Doctoring

Medical doctors have a bad reputation for never being around and being useless. Can you do better?

The Health System

All crew members spawn with 100% health, and with four categories of damage: suffocation, toxin, burn, and brute. Any damage taken will add to its corresponding category and subtract from total health. There is also brain and bleeding damage, which work differently from the others. As one's health declines, they will be slowed down and generally find it harder to move around. Certain drugs, such as morphine and salicylic acid, can reduce these penalties.

At 0% health, the patient enters critical health. They will stumble around, fall in and out of consciousness, begin to slowly take suffocation as well as brain damage and have an ever-increasing chance to develop shock and cardiac failure. If left untreated, they will eventually reach a certain amount of damage (overall, around 400) and can randomly die. Atropine and synaptizine when used together can greatly reduce this chance. Generally speaking, people are unlikely to survive 200 (-100% health) or more total damage.

Drugs

Main article: Chemicals#Medical Chems

Medical doctors have access to some of these in medbay, and others can be created by botanists (though you'll have to nag them for it). The quartermaster can order a number of medical resupply kits. Advanced drugs can be created by the scientists, assuming they haven't already burned themselves to death. Medibots synthesize many different medicines, which are indicated in the table below.

Basic

Drug	Use	Advanced version
Ephedrine	Stabilizes critical patients, but less effectively than epinephrine. Reduces stun/knockdown effects. Addictive.	Epinephrine
Epinephrine	Stops suffocation, stabilizes critical patients. Treats cardiac problems. Dampens severe allergic reactions and flushes out histamine somewhat. Reduces stun/knockdown effects. Slows down effects of sarin. Causes sickness on overdose (20+ units).	Atropine
Salbutamol	Treats suffocation damage and respiratory failure and repairs the lungs and spleen. Part of the standard medibot injection set.	Perfluorodecalin
Styptic Powder	Slightly slows down the health loss from bleeding and heals brute damage. Only apply topically (patch, dropper, etc.)!	Synthflesh
Silver Sulfadiazine	Heals burn damage. Only apply topically (patch, dropper, etc.)!	Synthflesh
Saline-glucose Solution	Slowly heals brute and burn damage, handles circulatory shock, increases the body's natural regeneration rate of blood. Part of the standard medibot injection set. Having Saline in your bloodstream for too long will cause hypertension due to its blood regenerating effects.
Charcoal	Treats toxin damage, absorbs other reagents in the body, heals damage to the liver, kidneys, stomach, and intestines, and can cure kidney and liver failure. Part of the standard medibot injection set.	Pentetic Acid
Calomel	Rapidly flushes chemicals out of people's bloodstreams, but causes toxin damage in the process.	Pentetic Acid
Potassium Iodide	Basic anti-radiation medicine. Reduces radiation, heals a small sliver of tox damage, and can repair kidney, liver, intestines, and stomach damage a little bit.	Pentetic Acid
Ammonium Bicarbonate (Smelling salts)	Basic anti-radiation medicine, weaker than potassium iodide. Stabilizes critical patients, slightly more effectively than ephedrine but not epinephrine. Flushes out certain depressants and knockout drugs.	Pentetic Acid
Cryoxadone	Heals all organs and most damage types; used in cryo chambers. Only works at low temperatures!	Omnizine
Salicylic Acid	Basic painkiller. Heals small amounts of brute damage. Decently reduces the speed penalty from injuries, and reduces overheating.	Morphine
Morphine	Sedation. Low doses significantly reduce the speed penalty from severe injuries and help with jitteriness. Addictive.
Chicken Soup	Basic anti-viral. Can cure minor diseases, such as food poisoning or the flu, but not as well as Robustissin can. Available from coffee machines.	Robustissin
Space Ipecac	Emetic. May induce vomiting, causing the patient spew out their most recent meal (and whatever reagents/poisons were in it) as half-digested food chunks. May cause food poisoning.
Menthol	Burn and fever medication. Attempts to lower body temperature back to normal, sometimes heals a little burn damage. Can penetrate skin.
Diphenhydramine	Also known as antihistamine. Treats allergic reactions by flushing out histamine and reducing its effects.	Epinephrine
Synaptizine	Stimulant, stronger buffs than epinephrine or ephedrine. Sometimes cures brain damage, more effective at higher brain damage levels. Causes sickness at high (40) doses.	Mannitol

