Medical... guide?

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BongCha
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Medical... guide?

Post by BongCha » Wed Apr 19, 2017 7:20 pm

I've had three really awkward scenes where I try to treat someone and have to bow out because I have no idea what I'm doing OOC. I get the whole memory loss thing but I'm also at a loss for what I'm supposed to be doing with these skills I have.

I'm not the only one.

Halp?

BongCha
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Re: Medical... guide?

Post by BongCha » Wed Apr 19, 2017 7:43 pm

So far, I know:

Start with:
vitals - checks to see if they're breathing & if their heart rate is normal, presumably indicating the presence internal injuries

surgery perform triage X - lets you see your patient's external wounds if they are exposed (ie. they are naked)
cleanwounds - requires sterile wipes, will clean concussive & gashy wounds


then, presumably, though I haven't had any of these commands work and/or had the occasion to use them:

surgery perform exploratory X - searches for internal injuries, is low risk apparently, requires... surgical suture kit? Not sure

surgery perform stitch-up X - works on external gash-type wounds, needs plain suture kit, also needs X to be unconscious or strapped down with a rope (haven't found ropes, think there is a drug that KOs people but haven't used it, and one player tried allying me and also fell asleep, though either of those is pretty clunky during a scene)

surgery perform trauma control X - presumably treats internal injuries detected by exploratory, likely requires surgical suture kit

How am I doing so far?

So I'm guessing vitals, triage, exploratory, clean wounds, stitch-up AND/OR trauma control is the order of usage?

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TheEbonPlague
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Re: Medical... guide?

Post by TheEbonPlague » Wed Apr 19, 2017 7:52 pm

And if someone is knocked out and their heart rate is weak you can perform cpr with the 'cpr' command

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Krelm
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Re: Medical... guide?

Post by Krelm » Wed Apr 19, 2017 9:36 pm

Alright I'll write up a guide here and maybe make it into a helpfile IG.

So say Joe gets into combat and gets a nasty wounds on his stomach/chest/back.

First, he or someone else wants to use the bind command (see help bind). This will close up his wounds from the worst one to the least bad one. It can be done barehanded, but benefits greatly from having bandages or tourniquet items in your hand (bandages, belts, even tampons). The command will automatically use up these items. No skill is required for binding, though you are unlikely to successfully bind too bad a wound without bandages unless you have the first aid skill.

At any point in time during all this, you can type vitals joe which will give you a readout of Joe's heartrate and breathing. (See help vitals). The patient will have to accept your request, be allied to you, or be unconscious. No skill is required for checking vitals.

To make sure the wound doesn't get infected, you'll want to use the cleanwounds command (see help cleanwounds). You can do this barehanded, but it benefits greatly from using antiseptic wipes. Like bind, it cleans the worst to the least bad, and uses up the wipes automatically. No skill is required for cleanwounds, though first-aid helps.

After the wound is closed, it still has the potential to open back up if Joe goes through just about any exertion - even walking between wounds can open it back up. So, what you're going to want to do is suture the wound closed (see help suture). Suture requires the first-aid skill, and also requires a suture kit. Like bind, you will stitch the worst wound first, all the way to the least bad, or until you stop. Keep it mind that it is less easy for the wound to re-open after it is stitched, but still possible - it just takes more effort (try not to sprint between rooms or fight).

After all that's said and done, Joe may still have some nasty internal injuries. That's when you use surgery perform "triage" joe (I believe the relevant helpfile is help triage). This command shows a list of wounds, and whether or not the patient is bleeding internally. The patient will either need to accept your proposal to triage them, be an ally, or be unconscious.

If there is internal bleeding, you then use surgery perform "exploratory surgery" joe (see: help exploratory for this one). This is generally a pretty easy-to-use skill, which makes a surgical wound in the patient and gives the surgeon a much more detailed view of what kind of internal damage there is. Keep in mind, after this command is used, you will need to use surgery perform "stitch-up" joe (help stitch-up) to close the surgical wound. The patient must be unconscious for this to be carried out.

Once you've located the internal bleeding, you can use surgery perform "trauma control" joe which will attempt to stem the bleeding. Some wounds (really bad ones) will take more than one use of this command. After you've finally stopped the bleeding, you can use surgery perform "stitch-up" joe to close the surgical wound. The patient must be unconscious for this to be carried out.

That's the basics, but there are four more commands:

surgery perform "amputation" joe arm (I think that's the syntax, see help amputation) will cut off Joe's arm, in case it's covered in infection and taking it is the only way to save him or something. The patient must be unconscious for this to be carried out. Also keep in mind that this will leave a big nasty hole in the patient, which you will need to stitch up with surgery perform "stitch-up" joe.

surgery perform "replantation" joe arm (you guessed it, help replantation) will put Joe's arm back in place. Keep in mind, the MUD knows which arm is Joe's, so while you can replace Joe's arm with someone else's, he'll have to take immunosuppressants or risk a nasty infection. The patient must be unconscious for this to be carried out.

