Difference between revisions of "Surgery"
(Adds a note about using grab to find broken bones)
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|Advanced Trauma Kit
|Advanced Trauma Kit
=== Ghetto surgery ===
=== Ghetto surgery ===
Latest revision as of 12:01, 15 August 2019
|Baystation 12 |
|Guide for New Players|
|Engineering & Construction|
|Part of the|
Head of Department |
Chief Medical Officer
Surgery is one of the most important parts of medicine on board the SEV Torch and is crucial to keeping the crew healthy and upright. Mechanically, it consists of placing the patient on an operating table, then clicking on them while on the help intent as you hold the appropriate surgery tool. Each time this is done, there will be a short delay before the action completes. After it does, move on to the next step with the next tool. Complete each step in order to successfully complete the surgery. Don't click on anything else or change hands while this is happening or your hand will slip and the patient will be harmed.
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 a dire emergency.
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 Standard steps
- 3.1.1 Making an Incision
- 3.1.2 Closing an Incision
- 3.1.3 Opening the Skull or Rib Cage
- 3.1.4 Bone Repair Surgery
- 3.1.5 Facial Reconstruction Surgery
- 3.1.6 Arterial Bleeding & Torn Tendon Surgery
- 3.1.7 Amputation
- 3.1.8 Limb Replacement Surgery
- 3.1.9 Organ Repair
- 3.1.10 Shrapnel and Implant Removal
- 3.1.11 Organ Removal or Transplantation
- 3.1.12 Decaying Organ Repair
- 3.1.13 Autopsy
- 3.1.14 Hardsuit Removal
- 3.1.15 Cavity Surgery
- 3.1.16 Extracting organs from detached body parts
- 3.1 Standard steps
- 4 So you messed up your surgery
- 5 How to help
Ideally, any given operation will take place within the Infirmary; either in the primary operating room or secondary robotics theater. To not impede the surgery, your patient should be stripped of as much of their equipment as possible then be properly anesthetized. Their vitals should be reading out on the console, allowing you to monitor their condition throughout the surgery. They should also have easy access to an IV in case of need for emergency blood transfusion.
It isn't practical to have multiple people performing the operation itself; however, in especially severe cases, it can be appropriate to have someone handy to monitor the patient's vitals, ensuring that they have the proper medications in their system to keep the patient stable until 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.
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.
|Standard Surgery Kit||Separate Items|
|Surgical Drill||Medical Mask|
|Circular Saw||Latex Gloves|
|Retractors||Roll of Gauze|
|Advanced Trauma Kit|
Matter of skill
In-character, performing surgery is a very complicated and dangerous process, so attempting it without appropriate skills will most likely result in a disaster.
- To perform simple surgery steps (incision operations mostly), you need both Trained Medicine and Experienced Anatomy.
- To perform complex surgery steps (anything inside the patient), you need both Experienced Medicine and Experienced Anatomy.
Robotic surgeries are special case:
- For metal-on-metal (e.g. FBP or working on robotic internal organs inside robotic bodypart) Trained Complex Devices is needed.
- For metal-on-meat (e.g. installing robotic parts inside organic bodies) both Trained Complex Devices and Trained Anatomy are needed.
Missing a single skill level of each applies 40% chance of failure, so it's not advisable to attempt surgery unskilled unless situation is very dire.
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, or maybe you just don't care.
You can use any table available as a makeshift operating table. 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, though with a 1/4 chance per step of accidental injury. Obviously, this is still inferior to an actual operating table, so try to keep surgery in the proper areas unless absolutely necessary.
|Surgical Basics||Opening Incision - Knife, Broken Bottle, Glass Shard|
|Clamping Bleeders - Cable Coil, Mouse Trap|
|Retracting Skin - Crowbar, Knife, Fork|
|Cauterisation - Cigarette, Lighter, Welding Tool|
|Bone Treatment||Bone Cracking - Hatchet, Knife|
|Bone Gelling - Duct Tape|
|Bone Setting - Wrench|
|Limb Amputation & Reattachment||Limb Amputation - Hatchet|
|Limb Reattachment - Cable Coil, Mouse Trap|
|Internal Organs||Internal Organ Treatment - Roll of Gauze, Duct Tape|
|Organ Detachment - Knife, Glass Shard|
|Removal of Organ - Wirecutters, Knife, Fork|
|Organ Attachment - Cable Coil, Duct Tape|
|Treatment of Decaying Organ with Peridaxon - Bottle, Beaker, Spray, Bucket|
|Tendon Repair & Internal Bleeding - Cable Coil, Duct Tape|
|Facial Surgery||Incision of Mouth - Knife, Glass Shard|
|Mending Vocal Chords - Cable Coil, Mouse Trap|
|Pulling Face into Place - Fork, Crowbar|
|Cauterisation - Cigarette, Lighter, Welding Tool|
|Creation of Cavity||Drilling (Carving) of Cavity - Pen, Metal Rods|
|Sealing of Cavity - Cigarette, Lighter, Welding Tool|
|Removal of Implanted Item - Wirecutters, Fork|
|Miscellaneous||Sterilisation - Spray, Dropper, Chemistry Bottle, Flask, Beaker, Drink Bottle, Drink Glass, Bucket|
|Removal of Hardsuit - Welding Tool, Circular Saw, Plasma Cutter|
Prepping for surgery
Make sure that your patient has been passed through the full-body scanner and that the results have been pushed to your surgery monitor, or a printed copy of them is available 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.
If you can't use a full-body scanner, you can still locate broken bones and other injuries by grabbing your patient and then interacting with areas of their body on help intent.
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 Medical Technician, 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, 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 latex gloves and a 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 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 main types of anesthesia available on board the SEV Torch: suppressors and injected. Using inhaled anesthesia is not recommended. The main source of anesthesia is the operating table itself. Surgical tables on the SEV Torch are equipped with Neural Suppressors. After placing your patient on the table, simply click on the table to active the suppressor. It will take a few moments to active but after it does there will be instant loss of consciousness. After your surgery is complete, repeat the process to disable it. If you want your patient to wake up faster, give them a good shake.
The other option is 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. There's no quick way to bring them out of this coma, unless you want to pump them full of Dylovene to counteract the soporific.
Soporific relies on your patient having a functioning organ, in this case, the heart. A small amount of chemicals will still be absorbed even if the heart is not pumping, but not a meaningful amount. Either way, if the heart is not pumping, soporific is not circulating. 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.
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.
When performing multiple surgeries on different body parts, it can be useful for speed to use the body-part selection hotkeys on your numpad by pressing the numbers corresponding in position to the body-part you wish to operate on. Double-press for secondary parts of that body-part, such as the hands or eyes.
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 rib cage 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
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.
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 & Torn Tendon Surgery
Repairing damaged arteries within the body to stop internal bleeding or fixing torn and cut tendons.
Removing a limb or a limb stump.
Limb Replacement Surgery
Replacing missing limbs or severed heads.
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 appendixess, etc.
Decaying Organ Repair
Repairing decaying or otherwise severely damaged organs. Necrotic organs cannot be repaired.
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:
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 miss clicked 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 (keeping 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, 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 Medical Technician, 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.