Advanced

Drug	Use
Atropine	More powerful version of epinephrine, useful when a patient is near death. Fixes cardiac problems, heals a bit of brain, brute, and burn damage, and rapidly flushes sarin out of the body.
Perfluorodecalin	Treats suffocation very well, causes mildly annoying gasping in the meantime. Slowly heals burn and brute damage and heals lung and spleen damage slightly faster. Can cure respiratory failure. Synthesized by the Head Surgeon medibot instead of salbutamol. Addictive. You might see people walking out of the cloner with a Perfluorodecalin addiction once in a while.
Synthflesh	Heals brute and burn damage very effectively, and also stops bleeding instantly. Only apply topically (patch, dropper, etc.)!
Pentetic Acid	Reduces radiation, heals toxin damage, treats damage to the liver, kidneys, stomach, and intestines, can cure kidney and liver failure, flushes all other chemicals. Causes brute damage.
Omnizine	Heals all organs and most types of damage, reduces bleeding slightly, and regenerates blood. Addictive.
Haloperidol	Anti-psychotic/sedative. Rapidly removes psychoactive drugs and stimulants, can cure certain psychoses, causes brain damage. Regular darts fired by the tranquilizer rifle also contain it.
Spaceacillin	Treats certain diseases. Part of the standard medibot injection set.
Robustissin	Can cure minor diseases, such as food poisoning or the flu.
Mannitol	Cures brain damage.
Mutadone	Removes mutations, harmful, beneficial, or harmless.
Oculine	Treats eye and hearing damage.
Antihol	Treats drunkenness.
Insulin	Handles hyperglycaemic shock.
Teporone	Normalizes body temperature. Addictive.
Filgrastim	Stimulates blood production; usually used after moderate blood loss.
Heparin	An anticoagulant, which will worsen bleeding but will also lessen the symptoms of hypertension, lower blood clots, and help with heart disease.
Proconvertin	A coagulant, which will significantly lessen blood loss, worsen or sometimes cause clots, and increase blood pressure.

Damage

Not all mobs are susceptible to all damage types, but humans and monkeys are generally the most vulnerable. A couple of mutations, for example thermal resistance, offer some immunity. Of note:

• Changelings don't have to breathe and are thus not affected by suffocation and gas leaks, and they also can't contract diseases and pathogens, or develop heart conditions.
• Vampires are immune to diseases and pathogens.
• Cyborgs don't have to worry about toxins, radiation or suffocation, but they can still be dented or burned.

In technical terms, the damage types are often referred to as OXY, TOX, BURN, BRUTE, BRAIN, BLEEDING, EYE, and EAR.

Note: Don't forget that every medical PDA (cyborgs included) is equipped with a reagent scanner! Separate hand-held devices and upgrades for regular health analyzers are also available. Its usefulness to quickly identify poisons cannot be overstated.

Suffocation

The patient has been exposed to an area without a proper atmosphere, or strangled. Other possible causes include:

• Presence of CO2.
• Certain chemicals and chemical fumes, for example pancuronium.

Salbutamol will speed up recovery, but suffocation damage will heal naturally if there is enough air to breathe, provided the patient has not gone into critical health. If they are wearing an air tank and mask, make sure the valve isn't closed. If it isn't, the tank is probably empty or not configured properly, so take it off.

A patient in critical health can't breathe unassisted. Inject saline and/or epinephrine to stabilize them, or give CPR by using an empty hand on them with Help intent. Make sure neither of you are wearing masks or hats.

LOSEBREATH

The patient is having trouble breathing. Whenever they try to speak, it comes out as whispers. Not really a damage type, but nevertheless acts like one and is very closely associated with suffocation damage and the things that cause suffocation, though, technically speaking, it does not in of itself, cause it.

You won't find it on a scanner reading, but if you ever see an O2 Warning icon pop up on your screen, that's LOSEBREATH at work.

Salbutamol will help the patient breath again, as will cardiac stimulants like epinephrine, but LOSEBREATH will reverse itself naturally, proved there is enough air to breathe, and the patient is not in critical condition or worst. Giving CPR by clicking on a patient with an empty hand with Help intent will also reduce LOSEBREATH.

Toxin

Toxin damage can come from a few sources:

• Breathing plasma causes toxic damage. Move the patient to a safe area if there is a gas leak.
• Certain viruses can cause toxic damage. Treat the virus first, then deal with the toxin damage.
• Ingesting harmful chemicals can cause toxin damage. Treat the poisoning first, then administer anti-toxins.
• Toxin damage is a byproduct of radiation poisoning. Deal with the poisoning first if anti-rad medicine is available.