CPR joe (doesn't have to be capitalized, see help cpr) can be used on a patient who is going through cardiac arrest. This will keep blood flowing to their brain until help arrives.

Defib joe (see help defib) will attempt to restart the patient's heart if it is stopped (under cardiac arrest or cardiac seizure). You need a defibrillator with a battery in it for this to work.

BongCha
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Re: Medical... guide?

Post by BongCha » Thu Apr 20, 2017 12:46 am

WOW. Thank you Krelm!!!

acceleration
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Re: Medical... guide?

Post by acceleration » Fri Apr 21, 2017 1:04 am

Help cleanwounds says it has to happen after bind and before suture-- which is accurate?

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Krelm
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Re: Medical... guide?

Post by Krelm » Fri Apr 21, 2017 11:50 pm

After bind and before suture is correct.

BongCha
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Re: Medical... guide?

Post by BongCha » Fri May 05, 2017 7:29 am

Hm. When I triage I don't get an echo that says there is internal bleeding like you say in your guide, Krelm. It does indicate loss but that's over all from external and internal, I guess.

I'm not sure how other surgery PCs are going about it - are you guys guessing by the difference in external injuries and their level of blood loss, and potentially echoes (blood coughing), and then double-checking with exploratory surgery?

Is that how it's meant to be, like a guessing/problem solving kind of thing? Or should I be seeing a bit more information from my triage?

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Krelm
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Re: Medical... guide?

Post by Krelm » Fri May 05, 2017 8:53 pm

I could be wrong in the guide - I'm pretty sure that it's supposed to be as you described: look for symptoms, watch for blood loss, and then check with exploratory surgery if it seems like there's something going on. Luckily exploratory surgery is easy to do and easy to close up, so the only thing you're likely going to lose when performing it is time.

BongCha
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Re: Medical... guide?

Post by BongCha » Sat May 06, 2017 10:47 pm

Hm. I don't know if I should be making exploratory surgery something that should happen when people are badly injured as a principle, used like a triage but with putting them under. The situation hasn't come up for me where it's been obvious: it's been blood loss, but blood loss from having gushing wounds. I haven't been able to tell if there was any reason to put the person under general anesthetic to do the exploratory surgery.

Other surgeon PCs: how/when do you do it? What kind of echoes/info are you basing them on, or are you using it more loosely like triage? From a search on the Discord I've seen Akari/Raukran talking about surgery as flying blind, is that true/intended?

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Japheth
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Re: Medical... guide?

Post by Japheth » Sun May 07, 2017 3:22 am

Exploratory surgery is really only useful (at the moment) if you suspect that your patient has an uncontrolled internal injury to one of their organs. The main reason you'd use it instead of just going straight to the trauma control procedure is that the stitch-up difficulty is super easy for exploratory surgery versus much harder for the trauma control, so there's a lower chance of infection if nothing turns out to be wrong.

In the future, I also intend to make an organ repair surgical procedure where you can reduce damage on a major organ by stitching it back together, and again in that circumstance you might want to confirm how bad it was before cutting them open.

Organ infections are super nasty, but if you don't really care about that, you can just ignore exploratory surgery.

BongCha
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Re: Medical... guide?

Post by BongCha » Sun May 07, 2017 4:33 am

My problem is definitely knowing when to suspect that there is uncontrolled internal injury.

Is it a string in triage, like what I think Krelm is saying? Is it when someone has no recent bleeding wounds and has a lot of blood loss, an educated guess?

Akari
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Re: Medical... guide?

Post by Akari » Mon May 08, 2017 5:54 am

I have no idea how to tell when there's an internal injury that needs further attention either.

I've never actually seen triage report anything except for what wounds I could have seen just by using 'look' except for the blood loss line. Overall, it feels somewhat like a wasted step. If it's supposed to provide anything else, I have yet to see it in easily over 100 triages.

Either I've just never had a patient that had anything going on worse than the 'look' wounds, or it doesn't report them, in which case, I'm not sure what its point is.

Akari
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Re: Medical... guide?

Post by Akari » Mon May 22, 2017 3:50 pm

Posting an update on this because Triage has received some awesome improvements lately.

Now you can detect fever.
You can also detect if a wound is infected.

I definitely feel like my character is able to make more accurate medical assessments with these changes.

Thanks Japh!

Arispe
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Re: Medical... guide?

Post by Arispe » Thu Jul 06, 2017 7:14 am

TheEbonPlageue wrote:
Wed Apr 19, 2017 7:52 pm
And if someone is knocked out and their https://www.pareup.com/zyppah-review-and-results new zyppah heart rate is weak you can perform cpr with the 'cpr' command
I had no idea you could do that lol.

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