TGMC:Guide to Surgery

For the full guide to medicine see: the TGMC:Guide_to_medicine

Malpractice Equipment

Equipment:	Use:	Horrible Alternative:	Success Chance:
Scalpel	Professional knife for cutting flesh.	Kitchen knife	75 %.
Retractor	Salad tongs used for rearranging and moving internals.	Crowbar	75 %.
Hemostat	Pulls out foreign objects, and stops scalpel bleeds.	Wirecutter	75 %.
Cautery	Cauterizes incisions closed.	Cigarette	75 %.
Bone Saw	A saw used to saw apart bones.	Hatchet	75 %.
Incision Management System	Cuts, retracts, and clamps bleeders for an incision
Bone Gel	Gel used to repair broken bones	Screwdriver	75 %.
Bone Setter	Sets bones back into their original place.	Wrench	75 %.
Fix-O-Vein	Fixes veins and arteries.	Cable Coil	75 %.
Trauma Kit	Patches up any damage to the organs, excluding the brain and eyes.	Bandages	20 %.
Surgical Suture	Can be used used to heal brute and burn damage.	Glass Shards	20 %.

Surgeries

Operation:	Steps:
Bone Repair Surgery (Everywhere except mouth/eyes.)	Make an incision. or -> -> Repair the bone. -> Close the incision.
Internal Bleeding (Everywhere except mouth/eyes.)	Make an incision. or -> -> Mend the artery. Close the incision.
Foreign Object Removal (Everywhere except mouth/eyes.)	Make an incision. or -> -> Open the skull or ribcage if needed. -> Pull out any unwanted crap until it's all gone. Close the skull or ribcage if needed. -> Close the incision.
Organ Repair (Groin/Chest. Excludes eyes/brain.)	Make an incision. or -> -> Open the ribcage if needed. -> Fix up the organ with a trauma kit. Close the ribcage if needed. -> Close the incision.
Necrosis Treatment (Wherever it appears.)	Make an incision. or -> -> Cut out necrotic tissue as needed. -> Close the incision.
Brain Damage (Head.)	Having alkysine makes this surgery defunct. Use first, if possible. Make an incision. or -> -> Open the skull. -> Repair heavy brain damage, if applicable. Pull out embedded bone chips until they're gone. Close the skull. -> Close the incision.
Eye Repair (Eyes.)	Using imidazoline is faster than surgery, if you have it on hand. Fix the eyes. -> -> Cauterize it.
Amputation (Head/Limbs.)	Cut through the limb/head with a saw. That's it.
Limb Replacement (Limbs.)	Target specific limb on the bottom right targeting doll. Seal the stump. -> -> Slap a new robotic limb on. Robotic arms fit for hands, and robotic legs fit for feet.
Facial Reconstruction (Mouth.)	This is a cosmetic surgery. If someone shows as Unknown (as), it'll restore it to normal. Fix the fucked up face. -> -> Cauterize it.

Combining Surgeries

Name:	Icon:	Why:
Fix-O-Vein		can be applied at any point during an operation to fix Internal Bleeding.
Organ Repair and Foreign Body Extraction	+	can be performed at the same time in the Head, Chest, and Groin.

Other Really Cool Important Epic Stuff

Surgical vest can hold all the tools AT ONCE. use it for field surgery Apply ointment preemptively to areas you will do surgery on to prevent them from getting infected

Field Surgery

Field Surgery can be a very effective way to keep your marines in the fight longer, and reduce the number of them out of commission as they get sent up to the ship and wait for the dropship to ferry them back down. Keep in mind however that your speed at surgery will always be somewhat slower in the field as compared to in a proper operating room thanks to the risk of mistakes due to the less than ideal conditions, and as such you should not expect to treat everyone who needs surgery on the ground.

People who are ideal candidates for field surgery:

1. People with only one or two broken bones.
2. People with several things wrong with only one part of the body (ie, damaged heart and lungs, broken chest bones, internal bleeding of the chest)
3. People who’ve been infected by alien parasites.
4. People who need work while the medivac is on cooldown or the dropship is away.

People who are not good candidates for field surgery:

1. People with things wrong on many parts of their body. The more steps you have to do on a single person the more likely you are to make mistakes which can injure them and cause an infection which eats up any time savings compared to sending them up to the ship.
2. People which your scanner cannot locate the problems. People can tell you where their aches and pains are, however this can be less than perfect and lead to you doing exploratory surgery on a bunch of unnecessary parts.
3. People who arrive as the dropship is about to head up to the ship, or while medivacs are off cooldown, however do try to keep the medivacs free if they have simple matters which can be fixed
4. If you are already busy with patients who need defibbing to prevent death.
5. If you’re already overwhelmed with surgical patients.

As a field surgeon your priorities are similar to doctors on the ship. They should be

1. People who’ve been infected with alien parasites
2. People who need defibbing (if there are patients who need parasites removed and patients who need defibbing, defib them to reset their death timer but otherwise ignore them until the parasites are removed)
3. People with internal bleeding or necrosis or moderate to severe organ damage
4. People with broken bones

Remember that Medics can heal most normal brute and burn damage so you should let them handle those unless you have no patients that need surgery.