The primary remedy is activated charcoal (anti-toxin pills). In severe cases, calomel will rapidly flush the patient at the cost of causing toxic damage itself. Pentetic acid is a superior alternative.

Certain toxins warrant special considerations:

• Embalming fluid: Will decay into histamine, which can cause anaphylaxis.
• Amanitin: This poison will cause toxic damage when the last unit decays. The amount of damage is based on how long it was in the patient's bloodstream.
• Coniine: Causes rapid asphyxiation and renders the victim incapable of speech.
• Sarin: Causes paralysis, shaking, vomiting, suffocation, toxin damage, and some burn damage. Neutralize with atropine.
• Venom: Causes toxic and brute damage. Decays into histamine, and can gib in large doses.

Toxin damage may also affect the kidneys and/or liver. Their own particular considerations are detailed in their respective sections.

Burn

Burn damage can come many sources, such as:

• Fire, acid and electrical shocks are the most common.
• Exposure to space and Trench tiles without protective gear.
• Exposure to extremely high or low temperatures.
• Explosions.
• Inhaling superheated gas will fry someone's lungs from within, causing massive burn damage. Make sure you have internals on before rushing to help these patients.
• Certain weapons (such as a welder or phasers) will also cause burn damage.
• Eating spicy food or food injected with certain hot chemicals.

If the patient is on fire, put the fire out before anything else, The burning sprite can be slow to update sometimes, so it can be hard to tell if you have extinguished the fire. Stuffing the patient into cryo will rapidly put out the fire while also healing them - making it perfect for all those flaming assistants running around. Once the source of the burn damage is removed, treat with burn medication (e.g. silver sulfadiazine, burn patches) or cryo.

Brute

Brute damage is probably the most common form you will see. It comes in many forms:

• Bruises from physical combat, melee weapons, etc.
• Being struck by a thrown object.
• Being shot by a revolver or other kinetic weapons.
• Explosions.
• Certain viruses and chemicals, for instance itching powder.
• Slipping on space lube.
• Taking a trip through a waste disposal chute.

Brute damage can be treated with styptic powder, synthflesh, healing patches or cryo. If the patient has been shot, they will continue to bleed until the bullet is removed. This requires surgery. If you cannot get the bullet out immediately, administer a pill of salicylic acid, which will boost their movement speed to normal, and send them to medbay for further treatment.

Brain

Brain damage is typically caused when other types of damage force a person into critical condition. Other possible factors include:

• Severe head injuries.
• Certain viruses.
• Exposure to a number of chemicals, such as neurotoxin, haloperidol, sarin or mercury.

Health analyzers don't provide an exact value for brain damage. If somebody has suffered brain damage, the readout will indicate the fact:

• "Significant brain damage detected. Subject may have had a concussion." (More than 10 BRAIN),
• "Severe brain damage detected. Subject likely unable to function well." (More than 60 BRAIN),
• "Subject is braindead." (More than 100 BRAIN).

Examining a person with severe brain damage will also reveal that they appear to have a stupid expression on their face. Heavy brain damage causes the patient to gibber everything they say and involuntarily scream over the radio in all caps. It also makes it difficult for them to do certain tasks, such as using computers and operating doors. Extreme brain damage will make it difficult to even breathe. Too much brain damage (120 BRAIN) will outright kill them.

Mannitol is the primary counter to brain damage. Synaptizine is highly effective at curing high levels of brain damage. Holy water is also excellent at healing brain damage, though only if topically (e.g. dropper, patch, beaker splash) applied. If the patient is in critical condition, stabilize them with epinephrine or other means first, preventing further accumulation of brain damage. To deal with any poisons, follow the standard detox procedures and then follow up with a pill of mannitol.

Bleeding

The cardiovascular system of human or monkey contains 500 units of blood. Any attack with a sharp object (e.g. broken bottle, scalpel or energy sword) or kinetic firearm is likely to open a wound, and the rate of the blood loss depends on the severity of the injury. Vampires are another major threat, as they tend to drain their victims dry when given the opportunity. While minor cases can be fairly harmless, blood pouring out at an alarming rate will have a life-threatening impact in a matter of minutes. If the blood level is lower than...

• 400: Small chance to go into shock.
• 300: Medium chance for shock, the patient will be slowed down to walking speed, experience random stuns or pass out.
• 200: High chance for shock, walking speed, random stuns and KOs.
• 100: High chance for shock, walking speed, lots of random stuns and KOs. The patient will steadily rack up OXY and BRAIN damage, enter critical condition and pass away in short order.

