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. From an out-of-character perspective, surgery is not very difficult as it mostly consists of following a number of steps in order. 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, such as having multiple failing organs, brain damage, radiation poisoning, or being poisoned by a giant spider. 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 and 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.
Mechanically, surgery 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, move, or change hands while this is happening, or your hand will slip and the patient will be harmed. 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, the following is required:
- Make sure your patient is stripped of any equipment that will impede surgery, such as voidsuits or hardsuits.
- Make sure your patient is properly anesthetized via the operating table's neural suppressors.
The patient's vitals should also be reading out on the vitals monitor next to the table, allowing you to monitor their condition during surgery. In addition, it is highly recommended to have an IV in the room in case the patient requires an emergency blood transfusion. Alkysine, Oxycodone, and Peridaxon should also be within arm's reach during surgical procedures, as all of the above are extremely useful during operations.
It's highly impractical to have multiple people performing the operation itself; however, in especially severe cases, it can be appropriate to have a Medical Technician 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 Surgery kit. Click on the kit while it is in your hand 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||Latex Gloves|
|Bone Setter||Autopsy Scanner|
|Cautery||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 the 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, maybe both the operating rooms are occupied, or maybe you just don't care.
If you have access to the Morgue, you can perform surgery on the operating table there. Otherwise, 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.
To anesthetize a patient without neural suppressors, it is recommended you use a mix of Chloral Hydrate and Oxycodone to knock the patient out and reduce pain, or hook the patient up to some nitrous oxide.
Tools capable of performing each surgical step are included below, alongside their success chance (assuming all other requirements are met). For example, attempting to perform an incision with a broken bottle gives you a 50% chance of success.
|Surgical Basics||Opening Incision – Scalpel (100%), Knife (75%), Broken Bottle (50%), Glass Shard (50%)|
|Clamping Bleeders – Hemostat (100%), Cable Coil (75%), Mouse Trap (20%)|
|Retracting Skin – Retractors (100%), Crowbar (75%), Knife (50%), Fork (50%)|
|Cauterisation – Cautery (100%), Cigarette (75%), Lighter (50%), Welding Tool (25%)|
|Bone Treatment||Bone Cracking – Circular Saw (100%), Hatchet (75%), Knife (50%)|
|Bone Gelling – Bone Gel (100%), Duct Tape (75%)|
|Bone Setting – Bone Setter (100%), Wrench (75%)|
|Limb Amputation & Reattachment||Limb Amputation – Circular Saw (100%), Hatchet (75%)|
|Limb Reattachment – Hemostat (100%), Cable Coil (75%), Mouse Trap (20%)|
|Internal Organs||Internal Organ Treatment – ATK (100%), Roll of Gauze (40%), Duct Tape (20%)|
|Internal Organ Treatment (Mechanical) – Nanopaste (100%), Screwdriver (70%), Bone Gel (30%)|
|Organ Detachment – Scalpel (100%), Glass Shard (50%)|
|Removal of Organ – Hemostat (100%), Wirecutters (75%), Knife (75%), Fork (20%)|
|Organ Attachment – Vascular Recoupler (100%), Cable Coil (75%), Duct Tape (50%)|
|Treatment of Decaying Organ with Peridaxon – Dropper (100%), Bottle (75%), Beaker (75%), Spray (50%), Bucket (50%)
Note: Container must have Peridaxon.
|Tendon Repair & Internal Bleeding – Vascular Recoupler (100%), Cable Coil (75%), Duct Tape (50%)|
|Facial Surgery||Begin Plastic Surgery – Scalpel (100%), Glass Shard (50%)|
|Repair Face or Finish Plastic Surgery – Hemostat (100%), Cable Coil (75%), Fork (75%), Mouse Trap (10%)|
|Creation of Cavity||Drilling (Carving) of Cavity – Surgical Drill (100%), Pen (75%), Metal Rods (50%)|
|Sealing of Cavity – Cautery (100%), Cigarette (75%), Lighter (50%), Welding Tool (25%)|
|Removal of Foreign Body – Hemostat (100%), Wirecutters (75%), Fork (20%)|
|Miscellaneous||Sterilisation – Spray (100%), Dropper (100%), Chemistry Bottle (90%), Flask (90%), Beaker (75%), Drink Bottle (75%), Drink Glass (75%), Bucket (50%)
Note: Container must have Sterilizine or strong alcohol.
|Removal of Hardsuit – Welding Tool (80%), Circular Saw (60%), Plasma Cutter (30%)|
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.
- 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.
- 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.
- 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 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.
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 makeshift surgery.
- Make sure you're wearing latex gloves and a sterile mask.
- Strip the person of any thick outer clothing, such as a voidsuit or hardsuit. When in doubt, click + drag the patient to you and remove their clothes manually.
- 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.
- Click on the operating table to turn on the neural suppressors and 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.
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 vein, 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. Applying advanced trauma kits at the right time in surgery will help repair injuries.
- 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.
- 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.
- For information on keeping a patient alive on the table, refer to the How to Help section.
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.
Note: If anyone is pulling on the patient, the surgery will not work properly. Make sure no one is pulling the patient.
Most surgeries follow a very basic pattern:
- Make an incision.
- [UPPER/LOWER BODY OR HEAD] Open the skull or rib cage.
- Perform the operation.
- [UPPER/LOWER BODY 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!
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.
- Don't get in the way.
The latter is particularly important. Accidentally bumping into the surgeon or moving them during the operation will 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. 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.
Keeping the patient alive is your primary goal. 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. (Note: Alkysine will not repair brain damage if blood oxygenation is below 85%.)
- If the patient is suffering from blood loss, hook them up to an IV.
- 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.
Warning: Do not inject Bicaridine or Tricordrazine while a patient is on the operating table, and be extremely cautious about Inaprovaline and Dylovene! Bicaridine and tricordrazine will heal any incisions that the surgeon makes during the surgery, requiring you to start over from scratch! Inaprovaline will mix with Dylovene in the patient's bloodstream to create Tricordrazine!
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