Руководство по хирургии

Этой странице требуется перевод

Эта статья содержит непереведенную информацию.

Хирургия - это один из важнейших разделов медицины на борту ИКН Сиерра, который имеет решающее значение для обеспечения здоровья и жизнедеятельности экипажа. С точки зрения игрока, хирургия не представляет особой сложности, поскольку в основном состоит из последовательного выполнения ряда действий. С точки зрения персонажа хирургия очень сложна и должна проводиться только квалифицированными специалистами, за исключением экстренных случаев.

Хирургическое вмешательство обычно требуется, если пациент находится в очень тяжёлом состоянии. Например, у него отказали несколько органов, повреждён мозг, он получил радиационное отравление или был отравлен гигантским пауком. Выполнить все шаги по завершению операции несложно. А вот выполнить все шаги по завершению операции и при этом убедиться, что пациент останется в живых достаточно долго, чтобы её закончить, очень сложно. По этой причине игрокам-медикам очень рекомендуется не начинать игру в роли хирурга. Знание остальных аспектов медицинской игры и понимание различных препаратов, доступных вам, очень важны при игре в этой роли. Вы ведь не хотите допустить несчастные случаи, когда пациенты умирают? Постарайтесь убедиться, что вы знаете хотя бы основы.

Overview

Surgery in progress.

Если смотреть на механику игры, то операция состоит в том, чтобы положить пациента на операционный стол, а затем нажать на него, пока вы держите в руках соответствующий хирургический инструмент. Каждый раз, когда это делается, будет небольшая задержка перед завершением действия. После этого переходите к следующему шагу, используя следующий инструмент. Выполняйте каждый шаг, чтобы успешно завершить операцию. Не нажимайте ни на что другое, не двигайтесь и не меняйте руки, пока это происходит, иначе ваша рука соскользнёт и пациенту будет нанесён урон. В идеале любая операция проводится в операционной: либо в основных операционных меда, либо в робототехнической лаборатории. Чтобы не мешать операции, необходимо следующее:

1. Убедитесь, что с пациента снято всё снаряжение, которое может помешать операции, например, ИКС или лабораторный халат.
2. Проследите, чтобы ваш пациент был должным образом обезболен с помощью нейроподавителей операционного стола.

Показатели пациента будут считываться на мониторе, расположенном рядом со столом, что позволит вам следить за его состоянием во время операции. Кроме того, настоятельно рекомендуется иметь в палате капельницу на случай, если пациенту потребуется срочное переливание крови. Алкизин, оксикодон и перидаксон также должны быть на расстоянии вытянутой руки во время хирургических операций, поскольку все вышеперечисленные препараты крайне полезны во время операций.

Нецелесообразно привлекать несколько человек для проведения самой операции. Тем не менее в особо тяжёлых случаях может понадобиться помощник, который будет следить за жизненными показателями пациента и обеспечивать его необходимыми лекарствами, чтобы поддерживать стабильное состояние до завершения операции. Наличие под рукой дефибриллятора или человека, готового провести экстренную сердечно-лёгочную реанимацию, также может быть очень важным для сохранения жизни пациента во время операции.

Хирургические принадлежности

Во всех операционных есть свой набор хирургических инструментов, хранящихся в хирургическом наборе. В большинстве случаев их не следует выносить из комнаты, так как в случае потери их трудно заменить подручными средствами. Если они каким-то образом пропали, вы можете заказать новые в отделе снабжения или напечатать несколько штук на автолате.

Стандартный хирургический набор		Отдельные предметы
	Скальпель		Стерильная маска
	Хирургическая дрель		Латексные перчатки
	Циркулярная пила		Нанопаста
	Зажим		MMI
	Костоправ		Аутопсический сканер
	Прижигатель		Бинт
	Костный гель
	Расширитель
	Сосудистый соединитель
	Улучшенный травматологический набор (УТК)

Скилы

Для персонажа проведение операции - очень сложный и опасный процесс, поэтому попытка сделать это без соответствующих навыков, скорее всего, приведёт к неудаче.

• To perform surgery steps on flesh alone, you need both Experienced Medicine and Experienced Anatomy.
• For metal-on-meat (e.g. installing robotic organs inside organic body parts), Basic Complex Devices and Experienced Anatomy are needed.
• For metal-on-metal (e.g. FBPs or working on robotic organs in robotic body parts) Experienced Complex Devices is needed.