You can assess the patient's condition with a health analyzer or by examining them. Somebody with a low blood level will appear "pale", for instance. More accurate readings can be obtained by upgrading the analyzer, which will tell you the exact amount of blood and blood loss per life cycle.

Stopping the Bleeding

When dealing with a bleeding patient, the priority should be to mend the wound, as they'll just bleed out any medicine you put in their bloodstream. Topical drugs (such as styptic powder) can still be somewhat effective, though. You have a number of options:

• Wait it out. The body can occasionally heal 1 BLEEDING over time, so minor wounds can be ignored under certain circumstances. Don't make the mistake to depend on it to save somebody's life, however!
• Using the Help intent on somebody may slow the rate of bleeding, but it's not very reliable. Both parties have to stand still.
• Cauterize the wound with a welding tool, zippo lighter, igniter or lit cigarette. Beware, this will burn the patient as well.
• Medical patches can reduce bleeding.
• Certain medical chemicals, for example, styptic powder, synthflesh, omnizine, and proconvertin. See Drugs for more info.
• Bandages and sutures work reliably and don't have negative side-effects.

Note: Only sutures are capable of mending surgical incisions. Every other option can slow the rate of blood loss, but won't close the wound entirely no matter how hard you try. If examining the patient reveals one or multiple "open incision[s] on their [body parts]", target the correct one and use a suture as many times as necessary to mend all incisions.

Restoring Blood

All patched up? Great, but your job isn't done yet. While the patient's body will replenish blood at a slow-but-steady rate if they have a healthy spleen, chances are an infusion (via blood bags) will be required in case of considerable loss of overall blood volume or severely-damaged/absent spleen, which prevents the body's natural blood regeneration. Filgrastim also helps to replenish the blood supply and is best of all medicines at it, followed by omnizine, saline-glucose solution, and iron.

Please note that, unlike real life, blood type does not matter. While a framework work for types exists, they currently do not come into play during blood transfusions. People with AB blood, for example, can donate to people with O blood, and vice versa. Besides, even if it did, the blood bags in Medbay's blood supply fridge and Blood Bank crates have synthetic blood that's coded to be accepted by all blood types (again, not that it means much).

Also of note: bullet and shrapnel wounds can be bandaged, but surgery is still necessary to get rid of the random stuns and accumulating brute damage.

Vampires can bleed as well, but only if they've already built up a reserve of blood. They bleed on a per-attack basis only (as opposed to a certain amount per tick), and are completely unaffected by the debilitating side-effects detailed in the paragraph above.

Eye

Patient's retinas are damaged, typically as a result of exposure to bright lights. One of the least common damage types, though probably one of the most annoying. Potential sources include:

• Welding without protection.
• Improper use of flash powder.
• Flashbangs.
• Getting capsaicin on the skin/face.
• Exposure to flashes and other bright lights while wearing optical thermal scanners.
• Blinding spells.

Eye damage worsens the effects of sources of eye damage. If eye damage is allowed to accumulate, later eye injuries can result in blurriness, temporary short-sightedness, and eventually permanent blindness.

Health analyzers do not detect eye damage. Instead, you must ask the patient if their sight is good. If not, administer oculine in any form, e.g. drops, patch, pill.

Welding masks and most varieties of space helmets outright block most sources of eye damage. Sunglasses, SecHUDs, and polarized eyes offer similar protection, though they only reduce damage from welding. Meanwhile, optical thermal scanners and NVG goggles intensify eye damage, often significantly.

Blindness can be alleviated by wearing VISOR goggles and administering oculine or mutadone. (Pro-tip: if you yourself become blind, simply click a pill/patch/auto-injector while it's in your hand to use it on yourself.)

Ear

The patient's eardrums are damaged, and they are having trouble hearing, often experiencing temporary deafness and tinnitus, "ringing" in the ears. Probably the rarest damage type, though easily the least lethal and debilitating. Potential sources include:

• Improper use of sonic powder/hootingium.
• Flashbangs and sonic grenades.
• Vuvuzelas, amplified and unamplified.
• Unholy screeches and screams.

Oculine quickly repairs ear damage, though ears heal naturally if the patient is not deaf. Heavy ear damage can result in permanent deafness, which can cured with mutadone and alleviated by wearing an Auditory Headset. Wearing earmuffs and being deaf in the first place prevents most ear damage entirely.

