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Chief Medical Officer
Since it largely consists of just following a known set of steps in order, surgery is not the most complex part of playing a Medical professional - at least from an OOC standpoint. In-character, surgery is very difficult and should only be attempted by trained professionals except in case of direst emergency. But the actual Hard Part of surgery comes from everything that surrounds it.
Surgery is generally required when a patient is in very bad condition. Multiple organs may require repair. Their brain may be failing. They may be suffering from giant spider venom, radiation poisoning, or catastrophic burns. Following the steps to complete surgery is not hard. Following the steps to complete surgery while making sure that the patient stays alive long enough to finish is difficult.
For this reason, it is highly encouraged for Medical players to not start out as a dedicated surgeon. Knowledge of the rest of Medical play an understanding of the various medications available to you are essential when playing this role. Accidents happen and patients die, but try to make sure that you at least know the basics.
- 1 General Overview
- 2 Prepping for surgery
- 3 List of operations
- 3.1 Basic Steps
- 3.2 Making an incision
- 3.3 Closing an Incision
- 3.4 Opening the Skull or Rib Cage
- 3.5 Bone Repair Surgery
- 3.6 Facial Reconstruction Surgery
- 3.7 Arterial Bleeding Surgery
- 3.8 Amputation
- 3.9 Limb Replacement Surgery
- 3.10 Organ Repair
- 3.11 Shrapnel and Implant Removal
- 3.12 Organ Removal or Transplantation
- 3.13 Decaying Organ Repair
- 3.14 Autopsy
- 3.15 Hardsuit Removal
- 3.16 Cavity Surgery
- 3.17 Extracting organs from detached body parts
- 4 So you messed up your surgery
- 5 How to help
- 6 Advanced techniques
Ideally, any given operation will take place within Medbay, in either the primary OR or secondary Robotics theater. Your patient should be stripped of as much of their equipment as possible (or at least enough to make sure that there's nothing in the way of the surgery), properly anesthetized (see below), and have their vitals reading out on the console so that you can make sure they aren't in any danger during the operation. They should also have easy access to an IV in case of need for emergency blood transfusion.
It isn't really possible to have multiple people performing the operation itself, but in especially severe cases, it can be appropriate to have someone handy to monitor the patient's vitals and ensure that they have the proper medications in their system to keep them stable while the operation completes. Keeping a defibrillator handy, or having someone ready to perform emergency CPR, can also be very important for keeping patients alive throughout the ordeal.
Of course, proper surgery isn't always possible. There are some situations where you have no choice but to operate outside of an OR - though it's certainly not a good idea in most cases. Maybe you haven't got a chance to get them to the Infirmary, though. Or maybe you just don't care.
You can use any table available as a makeshift operating table, if you have to. Get your patient in an aggressive grab and click on the table to lay them on it. This will allow you to use surgical tools on them as though you were performing surgery normally - except that you have a 1/3 chance per step to make a mistake and injure the patient rather than advancing the procedure.
Setting a patient on a roller bed also allows for surgery, with a 1/4 chance per step of accidental injury. Obviously, this is still inferior to an actual operating table, though, so try to keep surgery in the proper areas unless absolutely necessary.
Both the primary and secondary operating theaters have their own set of surgical tools, kept in a special black Medkit labeled "Surgery Kit". Click and drag from the kit onto yourself to access the tools inside.
In most cases, these should never be taken out of those rooms, as they're difficult to replace if lost. If they somehow manage to go missing, you can order replacements from Supply, or print a few replacements from an Autolathe.
The following are the standard surgical tools most doctors will need:
Some of the tools listed below aren't found in the standard Surgery Kit. The autopsy scanner, for example, is kept in the Morgue, while sterile masks and gloves are available as part of the standard medical equipment. Replacement trauma kits can also be procured from the NanoMed Plus vendor, anesthesia is kept in the various anesthesia closets, and so on.
Ghetto surgical tools:
- Cable coil
- Glass shard
- welding tool
- metal rods
- kitchen knife
If it's absolutely necessary, it is technically possible to operate on yourself - though obviously, you can't anesthetize yourself during this process, so get ready for some pain. Get on top of a table, or sit on a roller bed, and follow the instructions for a procedure normally as if you were doing it to someone else — the only exception is that you cannot target your head for surgical steps. Or the arm/hand you're holding the tool with, in case that's not obvious. Be warned: the amount of pain you are in will directly affect your chances of success, and as you go along, certain surgical steps will make the pain even worse! Take it slow, or have a painkiller like Tramadol to help you through the shock. Combine this with Ghetto Surgery for some real badass points.
