TGMC:Guide to Medicine

This page is a part of the TGMC wiki. TGMC is a project based on the CM-SS13 codebase.

This guide assumes that you are a medical role, such as a Medical Officer or Corpsman. If you are not a medical role, you will have to contend with certain fumble checks in advanced medical care, taking more time and in some cases cause a chance of failure (and damage to your patient.)

Medical Care is vital for the long term success of any Marine Operation. In a role expected to provide medical care to marines, it's important for you to understand as much about the medical system as possible, to provide expedient and efficient care to your patients. With aid of this guide, you should be able to work your way through almost any problem you will encounter, presuming you have enough time to provide treatment.

Identification

You're going to want the proper equipment to diagnose an injury before anything else, so be sure to grab a medical HUD and wear it so you can actually identify who needs your help and grab a health analyzer to see what is exactly wrong with them. Diagnosis is the first and foremost step in administering treatment.

Failure to identify not only what injuries a marine has, but also what chemicals are already in their system, could result in ineffective care or worse, risk an overdose or even death on a condition that was not life threatening already.

Types of basic damage

Humans can be injured in a multitude of ways, from the immediately obvious to the more subtle.

• Brute damage represents physical trauma. Causes can very wildly; bruises, lacerations, bruises and crushing among many other potential causes. This type of damage is the most common you will encounter, and will induce pain relative to the amount of damage present. This type of damage is usually the most obvious; bleeding and discoloration on the body, with examinations revealing cuts, gashes and blood soaking through clothing as symptoms. In case of severe or critical brute damage to a single limb, fractured or broken bones are likely. When applying Bandages, Gauze or Kits, the medical wheel will show brute damage on a limb as red cuts or gashes.

• Burn damage represents thermal damage to tissue. Primary sources of Burn damage include Fire, acid, lasers and extreme weather, such as the cold exteriors of Ice Colony and Ice Caves. Burns produce higher relative pain per damage than any other damage type (20% more pain compared to equal amounts of Brute damage.) Burns do not have any obvious symptoms, and can't be easily identified through examinations. When applying Bandages, Gauze or Kits, the medical wheel will show burn damage on a limb as yellow burns or boils.

• Toxin damage represents chemical damage to the body. Primary sources of Toxin damage include exposure to Neurological agents, Medicinal side effects, and a damaged Liver. Toxin damage is less painful than Brute or Burn damage (25% less painful as equal amounts of brute damage). Toxin damage has no obvious symptoms on examination, though Vomiting is often is a symptom of high level of toxins in a person.

• Suffocation damage, sometimes referred to as 'Oxyloss' represents de-oxygenation or lack of oxygen in the target's body. Suffocation is almost always a symptom of a bigger problem and not simply a lack of breathable air in the area. Sources of suffocation damage include, but not limited to: Blood loss, Lung Damage, Heart Damage, Extreme Stamina Depletion, Shock or Critical Condition. Suffocation is less painful than Brute and Burn damage (25% less painful than equal amounts of Brute damage.) In most cases, simply treating the suffocation with medicine will not prevent further suffocation, but treating the source of the suffocation will allow the body restore oxygenation on it's own. Gasping for air is one possible sign of Suffocation in a person.

Types of advanced damage

In addition to the above 4 types of damage:

• Pain is caused by nearly every other form of damage and injury a person can receive.
  • Untreated wounds are more painful than those that are stabilized or cared for.
  • Of the 4 common types of damage, burns are the most painful, with suffocation and toxins being relatively less painful than the others.
  • Causes Stuttering, decreased vision and slowing of movement, increasingly debilitating as pain level rises.
  • Extreme levels will cause collapse and stun, with maximum pain threshold causing blackouts and fainting.
  • Painkillers will offset pain, but will not reduce the severity of wounds. Once painkillers are metabolized, if wounds persist so will the pain.

• Fractures and Broken Bones are a direct result of extreme amounts of brute damage to a single limb.
  • Above a specific threshold (25 for Arms, Legs, Hands and feet, 50 for Head, Chest and Groin), each additional attack or effect that causes brute damage can fracture or break the limb.
  • If not stabilized, Fractures and Breaks cause extreme amounts of pain, and attempting to move can cause additional damage.
  • Hands and Arms will cause dropping of items, Legs and Feet will cause extreme slowness in movement if not stabilized.
  • Head, Chest and Groin can cause additional brute damage and internal injuries if not stabilized.
  • Splinting the fractured or broken limb will stabilize the limb, reducing the amount of pain they cause as well as allowing safe movement.
  • A splint may fall off if the limb receives additional damage
  • Dragging a person with such injuries is not advised, splint all fractures and breaks before moving, or use a roller bed to move them.