Organ Damage & Ailments

Humans, Monkeys, Vampires, Changelings, and most other humanoid mobs with organs can also suffer damage to specific organs, separate but still connected to the other damage types. To analyze organ damage, you need a health analyzer equipped with an organ scan upgrade, which will assess damage in these relative terms:

• 1-9: "Minor"
• 10-29: "Moderate"
• 30-64: "Significant"
• 65-99: "Critical"
• 100 and above: "Dead"

Usually, "Significant" and "Critical" are the most important ratings, for some organs cause extra problems upon reaching the "Critical" damage threshold. If left untreated, these problems can cause the organ to completely fail and die, resulting in same effects as lacking one. Dead organs cannot be healed back to full health and thus require transplants.

Any ranged or melee attacks that inflict brute damage specifically to the chest have a chance to also damage two random organs listed in this section. The attack has to cause more than 5 damage, and higher damage means more damage to the organs, though only 5-10% of it becomes organ damage. This is low enough that anything that causes significant damage to organs is usually enough to easily put the victim into critical condition, often a greater issue. The spleen and lungs are more resilient to attacks than the other organs in the chest.

Generally, if an organ hasn't died, to treat its particular ailments and damage, you administer whatever drugs heal the damage the ailment causes, e.g. liver failure causes TOX, so you can cure it and heal liver damage by administering TOX-healing drugs. When in doubt, try omnizine and cryoxadone, which heal all organs. All organ-related issues, including organ death, can also be treated simply by replacing the organ.

Lung Damage

Each lung takes damage separately, independently of each other, though some sources damage both. In addition to certain melee and ranged attacks to the chest, a patient can also receive lung damage by:

• Breathing in searing hot air. Higher temperatures cause more damage.
• Smoking cigarettes and similar tobacco products. Nicotine content does not matter, only length of smoking sessions.

If a single lung reaches "Critical" damage levels, that lung will eventually cause respiratory failure. If one lung goes missing or dies (i.e. has 100 damage or more), the patient will sometimes suffocate, and their max stamina is decreased by 75 and stamina regeneration by 3. If both lungs are gone or dead, the patient will rapidly accumulate OXY damage and LOSEBREATH with every second, with max stamina plummeting by 150 and stamina regen by 6.

Medications designed to treat OXY damage, such as salbutamol and perfluorodecalin will also heal lung damage. Omnizine and cryoxadone are both effective at treating lung damage.

Respiratory Failure

Should a lung accumulate too much damage, it will start to fail. Symptoms include gasping, twitching, pains in the ribs, sensations of trouble breathing, and, most importantly, occasional LOSEBREATH. In last stage of failure, the patient suffers frequent OXY damage and LOSEBREATH, and the lung starts actively deteriorating. If left unchecked, the lung will eventually die, causing the same effects as not having the lung at all.

Salbutamol, perfluorodecalin, and similar anti-suffocation medication can both cure respiratory failure and reverse the lung damage. Omnizine and cryoxadone exclusively do the latter. Getting a new lung solves respiratory failure entirely, naturally. Very rarely, respiratory failure may miraculously clear up on its own in the initial stage.

Liver Damage

Whenever the patient takes TOX damage, there's a 30% chance their liver may take damage too, though only about 1/12 of the amount of TOX damage becomes liver damage. The patient also suffers liver damage whenever they drink ethanol. If liver damage reaches 65, the "Critical" damage level, the body has a chance to develop liver failure, and is all but guaranteed to if it reaches 100. Speaking of which, if the liver is missing or dies, all chems deplete twice as slowly in the patient, and they suffer fairly quick, continuous TOX damage.

Drugs that treat TOX damage, such as charcoal, also treat liver damage, as do the usual suspects omnizine and cryoxadone. If the patient's liver is augmented, they can heal liver damage just by ingesting a lot of ethanol--alcohol really is a solution sometimes!

Liver Failure

The patient's liver is failing, signified by pains in the upper chest/abdomen. In later stages, the patient may start fainting, collapsing, and/or experiencing TOX damage, and the liver starts to deteriorate and will eventually die, resulting in TOX damage over time and halved chem depletion.

As usual, omnizine and cryoxadone can slow down liver failure by reversing the damage, and so can anti-tox drugs like charcoal, with the added bonus of also being able to cure the disease. Getting a new liver also cures the disease. Finally, liver failure may very rarely magically clear up in the early stages.