Items to bring down

Essential

• Surgical Tools
• 50u space cleaner 200u Sterilizine spray bottle
• Anesthetic gas tank
• Medical gas mask
• Roller Bed
• Latex Gloves
• Medical Mask
• Medical Apron
• Defib
• IV stand with 1 or 2 extra blood bags
• Spacecillin
• Belt with medicine pill bottles, and which can store your bed, defib, and scanner

Optional Additional Items

• Large backpack which can store all of your surgical tools instead of the tray, while also carrying the gas tank, mask and spray bottle. You will need to put it down to rummage through it unlike your starting backpack, however it frees up your hands to move around more easily and means you can quickly pick up everything if you need to move quickly due to xenomorphs overrunning the FOB or if you need to move from one side of the FOB to another.
• Additional medicines or advanced combinations available from chemistry (consider getting 30u spacecillin pills to avoid having to give patients 3 pills to treat necrosis after it’s been excised)

Germs and Field Surgery

Unlike the shipside facilities where you can prevent nearly all infections by simply washing your hands. Surgery on a roller bed or table has a significant chance of necrosis if steps aren’t taken to reduce the risk. Necrosis causes constant toxin damage and should be avoided if at all possible. Necrosis happens at 800 germs in a body part or organ. As long as your patient stays below that level you are fine. Necrosis is calculated independently for each body part and each organ, so if you have 400 germs in the chest and 200 each in each arm, there won’t be necrosis. Organs track their own germ level independently of the body part they are a member of, however they often mirror each other unless Sterilizine is used.

Items that can reduce the risk of infection

• Latex Gloves*
• Surgical Masks*
• Surgical Apron*
• Roller Bed - Add 75 germs per step
• Tables - Add 100 germs per step
• Sterilizine
  • Removes germs based on a complicated calculation. Two spritz will nearly clear out the germ level of anyone it’s sprayed on. If sprayed on you it will reduce your personal germ level and thus the contribution that is mitigated through the gloves/mask/apron. If sprayed on the patient it will reduce their current germ level and thus allow you to do more steps.
  • Sterilizine will NOT reduce the level of germs in organs, if you have a patient who needs multiple things fixed for the same body part you should either predose them with >25u of Spacecillin or only fix one thing per surgery. Note that doing the latter drastically increases the number of steps you need to do and thus increases the risk of injury to the patient from failed steps.
• Spacecillin - If there’s >25u in them they cannot get necrosis, regardless of their germ level
• The Cautery tool - Every time you finish a surgery with a cautery it resets the germ level for that limb and all organs in that limb to 0

(*)note that with gloves, mask and apron, your personal contribution to the germ level of the patient is near zero and almost all germ contribution comes from the bed/table and their starting germ level

Items/Actions that increase the risk of infection

• Not wearing gloves/mask/apron
• Working on the ground or on a table
• Using ghetto tools which waste steps
• Moving around. The less you move after getting clean the fewer germs your body collects. Assume your patient comes to you with ~200 germs on all body parts unless you sterilize them before you start. Standing still still results in you having 120 germs thanks to ambient levels.
• Screwing up steps DO NOT contribute additional germs over and above what would normally happen for that step, however it does waste a step which you are required to re-do and thus the redone step will contribute at least 75 germs.

Sterilizine is your friend

Since Sterilizine can mostly reset the germ level with 2 spritz, other than the proper surgical tools and the roller bed, it is probably your most vital item to have with you. A spray bottle with 50 units of space cleaner and 200 units of Sterilizine will cover you for almost any round. Sterilizine will NOT reduce the germ level of organs, it only affects the germ level of limbs.

Spacecillin is your friend

25u of Spacecillin will prevent all necrosis no matter how high the germ number gets. Predose the patient with ~30u of Spacecillin if there are multiple things wrong in the same body part and you’ll be fixing them in the same surgery, or if the surgery is more complex than just fixing bones.

Infection Summary

Basically assume anyone coming to you has ~200 germs to start with on all body parts from their movement unless you spritz them a couple of times with Sterilizine. Wearing gloves/masks/aprons reduces your personal contribution of germs to them to nearly, but not quite, zero. Roller beds contribute 75 germs per step. 800 germs starts necrosis unless they have at least 25u of spacecillin them.

Basically on a roller bed you can assume slightly less than 8 steps per body part before infection thanks to the starting germ level and your non-zero contribution from your own body's germs and the roller bed. If you spritz them twice before starting surgery you can get ~10 steps in each body part without risking infection. If the patient only has broken bones spritz them with sterilizine, otherwise pre-dose them with ~30u of Spacecillin.

Failure Chance for Steps

Different platforms for performing surgery have different chances of causing a failed step. As stated before, failed steps do not in themselves contribute to the germ level, but they do require you to repeat that step, which adds the additional germs for each step as normal. Failed steps also generally damage the patient and can break bones or cause bleeding requiring additional work to fix.

Best platforms to perform surgery:

• Surgical Table - 0% Failure
• Roller Bed with anesthetic gas - 10% failure
• Roller Bed with Oxycodone AND another pain medicine - 15% failure
• Roller Bed with only Oxycodone - 20% failure
• Table with anesthetic gas - 20% failure

Given how plentiful roller beds are, there is little reason to ever do surgery on anything other than it, unless you have access to a surgical table at the colony’s medbay.