be flipped face-down again before another one is revealed. As soon as you locate a matching Urinalysis token, place that token into the Patient's Bed and then draw the top card of the Urinalysis Diagnosis deck. Then, place it face-up on that Patient's Treatment area, in their Ward. You may then move that Patient away from the Urinalysis Exam area (even if the sand in the Doctor Hourglass is still running).

Both letters of the pair should appear highlighted on one token for it to match. For example, this Urinalysis Diagnosis card requires one matching token for AC.

Urinalysis is used to examine Patients with Infection Signs.

A Patient with an Autoimmune Sign needs to have an Allergy Test.

Allergy Test: With this Action you perform an Allergy Test on the Patient placed in the Allergy Test area. To do so, look at the back of the top card of the Allergy Test Diagnosis deck. There are three types of allergies for which the Patient is being tested: pets, food and pollen. Using a pair of Tweezers you must place Allergy Test tokens on the Allergy Test tile as follows, depending on the level of allergic reaction shown on each allergy type:

• For an allergic reaction of 0, do not place any Allergy Test tokens on its corresponding slot on the Allergy Test tile.
• For an allergic reaction of 1, place 1 green Allergy Test token on its corresponding slot on the Allergy Test tile.
• For an allergic reaction of 2, stack 2 yellow Allergy Test tokens on top of each other on its corresponding slot on the Allergy Test tile.
• For an allergic reaction of 3, stack 3 red Allergy Test tokens on top of each other on its corresponding slot on the Allergy Test tile.

Once you stack the Allergy Test tokens so that they match and correctly display the levels of allergic reaction shown on the back of the top card of the Allergy Test Diagnosis deck, you may draw that card and place it face-up on that Patient's Treatment area, in their Ward. You may then move that Patient away from the Allergy Test Exam area (even if the sand in the Doctor Hourglass is still running).

Using a pair of Tweezers, stack the Allergy Test tokens to match the levels of allergic reaction shown on the back of the top card of the Allergy Test Diagnosis deck. Allergy Test is used to examine Patients with Autoimmune Signs.

NOTE: If any Urinalysis or Allergy Test Diagnosis card you draw for a Patient features the Contagious symbol, you must also draw an Epidemic card and place it on the Ward Treatment area of that Patient's Ward (see Epidemics, for more details, on page 18 of the Rush M.D. base game rulebook).

Disclaimer: Allergies, in real life, have only a vague correlation to autoimmune diseases and they are by no means contagious. Both categorizations only serve gameplay purposes.

A Patient with a Physical Sign needs to have an Ultrasound.

Ultrasound: With this Action you perform an Ultrasound on the Patient placed in the Ultrasound area. Each Ultrasound Diagnosis card's back features 2 Bed identities which are illegible to the naked eye. You must locate an Ultrasound Diagnosis card that shows the Bed identity of the Patient being examined. To do so, take the Ultrasound token, place it on top of the Ultrasound Diagnosis deck and search the top card for the two Bed identities, using the Ultrasound token to reveal them. If the top card does not feature the Bed identity of the Patient being examined, put it on the bottom of the deck and check the new top card. Repeat this process until you find a card that features the Patient's Bed identity on it and place it face-up on that Patient's Treatment area, in their Ward. You may then move that Patient away from the Ultrasound Exam area (even if the sand in the Doctor Hourglass is still running).

Look at the top card of the Ultrasound Diagnosis deck and locate the Patient's Bed identity. Each Ultrasound Diagnosis card features, and therefore corresponds to, two Bed identities. Ultrasound is used to examine Patients with Physical Signs.

A Patient with a Neuropsych Sign needs to have a CT Scan.

CT Scan: With this Action you perform a CT Scan on the Patient placed in the CT Scan area. To do so, after placing the Patient's Bed inside the CT Scanner, as shown in the example, hold the top part of the CT Scanner with your fingers and then place the Doctor Hourglass on top of the CT Scanner on the designated area. Without touching the Hourglass, keep the Doctor Hourglass balanced on top of the CT Scanner until the sand runs out. If the Hourglass drops before the sand in it runs out, the entire process must be repeated until successfully performed. Once the CT Scan is successfully performed, draw the top card of the CT Scan Diagnosis deck and place it face-up on that Patient's Treatment area, in their Ward. Contrary to how the other Exams work, the Patient must remain in the CT Scan area for the entirety of the process.