Kidney Damage

Similar to the liver, whenever the patient takes TOX damage, there's a 30% chance, separate for each one, for a kidney to also receive 20% of the damage; this does not reduce the TOX damage in any way. In fact, they do very little until they become too deteriorated.

Speaking of which, the patient will be fine if just one of their kidneys is missing or is dead due to excessive damage, but if both of them are, all chems deplete twice as slowly, and they take TOX damage every second. While it's not much, it adds up over time. Moreover, once a kidney reaches the "Critical" damage threshold, kidney failure occurs.

You can fix kidney damage by, fittingly, administering anti-TOX chems, such as charcoal and pentetic acid. As usual, omnizine and cryoxadone do a fair job of healing the kidneys.

Kidney Failure

Kidney failure occurs when a patient's kidney passes 65 kidney damage, the "Critical" organ damage threshold. In the first two stages of failure, the afflicted feels pains and aches in the upper-right abdomen. Once the ailment reaches its final stage, the patient starts suffering TOX and kidney damage, eventually rendering the organ nonfunctional. While a patient could theoretically survive one kidney completely failing if continually given enough medicine, if both kidneys are put out of commission by kidney failure, they will suffer the same effects as missing both kidneys, as described above.

You treat kidney failure with medicines that treat TOX damage, such as charcoal. These drugs reverse the kidney damage and may cure it altogether. While omnizine and cryoxadone can't cure the disease, they can still fix the kidney damage and thus slow down its effects. Kidney failure may also, very rarely, magically disappear in the first two stages.

Pancreas Damage

When the amount of sugar in the blood exceeds 80 units, there is a chance for the pancreas to secrete insulin to deplete it. However, there is also a separate chance for the sugar to damage the pancreas. While a patient can survive without a pancreas or one that is dead, they will be unable to secrete insulin in the meantime. Furthermore, if the pancreas incurs 65 or more damage, the patient may contract pancreatitis.

There are no medications that specifically treat damage to the pancreas, though omnizine and cryoxadone can still heal it.

Pancreatitis

The patient's pancreas is inflamed due to excessive damage, characterized by fainting, groaning, and aches and pains in the upper right abdomen and back in the early stages. In last stage of pancreatitis, the patient sometimes suffers TOX damage, and the pancreas may sometimes lose health, eventually causing the same effects as not having a pancreas at all.

There is no cure for pancreatitis, barring a pancreas transplant, but omnizine and cryoxadone can and potentially prevent the pancreas from totally failing. Very rarely, pancreatitis may clear up on its own its the first stage.

Appendix Damage

Currently, the only source of appendix damage is from attacks to the chest, detailed above in the introduction of this section. Spacepeople can live without an appendix, and it's probably for the better, because once it reaches the "Critical" level (i.e. 65 organ damage and above, as previously stated), there's a risk of contracting appendicitis. Fortunately, omnizine and cryoxadone counteract appendix damage, the former better than the latter.

Appendicitis

Because of excessive damage or random chance, the patient's appendix is dangerously enlarged, causing abdominal pains and shudders that progressively worsen. In the last stages, the appendix may become so inflamed that it begins to tear apart and damage itself. If left unchecked, the appendix will eventually burst, dumping several pathogens and sometimes lots of toxin into the afflicted.

While there is no specific medicine for the disease, omnizine and cryoxadone can slow the disease down, as the appendix does not have chance to explode until it's reached 90 damage, well beyond the "Critical" organ damage level. Removing or replacing the appendix will cure the disease. Very rarely, the disease may go away on its own. Having a cyberappendix or no appendix at all will prevent appendicitis entirely.

Spleen Damage

Just like in the movies, kinetic bullets and melee attacks to the chest have a chance to hurt the spleen, so when patients scream that about their spleen hurting after getting shot, sometimes it really is hurt. Unfortunately, it's the only way to receive spleen damage, so this doesn't happen with, for example, being set on fire (or something that clearly doesn't hurt the spleen), reducing potential comedy value. Less comedically, if the spleen dies (i.e. more than 100 damage), the body can't regenerate blood naturally.

Fortunately, omnizine and cryoxadone can heal this butt monkey of an organ, and any meds that heal lung damage, such as salbutamol, also heal spleen damage, because that's just how spacepeople work.

Stomach Damage

Blows to the chest can sometimes translate into blows to the stomach, as described above. If the patient has no stomach or one that's too damaged, they cannot can't eat food, though they can still swallow pills, sip drinks, things like that.

