Руководство по хирургии

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.

Overview

Surgery in progress.

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:

1. Make sure your patient is stripped of any equipment that will impede surgery, such as voidsuits or hardsuits.
2. 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.

Surgical Tools

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
	Scalpel		Sterile Mask
	Surgical Drill		Latex Gloves
	Circular Saw		Nanopaste
	Hemostat		MMI
	Bone Setter		Autopsy Scanner
	Cautery		Roll of Gauze
	Bone Gel
	Retractors
	Vascular Recoupler
	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 surgery steps on flesh alone, you need both Experienced Medicine and Experienced Anatomy.
• For metal-on-meat (e.g. installing robotic organs inside organic bodyparts), Basic Complex Devices and Experienced Anatomy are needed.
• For metal-on-metal (e.g. FBPs or working on robotic organs in robotic bodyparts) Trained 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.

Improvised Surgery
Surgery Type	Equivalents
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

Diagnosis

1. 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.
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. This may take several attempts. [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!

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