NOTE: If at any moment during this process, the Doctor Hourglass is knocked over the CT Scanner, it must then be reset before being placed again on top of the CT Scanner.

During a CT Scan, be very careful not to knock the Doctor Hourglass over, otherwise you will have to repeat the entire Exam. CT Scan is used to examine Patients with Neuropsych Signs.

Intensive Care Unit (ICU)

Some patients must first be brought into the ICU to be stabilized before they can be hospitalized in the Ward.

All ICU Patients must be stabilized before they can be transferred to a Ward to have their Exams and receive their Treatment.

Stabilize ICU Patient: In order to stabilize an ICU Patient, all Procedures indicated on that Patient's Symptoms must be performed. Using a Doctor Hourglass, you can perform all of the indicated Procedures. The ICU Procedures required to stabilize an ICU Patient may be any of the following:

• Defibrillation: An ICU Patient may require Defibrillation. Take two Defibrillation tokens and balance them on that Patient's ICU Bed; one token on each of the two top corners of the ICU Bed, as shown in the example. Then, shout "Clear!" making sure that all of the other players hold their hands up in the air. Once this is done, roll the Defibrillation die again and again until it lands on one of the two sides indicating a Normal Cardiac Rhythm. As soon as a Normal Cardiac Rhythm is shown on the die, the Procedure is considered to be successfully completed and you may remove the Defibrillation tokens from the Patient's ICU Bed.

IMPORTANT: The player performing a Defibrillation does not interrupt the other players' Actions by forcing them to hold their hands up in the air!

As soon as the Defibrillation is successfully completed, all other players may continue the Action that they were already performing, assuming, of course, that there is still time in the current Action Phase or the sand inside their Hourglasses is still running. An exception to this are Actions requiring physically balancing a Patient's Bed or an Hourglass. As those Actions must be completed once started, in such cases, the player who wants to perform the Defibrillation must wait for the other players to finish their Actions first, before starting to roll the Defibrillation die, so that they can free their hands and hold them up in the air.

• Electrocardiogram (ECG): An ICU Patient may require an ECG. Place the top card of the ECG deck face-down on the designated area below that Patient's ICU Bed. Then, look at the back of the ECG card and recreate the ECG pattern shown on it by rearranging the 4 ECG tokens (A, B, C and D) next to the ICU game board. Once this is done, turn the ECG card face-up to compare your pattern with the one shown and verify the correct order of the ECG tokens. If you have not successfully recreated the ECG pattern, discard that ECG card and repeat the process with another ECG card. Once you have successfully recreated the ECG pattern, the Procedure is considered to be successfully completed.

• Pump Infused Drugs (PIDs): An ICU Patient may need to be provided with one or more PIDs. Take an IV Pole and place it next to that Patient's ICU Bed. Then, take a PID token of the corresponding color for each one shown on that Patient's Symptoms and hook them onto the IV Pole, making sure that the bottom part of each PID token ends up within the Patient's ICU Bed. Once this is done, the Procedure is considered to be successfully completed.

IMPORTANT: Once a Patient has been provided with PIDs, they must accompany that Patient throughout the Hospital!

When an ICU Patient requiring PIDs is transferred to a Bed in a Ward, the IV Pole along with all the hooked PIDs must also be transferred and reattached to that Patient's Ward Bed. Also, whenever that Patient is moved throughout the Hospital (for Exams, Surgery, etc.), the IV Pole along with all the PIDs hooked onto it must also be moved together. Even though there is no penalty if one or more PIDs temporarily get detached and no longer end up within a Patient's Bed, the PIDs must be attached correctly, once again, before any new Action can be performed on that Patient. Each time an Action is performed to a Patient without having the required PIDs properly attached, you must immediately lose 1 Medical Point.