• External Bleeding is caused by brute damage and can randomly happen to a limb with each attack.
  • If a person is bleeding, they will leave blood drops on the floor, and deplete their body's reserve of blood over time.
  • If left untreated, bleeding can potentially become infected, as well as lead to low blood.

• Internal bleeding is caused randomly when brute damage to a limb exceeds the fracture threshold, as well as from attacks with armor penetration (most ballistic weapons.)
  • Internal Bleeding will be identifiable on a Medical Scanner, both as brute damage to a limb that can not be treated normally, and the scanner identifying an Internal Bleeding condition.
  • Left untreated, Internal Bleeding will continue to get worse overtime, QuickClot or Bicaradine and Inaprovaline can prevent this damage from getting worse, but will not stop the Internal Bleeding already present.
  • Bleeding can lead to low blood, and a patient will begin to suffocate as their blood drops below specific thresholds.
  • Internal Bleeding can be treated with Surgery, or special Medicine Treatment.

• Low blood is a condition caused by untreated bleeding or adverse effects of certain medicines and chemicals.
  • Low blood directly causes Suffocation and eventually Toxin damage as it get worse.
  • A standard human has 560u of blood in their system.
  • Below 501u (90%), suffocation damage will regularly occur (up to 20) and the patient will feel woozy.
  • Below 336 (60%) more severe suffocation damage will regularly (up to 40), eyesight will become blurry, patient may faint at irregular intervals.
  • Below 224u (40%) suffocation and toxin damage will regularly continue until death or treatment.
  • Below 122u (~21%), results in immediate death. Revival via Defibrillation is impossible until raised above this value.

• Infections are bacterial buildups in the body.
  • Caused by untreated brute and burn injuries, as well as improper (dirty) surgery.
  • Medical Scanners will identify Infections directly, and an increase in body temperature can also be used to predict a developing infection before it becomes a problem.
  • Left untreated, Infections will cause Toxin damage in the body overtime, and ultimately can lead to Necrosis if not treated.

• Necrosis is the final stage of Infection
  • Primarily caused by improper surgery, such as not using proper PPE or a dirty environment and gear.
  • Other Infections caused by untreated bleeding or burns can also develop into Necrosis is left untreated too long.
  • Necrosis will deal more Toxin damage than lesser infections, and will attempt to spread to other limbs until the patient is dead or the Necrosis is treated.

• Organ damage is a perforated or injured organ.
  • Can be caused by any condition that causes Internal Bleeding, such as unstabilized broken bones, or armor piercing attacks.
  • Does not appear on the Medical Scanner, but can be identified through information provided by the scanner.
  • Causes continual damage or side effects relative to the damage the organ sustained.
  • Heart and Lungs can both be identified by unexplained Suffocation that does not reduce normally.
  • Heart damage also causes continual bleeding until treated, if blood level is dropping between scans without other bleeding wounds, heart damage is likely.
  • Liver and Kidneys can be identified by Toxin damage continually building up despite no obvious source.

• Eye damage is identical Organ Damage, but mechanically different.
  • Eye damage is caused by not wearing eye protection during welding or plasma cutter use, as well as armor piercing attacks to the skull, or moving around with an unstabilized fracture or broken skull.
  • You will not be able to detect eye damage with a Medical Scanner, but marines will usually tell you if they can not see.

• Brain Damage is functionally similar to Organ Damage and Eye Damage.
  • Brain Damage can be caused by certain Drug Overdoses (Such as Tricordrazine), Armor Piercing attacks to the skull or unstabilized fractures or broken skulls.
  • Medical Scanners will identify Brain Damage and give a clue to it's severity.
  • The more Brain Damage a person has, the more likely they are to randomly drop items, or collapse when their legs momentarily cease to function.
  • If Brain Damage is allowed to rise to a high enough value, will cause loss of all motor function and eventually death.

• Dismemberment is the complete removal of a limb.
  • Caused by extreme brute damage to a specific extremity (Hand, Arm, Foot, Leg or Head)
  • Is extremely painful, and can result in additional bleeding or infections if not treated promptly.
  • Dismembered limbs can not be used to hold items, missing feet or legs slow a victim considerably.
  • Dismemberment of the Head, also called Decapitation, is instantly fatal, can not be treated or reversed.
  • Wearing a Helmet or other appropriately armored headgear will prevent decaptions. (WEAR YOUR HELMET!!)

• Shrapnel and foreign objects is any object embedded inside the flesh that can not be pulled out.
  • Bullets are the most common form of shrapnel, an unfriendly result of friendly fire.
  • Shrapnel will continue to cause pain and potentially cause additional brute damage (and all side effects that brute damage can cause) to the limb if not stabilized
  • Splinting a limb with shrapnel in it will prevent further damage and discomfort as long as the splint remains in place.