Anything that's good for the liver is good for the stomach. That is, if it heals toxin damage, not only does it repair the liver, but it should fix up your stomach too. That means drugs such as omnizine, cryoxadone, and charcoal.

Intestines Damage

Currently, intestines only take damage from certain melee attacks to the chest, as stated above. While Trent's Anatomy/Surgical Textbook might imply the intestines allow people to absorb reagents and gain buffs from food, they can do both without intestines, with no ill effect.

Just like with the liver, stomach, and kidneys, omnizine, cryoxadone, and anti-TOX drugs, such as charcoal, all heal the intestines.

Surgery

Several problems require immediate surgery to save the patient, some of which concern their extremities or internal organs. People coming into medbay will expect you to be able to help, so you should familiarize yourself with this guide.

Basics & Controls

Surgery starts by placing someone on an operating table , found in the Operating Theatre in Medbay and sometimes other places. To do this, stand near the table your patient and drag & drop them onto the table. Putting people on an operating table has a small delay that's interrupted if either of you move; putting yourself on the table, again through drag & drop, has no such delay.

Once the patient is on the table, you need to use certain tools and objects on them in a specific order, particular to each procedure; often different things also happen depending on what body part you're aiming for and what intent you're on. To use a tool on someone as a human, you simply need to click on the person with the required tool in your active hand. As a medical cyborgs, you need to have the necessary tool in your active slot. Human and robotic surgeons can drag & drop organs onto someone to try to attach them to/insert them into the patient. It's very handy for the latter, since robots don't actually have hands, though they are restricted to organs.

Surgical tools are often found near the operating tables, often on surgical trays. Scalpels and saws see a lot of use; scissors and staple guns also see a fair bit of use. More of these can be printed at a medical fabricator.

Once the procedure is done, remember to heal them up. Surgery often causes BRUTE, which you can treat by adminstering styptic powder or similar, and bleeding, which you can alleviate by clicking on them with a suture .

At no point does the patient need to be under anesthetic, though it does help. Surgeries can also be done on the dead. Just as in real life, working on cadavers can be great for learning surgery and anatomy!

Success & Safety

During each step of every surgery, there is a chance to you to make a mistake and cause damage instead of progressing. Several factors influence the probability of complications. Injecting the patient with sedatives (morphine, haloperidol) or painkillers (salicylic acid, alcohol) has a positive effect, as does using N2O (anesthetic) tank. Jitteriness should be addressed beforehand. Clumsy people have no place in the operating room and surgeons may also wish to avoid excessive consumption of alcohol. Last but not least, trained professionals (the medical staff) are less likely to screw up in general.

Since surgery can be a very bloody affair, you may want to make use of a hemostat where available to reduce the amount of bleeding damage taken. Either way, it is never a bad idea to have sutures (see the previous section on "Bleeding") on hand for dressing the patient's wounds immediately. A full blood bag can also be required for complicated and lengthy surgery (such as heart replacement).

Improvised Surgery

Should proper tools be unavailable and/or a trip to the Operating Theater undesirable/inconvenient, you may need to perform some procedures with nonstandard tools. Certain surgical tools can by substituted by the following items:

• Scalpels: Glass shards (material type doesn't matter), knives, plastic knives, bread knives, meatcleavers, razor blades, butcher's knives.
• Circular saws: chainsaws, pizza cutters, forks, plastic forks, chopsticks.
• Enucleation spoons: spoons, plastic spoons.
• Surgical scissors: wirecutters, scissors.
• Staple guns: staplers.

Sutures have no real analogue, but there are some partial substitutes. If you are using it to "reset" an attempt to extract certain organs in the chest, you are unfortunately out of out, but if you are using it to fix bleeding wounds, you can use some sort of portable heat source, such as a welder or lighter to cauterize the wound, sealing it at the cost of BURN. In addition, for limb reattachment, office staplers work just as well for securing the limb.

Similarly, you may, for whatever reason, find yourself without an operating table. You can operate on certain surfaces in place of one, but there are some special considerations for each:

• Beds: The patient must be buckled to the bed (procedure is same as buckling to chairs), but they can otherwise be alive or dead, conscious or unconscious.
• Tables: The patient must be unconscious; simply lying prone on the table isn't enough. For willing patients, it is common practice for the one going under the knife to repeatedly *faint (entered like any other emote). For unwilling patients...some sort of stun weapon is necessary.