NOTE: As long as their Beds are close to each other, a single IV Pole may be used to provide, at the same time, 2 ICU Patients with their required PIDs.

After all the required Procedures have been successfully completed, the Patient is considered stabilized. Take a Stability token and place it in that Patient's ICU Bed as a reminder, until removed during the next Patient Evaluation Phase. The Condition of an ICU Patient with a Stability token does not change during the Patient Evaluation Phase. This gives you one more round to treat that Patient.

IMPORTANT: Always make sure, after successfully stabilizing an ICU Patient, that you did not forget to place the Stability token in that Patient's ICU Bed!

Transfer ICU Patient: Once stabilized, an ICU Patient may exit the ICU. Using a Doctor Hourglass, you can transfer that Patient out of the ICU. To do so, first and foremost, check if the Patient has been successfully stabilized and there is a Stability token in that Patient's ICU Bed. If not, the Patient is NOT allowed to exit ICU, as you should have performed the Stabilize ICU Patient Action first. If a Stability token is present, then remove the card of that Patient from the ICU Bed and place it on any available Bed in either Ward. The Stability token and any PIDs attached to that Patient, along with the IV Pole they are hooked onto, must also accompany the Patient to the new Ward Bed. Finally, return any ECG card from the designated area below that Patient's ICU Bed to the bottom of its respective deck.

IMPORTANT: Even though performing the Transfer ICU Patient Action is not compulsory, as there is also another way for an ICU Patient to exit the ICU once successfully stabilized, that Action not only frees up an ICU Bed for another ICU Patient to occupy, but also makes it possible for you to stabilize, diagnose and treat an ICU Patient within a single round.

NOTE: ICU Beds feature a gap at their bottom side that allows you to easily remove a Patient card, during the Action Phase, just by sliding it through the gap.

Patient Evaluation Phase

During Patient Evaluation Phase, additionally perform the following steps:

Checking PIDs Administration: The first thing you do, before proceeding to the Evaluating Patients step, is to check whether PIDs have been properly provided (i.e., the PID tokens of the correct color have been hooked onto an IV Pole and the bottom part of each of them ends up within the Patient's Bed) to all the ICU Patients requiring them. ICU Patients who were not administered the EXACT PIDs they should have had or whose PIDs are not correctly attached to them decease, costing you 8 Medical Points.

IMPORTANT: During the Evaluating Patients step, ICU Patients with a Stability token are NOT checked for Medical Errors; their Condition does not change and you lose no Medical Points, even if they had no Exams or they received no Treatment at all this round. That being said, ICU Patients are evaluated as every other Hospitalized Patient; an ICU Patient without a Stability token deceases in case of a Medical Error (as all ICU Patients are of Critical Condition), costing you 8 Medical Points, whereas an ICU Patient that received the EXACT Treatment they should have is discharged.

NOTE: Stability token does not prevent you from losing Medical Points due to Overtreatment.

NOTE: An ICU Patient with a Stability token who has not yet received the Treatment they should have by the end of the last round of the game is not going to be discharged. Therefore, that Patient scores no Reputation Points and does not count toward the goals set by Objectives and Research Tasks referring to successfully treated and discharged Hospitalized Patients. However, as that Patient has been properly stabilized, you will not lose Medical Points either.

NOTE: When Discharging Patients, unhook any PID tokens from any IV Poles no longer in use and return them near the ICU game board.

Monitoring ICU Patients' Condition: Right after completing the Discharging Patients step, stabilized ICU Patients exit the ICU and they are transferred to any available Bed in either Ward, following the exact same process you would, during the Action Phase, when performing the Transfer ICU Patient Action. Then, remove the Stability tokens from all Patients. Those Patients remain in their Ward Beds and they must have all the necessary Exams and receive the appropriate Treatment during the next round.

NOTE: If at the end of the round there are no empty Beds in either Ward, ICU Patients who could not exit ICU decease, costing you 8 Medical Points.