• Alien Larva or Infestation is the result of a Larval Hugger impregnating victim.
  • Larva or Embryos can not be detected with Medical Scanners, only Body Scanners in Medical Bay can detect these parasites.
  • A victim has roughly 10 minutes to seek medical attention to have the parasite removed.
  • The embryo will go through 5 stages of growth while in the body, causing shaking of the victim with each growth phase, as well as other symptoms the host may detect.
  • Use of a Stasis Bag will slow the rate of Larval Growth in a victim.
  • Larval Accelerant Toxin can double the rate of growth in a victim.
  • If the Larva reaches the final stage of growth without being removed, it will emerge from the victim's chest, instantly killing the host and producing a Xeno Larva.

• Overdose is what happens what a patient is given (or self administers) too much of a particular kind of medicine or chemical.
  • Overdose thresholds vary depending by chemical, though most common ones have a 30u threshold.
  • Increased damage or debilitating effects will occur if Critical Threshold is surpassed.
  • See the TGMC:Guide_to_chemistry for full list of thresholds an effects
  • Always scan before administering medication to avoid Overdosing a patient.

• Genetic Damage also known as Cloneloss, is instability a the genetic level.
  • Caused by exposure to dangerous compounds. Currently, Russian Red is the only source of Genetic Damage.
  • Functions similar to Toxin damage, damaging the entire body and not a single limb.
  • Identifiable on Medical Scanner as being Imperfectly Cloned
  • Cause pain in equal amounts to brute damage.

Treatment

Now that you know the signs and the effects of various damage, it is time for you to learn how to treat them.

Basic damage

• Brute - Brute can be treated directly with bandages and brute kits, or chemically with medicine like Bicardine or Meralyne. Surgical treatment is also possible, suches as Sutures or Autodoc procedure Surgical Brute Treatment.

• Burn - Burn can be treated directly with ointment and burn kits, and chemically with medicine like Kelotane or Dermaline. As well as surgically through Sutures or Autodoc procedure Surgical Burn Treatment.

• Toxin - Toxin can be treated with medicine like Dylovene and Hyrolane, as well as with Autodoc procedure Toxin Chelation treatment.

• Suffocation - Is primarily treated by fixing the conditions that cause suffocation, while medicines like Dexalin or Dexalin Plus will reduce suffocation damage, and CPR can be done on unconscious patients to breathe for them.

Advanced damage

For a more in-depth treatment of surgery to heal advanced damage, see the TGMC:Guide_to_Surgery

• Pain - Pain is primarily treated by stabilizing and treating injuries that cause pain.
  • Can be subsided with a variety of painkillers from Paracetamol and Synaptizine for mild pain, tramadol for strong pain, or oxycodone for severe pain.

• Fractures - Splints will prevent the worsening of fractures and help manage the ill-effects of a broken bone.
  • To treat, Bone Surgery can be completed to each broken limb,
  • Autodoc procedure Broken Bone Surgery.
  • Cryotubes also repair broken bones over time, providing brute damage is present on the bone when healing it.
• External bleeding - Can be treated with bandages and brute kits.
  • Treating the Brute damage via medicinal means, such as Bicaradine, also stops external bleeding.
• Internal bleeding - Internal Bleeding will continually get worse as it continues, using QuickClot or Bicaradine and Inapprovaline will prevent this bleeding from getting worse.
  • To treat the Internal Bleeding directly, QuickClot Plus is the optimal route, though this causes extreme pain and metabolizes toxin in the bloodstream.
  • Bicaradine Overdose also heals a small amount of Bleeding, at the cost of more Burn damage.
  • Surgery can also be done to instantly heal all IB in a limb.
  • Autodoc procedure Internal Bleeding Surgery.

• Low blood - Blood loss has numerous, some faster or more efficient than others. A Blood Transfusion with an IV and appropriate Blood Bag(See table below) is perhaps the easiest method, though outside of Medical Bay this may not be an option. Isonotic Injectors, containing Nutriment, Iron and Sugar, are perhaps the next best thing, though takes considerably longer to regenerate from low blood levels. Eating Food will also accomplish a similar effect, MREs having slightly more Nutriment than an Isotonic Injector, while protein bars and prepared meals on the ship having equal or less.
  • The final, more exotic options, is NanoBlood, which will instantly restore blood level to 40% if it is initially lower, and then restore more blood depending upon if the patient has more or less than 60% of their normal value.

Blood compatibility table

Recipient	Donor
	O−	O+	A−	A+	B−	B+	AB−	AB+
O−
O+
A−
A+
B−
B+
AB−
AB+

• Infection - Spaceacillian is the primary method for treating infections.
  • Bandages and Brute Packs on external bleeding and ointment or Burn Kits will patch and salve them, preventing them from getting infected, or the infection getting worse.
  • Polyhexanide can be administered to fight severe (but not Necrotic) infections, though this will cause additional toxin damage and likely put the the patient to sleep.
  • Surgery, in proper sterile conditions, will purge an infection on cauterization.
  • Autodoc procedure Limb Disinfection Procedure for limbs and Organ Infection Treatment for organs will respectively purge the appropriate limbs of infection.