Prepping for surgery
Make sure that your patient has been passed through the full-body scanner and that you have a printed copy of its readings before beginning your operation. Double-check that you're targeting the right limbs and that you haven't missed any organ damage or other important facts before you start, or you may end up really hurting your patient.
More importantly, make sure that all non-surgical issues that can be cured before operating have been cured before operating. Trying to repair a patient's organs while they're still pumped full of spider venom is liable to result in a dead patient. Get your victims as stable as possible before strapping them to the slab.
Also make sure that you - or the Corpsman, if there's one available - have given your patient all the necessary medications to keep them stable during the operation. You don't want to have to run out of the OR in the middle of an operation in search of emergency Dexalin Plus. If you need assistance during the surgery - someone to administer further medication, perform CPR, or apply a defibrillator, for example - make sure that they're also ready to go and know the game plan.
The preparation process
Are you sure you've got your scanner printout handy, all medications administered, all other conditions dealt with, and all necessary personnel ready to go?
- Find a suitable Operating Table unless you're willing to risk Ghetto Surgery.
- Make sure you're wearing File:LGloves.png latex gloves and a File:Sterilemask.png sterile mask.
- Ask the person to strip, or click+drag them onto your body and manually remove their clothing.
- Grab the person and click on the operating table to lay them down on it.
- Check the File:Crewmonitor.gif Operating Computer to ensure the patient is positioned properly; if the monitor does not show the patient's vitals, the surgery will not work.
- Anesthetize the patient.
- Be sure that the patient is asleep.
- Make sure you're set on the Help intent.
- Use a sink to wash your hands.
Operating on people who are awake is kind of difficult. They tend to scream and squirm around a lot. It's technically possible to complete surgery on someone who's awake, but you're best off restraining them if that's the case, and the patient is likely to have their heart stop from the sheer agony of it unless they're high as a kite on painkillers.
Ideally, you want the patient to be asleep and unresponsive before shoving your hands into their rib cage. As such, you'll need to apply anesthesia.
There are two types of anesthesia available on board the SEV Torch: inhaled and injected.
Inhaled anesthesia is the one that you want to be using most of the time. It's quick to apply, quick to work, and quick to wear off when you're finished. Just put a breath mask and anesthetic tank from the closet on the patient and turn on their internals (or, if you're in the primary OR, use the automatic pump on the wall, by the operating table). Within a few seconds, your patient will be asleep. When you're done, just remove the mask, and they'll be up again in no time.
Of course, inhaled anesthesia is dependent on the patient having a functioning set of lungs. If their lungs are damaged, then you're going to have to rely on injected anesthesia.
The NanoMed Plus vendor in the Treatment Center contains bottles of Soporific. Fill up a syringe and pump your patient full. It'll take a while to fully knock them out (so be sure to keep looking at them with Shift + Click so that you know when they finally do conk off), but it'll last a while, too. There's no quick way to bring them out of this coma, though, unless you want to pump them full of Dylovene to counteract the soporific.
Like the inhaled anesthetic, though, soporific relies on your patient having a functioning organ - in this case, the heart. If the heart's not pumping, soporific's not circulating - but, then again, neither is anything else, so your patient is unlikely to be awake anyway. If for some reason, they are, and their lungs also aren't working, then they're shit outta luck. Pump 'em full' of painkillers and pray they don't fight back, 'cause if both the lungs and heart are out, you haven't got time to waste.
It is recommended to use the wall-mounted N20 to quickly achieve anesthesia on the patient. It can be found just above most surgery tables. Click and drag them onto the patient to use them.
If you fail to properly prep for surgery (don't wash your hands, don't wear sterile gloves, and so on) you run the risk of giving your patient an infection. This can be very dangerous if allowed to progress and should be treated promptly by applying Ointment to the affected area. If the infection is particularly advanced, consider dosing the patient with Spaceacillin.
If you're not sure whether or not you prepped properly, better safe than sorry. Slap some ointment down on that healing incision once you've finished with the operation.
A few final notes
Be sure that your patient doesn't have bicaridine or tricordrazine in their system before beginning surgery. These medications will close any incisions you make, rendering surgery impossible. In the same way, do not apply gauze to a patient while surgery is in progress, or you will close the incision and force yourself to start over. Advanced trauma kits will do the same thing, but there are a few surgeries that require you to use them. Doing that at the right time in the surgery won't close the incision. Just make sure you're following the instructions correctly.