Missing a single skill level of either applies a stacking chance of failure, so it's not advisable to attempt surgery unskilled unless the situation is very dire.

Improvised Surgery

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.

Импровизированная хирургия
Тип взаимодействия	Equivalents
Основы хирургии	Разрез – скальпель (100%), нож(75%), розочка (50%), осколок стекла (50%)
	Остановить кровотечение – зажим(100%), провода (75%), мышеловка (20%)
	Отодвинуть кожу– расширитель(100%), челюсти жизни (80%), лом(75%), нож(50%), вилка(50%)
	Прижигание– прижигатель(100%), сигарета (75%), зажигалка(50%), сварка(25%)
Лечение костей	Ломание костей – циркулярная пила (100%), топорик(75%), нож(50%)
	Нанесение геля – костный гель (100%), скотч(75%)
	Постановка костей на место – костоправ (100%), гаечный ключ(75%)
Ампутация и прикрепление конечностей	Ампутация конечностей – циркулярная пила (100%), топорик (75%)
	Прикрепление конечностей – зажим(100%), провода (75%), мышеловка (20%)
Внутренние органы	Лечение внутренних органов – УТК(100%), бинт (40%), скотч (20%)
	Лечение внутренних органов (механическое) – Нанопаста (100%), ручная дрель (50%), отвёртка (30%), костный гель (30%)
	Отделение органа – скальпель(100%), осколок стекла (50%)
	Удаление органа – зажим(100%), кусачки(75%), нож(75%), челюсти жизни (50%), вилка (20%)
	Прикрепление органа – сосудистый соеденитель (100%), провода(75%), скотч (50%)
	Лечение разлагающегося органа с помощью перидаксона – пипетка (100%), бутылка(75%), бикер(75%), спрей(50%), ведро(50%) Примечание:в ёмкости должен находиться перидаксон.
	Восстановление сухожилий и внутреннее кровотечение – сосудистый соединитель (100%), провода (75%), скотч (50%)
Пластическая операция	Начать пластическую операцию – скальпель(100%), осколок стекла (50%)
	Восстановить лицо или закончить пластическую операцию – зажим(100%), проводка (75%), вилка (75%), мышеловка (10%)
Создание полости	Сверление (вырезание) полости – хирургическая дрель (100%), ручная дрель (90%), ручка(75%), металический стержень (50%)
	Герметизация полости – прижигатель(100%), сигарета (75%), зажигалка (50%), сварка (25%)
	Удаление инородного тела – зажим(100%), кусачки(75%), вилка (20%)
Разное	Стерилизация – спрей(100%), пипетка(100%), химическая бутылка (90%), фляга(90%), бикер (75%), бутылка (75%), стакан (75%), ведро (50%) Примечание: в ёмкости должен находиться стерилизин или крепкий алкоголь.
	Снятие костюма – сварка (80%), циркулярная пила (60%), плазменный резак (30%), пси-лезвие(75%), пси-лезвие (высший) (100%)

Подготовка к операции

Диагноз

1. Перед началом операции проведите полное сканирование тела пациента. и желательно, имейте скан в распечатанном виде.
   • Если у вас нет возможности провести полное сканирование тела, вы всё равно можете определить местоположение сломанных костей и других повреждений, схватив пациента и взаимодействуя с участками его тела с помощью хелп интента.
2. 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.
3. 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.

Setting Up

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?

1. Find a suitable operating table unless you're willing to risk improvised surgery.
2. Make sure you're wearing latex gloves and a sterile mask.
3. 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.
4. Grab the person and click on the operating table to lay them down on it.
5. 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.
6. Click on the operating table to turn on the neural suppressors and anesthetize the patient.
7. Be sure that the patient is asleep.
8. Make sure you're set on the Help intent.
9. Use a sink to wash your hands.

Infection

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.