• Necrosis - Primary treatment for Necrosis is Necrosis Treatment Surgery
  • Autodoc procedure Necrosis Removal Surgery will also remove all necrotic tissue from a patient.

• Organ damage - Peridaxon will stop all side effects of damaged organs (but not cure them) while it is the subjects system. At Cryogenic temperatures (cryotube) it will repair organ damage.
  • Peridaxon Plus will repair organs, but will metabolize into Toxins. Warning: Peridaxon Plus has a 1u OD limit. Never administer more than 1u at a time, and always administer with a Toxin treating and purging chemicals, preferably Dylovene and Ryetalyn. Overdoses and Critical Overdoses and quickly become lethal.
  • Organ Surgery can performed to treat all organs at once.
  • Autodoc procedure Surgical Organ Damage Treatment will treat all organ damage and brain damage at once.

• Eye damage - Can be treated chemically with Imidazoline
  • Eye Repair surgery can be done to instantly heal all eye damage at once.
  • Autodoc procedure Corrective Eye Surgery will restore eyesight.

• Dismemberment - Requires a limb replacement, done via surgery or autodoc. Only Prosthetic limbs can be reattached, organic limbs decompose and become lifeless.
  • Surgically prepare the stump before applying the appropriate prosthetic limb (Robotic Arm to missing arm or hand, Robotic Leg to missing leg or foot. Be sure to check for LEFT or RIGHT)
  • Autodoc procedure Limb Replacement Surgery to automatically replace all missing limbs with the appropriate robotic counterpart.

• Shrapnel and foreign objects - Use Medical Tweezers on the limb to remove one piece of shrapnel. Multiple pieces will require multiple attempts, ask the marine which limb shrapnel is in if multiple brute damage limbs, or try all limbs with brute damage or that appear on the scanner as injured.
  • Shrapnel removal surgery to remove one piece of shrapnel per use of Hemostat. Does not require sawing through bone.
  • Autodoc procedure Foreign Body Removal Surgery to remove all pieces of shrapnel at once.

• Alien infestation - Stasis bags and poor health will slow the larva's gestation and a cryopod will halt it all together.
  • Surgically remove from chest after opening rib cage. Will result in one Larva Embryo that can be grinded into Larval Jelly for advanced chemical production.
  • Autodoc procedure Foreign Body Removal Surgery. (Destroys the Embryo, can not recover for Larval Jelly production)

Death

For a full breakdown, see the Guide to Defibrillation

People are going to die, that's a simple fact. However, there's a difference between being dead and being dead. And the former is one you can treat. The recently departed still yet cling to the mortal coil and with a defibrillator, you can pull their soul back into the land of the living (assuming they wish to), however, there are a number of stipulations to reviving someone:

• They must have not been dead for longer than 5 minutes.
• They must not have basic damage (brute/burn/tox/oxy) of any type greater than 200.
• They must have a functioning working heart and brain.
• They must not be suiciding.
• They must have an actual player associated with their mob (no reviving the long-dead colonist bodies).
• They must not be wearing an exosuit (such as marine armour) that would interfere with the resuscitation.

Please remember, that you can use trauma and burn kits on dead bodies to help repair the damage done and make them valid for reviving. The defibrillator also heals some damage (of all basic types) itself, the greater the medical skill the more powerful the defibrillator healing ability is. These values are as follows:

• Staff Officer or Squad Leader: 4 per shock
• Medics: 8 per shock
• Doctors: 12 per shock
• CMO or Synth: 16 per shock

Treatment priority

In a hectic situation, you're going to need to be able to discern who needs treatment immediately as a snap judgement and focus on who needs your help more. The first rule of performing your duty of care is to not panic. Take a deep breath and try to remember this rule of thumb as to who needs you more:

• The recently dead
• Xeno hosts
• Those in critical condition
• Immobile patients
• Everyone else

The recently dead are on a hard timer and the longer you leave them, the more likely that timer will have expired and making them permanently dead, no matter what everyone else's problem is - they're unlikely to be in as much need as they do. You can identify the recently dead by the lightning bolt symbol that your health HUD assigns them. Xeno hosts can afford to wait but they're on a timer as well and if it expires - their deaths are just as permanent. In a triage situation, stabilisation matters first, once people are out of the danger zone - you can focus on the underlying causes. Don't be afraid to conscript marines as nurses to tend to the wounded if you absolutely need a hand.