You may also want to read the How to Help section for a few notes on keeping patients alive on the table.
As a final note, if, for whatever reason, you are operating on a patient with no limbs, you will not be able to use the circular saw to open the ribcage or skull. It will assume that you are trying to amputate. This renders most surgery on limbless patients impossible; either stabilize them and attach new limbs, or just saw off the head and transfer them to a cyborg body.
List of operations
As mentioned above, performing a surgery itself is simple. Target the appropriate limb or part of the body, make sure you're on Help intent and click on the patient with the appropriate surgical tool in your hand. You'll then have to wait for a short period while the action completes. During this time, you can't do anything but talk, or your hand will slip and you'll hurt the patient. Once the action is completed, click on them again with the next appropriate tool in hand. Rinse and repeat until the surgery is complete.
If you're not actually performing the surgery, but are just assisting the surgeon with things like medicating the patient and keeping the IV going, see the section on How To Help.
Most surgeries follow a very basic pattern:
- Make an incision.
- [CHEST OR HEAD] Open the skull or rib cage.
- Perform the operation.
- [CHEST OR HEAD] Repair the skull or rib cage.
- Close the incision.
Learning this basic pattern will make most surgery extremely simple, but be warned that not every surgery follows this pattern. Be sure to read the full instructions in order to avoid hurting a patient!
Making an incision
The first step of most surgeries.
- (Optional) Complete Prepping for Surgery.
- Aim for the area which you want to operate on in the Damage Zone.
- Use the scalpel to make a cut. Can use existing cut wound if it's big enough.
- Use the hemostat to stop any potential bleeding.
- Use your retractors to spread the incision.
Closing an Incision
The last step of most surgeries.
Opening the Skull or Rib Cage
For operating on internal organs in the chest or head.
Bone Repair Surgery
The mending of broken bones and fractures, or closing of opened ribs and skulls.
Facial Reconstruction Surgery
The fixing of facial and vocal deformaties.
Arterial Bleeding Surgery
Repairing damaged arteries within the body to stop internal bleeding.
Removing a limb or a limb stump.
- (Optional) Complete Prepping for Surgery.
- Aim for the patient's limb using the Damage Zone.
- Use a circular saw to amputate the limb.
Limb Replacement Surgery
Replacing missing limbs - or severed heads.
- Ampuate the stump, if one is present.
- Attach the limb you recovered (hopefully), or a prosthesis if one is available.
- Use hemostat to connect the tendons and such.
Keep dylovene and spaceacillin handy. If meat limb was left outside of freezers for long, it might be infected. If it comes from someone of different species, be ready for rejection.
Mending brain hematomas, damaged eyes, collasped lungs and other broken organs.
Shrapnel and Implant Removal
Removing implants, bullets, shrapnel, or other objects that have become stuck in the patient's body.
Organ Removal or Transplantation
Removal and re-insertion of the brain, heart, lungs, inflammed appenxies, etc. This also applies to neural laces.
The Head contains the brain, eyes, and neural lace. The Chest contains the heart and lungs. The Groin contains the liver, kidneys, and appendix.
- [REMOVAL] Use the scalpel. This will open up a window asking you which organ you'd like to cut loose.
- [REMOVAL] Use the hemostat. This will open up a window asking you which loose organ you'd like to remove.
- [REMOVAL] Dispose of the organ or store it in a freezer. For Borgification, place the brain in an MMI and give it to a Roboticist.
- [TRANSPLANTATION] Use the organ you intend to transplant on the patient.
- [TRANSPLANTATION] Use the FixOVein to reconnect the organ to the body.
- [TRANSPLANTATION] Administer a advanced trauma kit or use the nanopaste if required, to repair any damage received during transport/transplantation.
Decaying Organ Repair
Repairing decaying or otherwise severely damaged organs. Necrotic organs cannot be repaired.
Examination of cadavers to find cause of death.
- Place cadaver onto the operating table.
- Scan the cadaver with a Health Analyer to find injured locations.
- Aim for the patient's affected area in the Damage Zone.
- Cut the skin with your scalpel (the chest may require two cuts).
- Use the autopsy scanner to scan the area.
- Repeat scalpel and scan procedure for all affected areas.
- Right click the autopsy scanner to print out autopsy data.