Standard Steps

Most surgeries follow a very basic pattern:

1. Make an incision.
2. [UPPER/LOWER BODY OR HEAD] Open the skull or rib cage.
3. Perform the operation.
4. [UPPER/LOWER BODY OR HEAD] Repair the skull or rib cage.
5. 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. After you are finished with main procedure, use the cautery to seal the incision. If it was clean surgical one, this will mitigate most of damage. (Optional) Apply an advanced trauma kit to the area to prevent infection and promote rapid healing.
Opening the Skull or Rib Cage For operating on internal organs in the chest or head. Use the circular saw to open the ribs or skull. Once the rest of the operation is complete, remember to perform steps two through four of Bone Repair Surgery to close the ribs or skull before Closing the Incision.	Bone Repair Surgery The mending of broken bones and fractures, or closing of opened ribs and skulls. Make an incision. Apply bone gel to the broken bone. Use the bone setter to put the bone in place. Apply more bone gel. Close the incision.
Facial Reconstruction Surgery The fixing of facial and vocal deformities. NOTE: This surgery will NOT work if the skull is fractured. (Optional) Complete Prepping for Surgery. Aim for the patient's head in the Damage Zone. Cut the skin with your scalpel. Use your hemostat to prevent bleeding. Use your retractors to widen the incision. Use your hemostat to mend their vocal cords. Close the incision.	Arterial Bleeding & Torn Tendon Surgery Repairing damaged arteries within the body to stop internal bleeding or fixing torn and cut tendons. Make an incision. Use the vascular recoupler to repair the damaged blood vessels/damaged tendons. Close the incision.
Amputation 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 the hemostat to connect the tendons and such. Note: 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.
Organ Repair Mending brain hematomas, damaged eyes, collapsed lungs and other broken organs. Make an incision. [CHEST OR HEAD ONLY] Open the skull or rib cage. Use the advanced trauma kit to mend the organs, or nanopaste on an robotic organ. [CHEST OR HEAD ONLY] Close the skull or rib cage. Close the incision. Warning: Repairing badly damaged organs (severe damage or worse) this way can cause permanent scarring, lowering its maximum health. It will also happen if the brain is repaired at insufficient oxygenation (below 60%), so if you can, try to restore oxygenation first.	Shrapnel and Implant Removal Removing implants, bullets, shrapnel, or other objects that have become stuck in the patient's body. Make an incision. [CHEST OR HEAD ONLY] Open the skull or rib cage. Use the hemostat to extract the object. [CHEST OR HEAD ONLY] Close the skull or rib cage. Close the incision.
Organ Removal or Transplantation Removal and re-insertion of the brain, heart, lungs, inflamed appendixes, etc. Note: The Head contains the brain and eyes. The Chest contains the heart and lungs. The Groin contains the liver, kidneys, and appendix. Make an incision. [CHEST OR HEAD ONLY] Open the skull or rib cage. [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 MMI-ification, 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 vascular recoupler 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. [CHEST OR HEAD ONLY] Close the skull or rib cage. Close the incision. (Optional) Watch the patient closely for signs of organ rejection.	Decaying Organ Repair Repairing decaying or otherwise severely damaged organs. Necrotic organs cannot be repaired. Make an incision. [CHEST OR HEAD ONLY] Open the skull or rib cage. Use a dropper filled with Peridaxon to revive the decaying organ. [CHEST OR HEAD ONLY] Close the skull or rib cage. Close the incision.
Autopsy Examination of cadavers to find cause of death. Place cadaver onto the operating table. Scan the cadaver with a health analyzer 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. Click the autopsy scanner to print out autopsy data.	Hardsuit Removal Cutting the seals on a sealed hardsuit so that it can be removed from the person wearing it. Place the patient or cadaver onto the operating table. Cleanliness is not required. Aim for the chest in the Damage Zone. Use a circular saw or welding tool to slice the hardsuit seals open (either tool will work). This may take several attempts. Pull the hardsuit control module off, as when unsealed.
Cavity Surgery 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 vascular recoupler 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. Place the body part on any surface, or hold it in hand. Use the scalpel to cut the body part open. Use the retractor to crack the body part open. Use the hemostat to extract an organ. Repeated applications will yield further organs, until all organs present in the body part have been removed.
Plastic Surgery Changes the appearance and apparent name of the patient. Only works if the skull is unbroken. Note: This only changes mob name and voice, not mob appearance/sprite. Aim for the patient's head in the Damage Zone. Make an incision. Use the scalpel to peel away the skin from the face. Use the hemostat to re-arrange the facial tissue to create a new appearance. Close the incision.

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:

1. Keep the patient alive.
2. 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!

---