Cutting the seals on a sealed hardsuit so that it can be removed from the person wearing it.
Putting things inside peoples' body cavities.
Maxiumum size of item that fits inside:
- Head - tiny (i.e. pen, paper)
- Abdomen - pocket-size (i.e. most surgical tools)
- Chest - small (i.e. bone saw, revolver)
- Make an incision
- [CHEST OR HEAD ONLY] Open the skull or rib cage.
- Use the surgical drill to prepare the cavity.
- Insert the item by clicking on the patient with the item in hand.
- If insertion has caused internal bleeding, use FixOVein to fix it.
- If you decided against inserting the item, use the cautery to mend cavity wall.
- [CHEST OR HEAD ONLY] Close the skull or rib cage.
- Close the incision.
Extracting organs from detached body parts
Removing internal organs from parts of the body, such as heads, which are no longer attached to the rest.
So you messed up your surgery
You misclicked or swapped hands, or whatever else, and now your patient is bleeding everywhere. It's okay! It happens. It'll just probably make you lose your job and be ostracized by your peers as a failure, is all.
The important thing is to avoid panicking. You can still finish the surgery; just pick up where you left off before your mistake. The question is whether or not you should.
Examine your patient's vitals to find out whether or not the damage you've caused is severe enough to be an immediate threat (and keep in mind that you might have damaged some organs, if your patient has been opened up already). If it is, then consider closing early and stabilizing the patient before continuing. Having to perform an operation twice is a small price to pay to keep your patient alive. If it isn't, though, you may as well finish what you were doing before administering bicaridine or whatever else is necessary to fix your little oopsie.
How to help
Sometimes a patient's condition is too severe, and they need constant monitoring and medical assistance even during surgery. When this is the case, the surgeon may call in another player - ideally a Physician or Corpsman - to administer the necessary treatment that will keep the patient alive throughout the procedure.
This is largely a matter of knowing your medical systems and understanding the various medicines available to you. Remember, when assisting your friendly neighborhood surgeon in the operating room, you have two objectives: keep the patient alive and don't get in the way.
The latter is important, because accidentally bumping into the surgeon during the operation can cause their hand to slip, which may harm or even kill the patient, and which will certainly cause unwanted complications. Try to avoid nudging the surgeon or getting in their way as much as possible. Ideally, you should plant yourself in front of the surgical monitoring console and not move, so make sure that you have all the equipment you need before the operation begins. In emergencies, it may be necessary for you to climb over various tables to reach the patient or various pieces of equipment without disturbing the surgeon.
But keeping the patient alive is your primary goal. Know what the patient's condition is and how to treat it before the operation begins, and have all necessary equipment and medicines at the ready. Remember, to keep the patient alive, you must keep the brain intact. Your primary threats to this in a surgical situation are lack of oxygen flow to the brain (if the lungs or heart have failed, or if the patient has lost a lot of blood) and toxins in the bloodstream (if the kidneys and liver have failed). The patient may also enter cardiac arrest from shock if damage is severe enough, so have the defibrillator handy.
In the case of toxins in the blood, be sure to keep the patient pumped full of Dylovene. If the patient isn't getting enough oxygen to the brain, administer Dexalin Plus and Alkysine. If the patient is suffering from blood loss, be sure to keep their IV going. If the patient's heart or lungs have ceased operation, perform repeated CPR until they can be repaired in addition to the previous treatments, and be ready with the defibrillator when the heart is repaired and blood loss has been corrected. Other medications may also be called for depending on the situation.
Sometimes your average, everyday surgery just doesn't cut it. Sometimes, the situation calls for a true hero in the operating room.
On days like these, you will have no choice but to make use of some advanced black magic fuckery surgical techniques, which will be added to this section as various Medical players discover them. They may or may not be classified as bugs and/or exploits, and so they may be removed without warning at any point. Use at your own risk.
The normal rule against clicking anywhere else while performing a surgical step has one single exception: it is possible to perform the same surgical step on two or more areas of the body at once.
For example, when using your scalpel to start an incision, you could open up the chest and head simultaneously by first clicking on the patient while targeting the chest, then targeting the head and clicking again. This will result in two surgical timers running simultaneously, and the same action will be completed on both zones of the body when the timers complete.
Using this technique, you can, for example, simultaneously cut open a patient's chest and skull, allowing you to repair their heart and brain at the same time. This can keep otherwise impossible-to-salvage patients alive, so long as you are careful and keep track of where you are in both surgeries.