Self-Surgery

For whatever reason, in some situations, the one going under the knife is the also the one holding it. That is, you may sometimes have to conduct surgery on yourself. There are a few techniques for performing self-surgery, with varying levels of legitimacy.

The usual way of performing surgery on yourself is to lie down on the operating table, stand up, and have at it as if you were lying down.

There's one technique that doesn't require an operating table, or really any table at all. Instead, it simply involves the Captain's favorite past-time: drinking lots of booze. If you ingest enough ethanol, you can actually conduct surgery on yourself while standing up, but you need a fair bit of it in your system: about 45 units or more. Generally, if you're so drunk that your vision's blurry and you can just barely make out your surgery tools, self-surgery is possible.

Finally, you can do a similar thing with morphine, and it works quite well. Unlike ethanol, you only need at least 5 units in you to operate on yourself, which is low enough that you don't have to worry about accidentally knocking yourself out or blurring your vision. Not to mention, as previously discussed, having morphine in the patient (in this case, you) reduces the chance of the surgery going awry, and unlike alcohol, it doesn't inherently inhibit the surgeon. It's not as abundant as ethanol, but it's not exactly scarce either. Overall, it's a viable alternative to ethanol.

Surgical removal

-ectomy	Scenario	Tools	Procedure	Considerations
Headspider	The patient fought a changeling and ended up being infected by its headspider.		Target the chest with Help intent. Use the scalpel.	Time is of the essence! This should cut a "strange tumor" out – if it doesn't after repeated attempts, the transformation has already been completed.
Implant	The patient has an implant that requires removal.		Target the chest with Help intent. Use the scalpel.	Most of the time, the implant can be recycled by loading it into an empty implanter. However, some implants cannot be recovered by surgery, such as mindslave implants.
Bullets, shrapnel	The patient has bullets and/or shrapnel in their chest and cannot bear the random stuns and brute damage. Scan them with a health analyzer ("Foreign objects detected") to confirm your suspicion.		Target the chest with Help intent. Use the scalpel.	One foreign object is removed at a time, so you may need to repeat.
Limb	The patient is a healthy human with four limbs. For augmentation or other reasons, some of the limbs have to go.		Target the limb in question. Use the scalpel, then saw, then scalpel.	Even if you neglect to do the final step, the half-cut limb will still fall off after some time. This procedure will inflict a lot of tissue damage and will put the patient in critical condition very quickly, so you need to have bandages and medical drugs at the ready.
Butt	The patient is alive or dead, and you need their behind for a buttbot or the kitchen.		Target the chest with Harm intent. Use the scalpel, then saw, then scalpel, then saw.
Eyeball	You need to remove somebody's eyes, presumably for augmentation.		Target the head. Use the spoon, then scalpel, then spoon using the hand of the side in question.	Hold the surgery tools in your left hand to target the left eye, and vice versa.
Brain (Humanoid Corpse)	Your patient is quite dead, or wishes to be a cyborg, and you need their brain.		Remove the patient's headgear (hat, mask). Target the head with Help intent. Use the scalpel, then saw, then scalpel, then saw.	You can use the same procedure (headgear removal not necessary) on severed heads.
Brain (Critter Corpse)	Your patient has, through special wizardry, been turned into an animal, and now is quite dead, or wishes to be a cyborg, and you need their brain.		Use the scalpel twice.	No operating table necessary.
Head	Your wish to sever your patient's head for...science?		Remove the patient's headgear (hat, mask). Target the head with Harm intent. Use the scalpel, then saw, then scalpel, then saw.
Skull	The patient is dead and you for some reason require their skull.		After removing their brain (see above), target the head. Use the scalpel, then saw.	You can use the same procedure on severed heads.
Heart	Your patient has a heart and needs it removed or replaced (See possible replacement hearts).		Target the chest with Help intent. Use the scalpel, then saw, then scalpel, then saw.	Foreign objects will be removed first, so you may have to cut several times. The patient won't survive long without a heart. Cardiac stimulants are essential for any successful transplant, but removing a heart will also transfer all the reagents from the patient's system into the heart, so you'll need to top off on those stimulants after removal.
Lung	Your patient has a lung and needs it removed or replaced.		Target the chest with Help intent. Use the scissors, then saw, then scissors using the hand of the side in question.	Whether you remove the right or left lung depends on the hand in which you do the final cut with the scissors. Naturally, the patient is less able to breathe if a lung is missing, moreso if both are, so salbutamol and the like are useful for counteracting the suffocation.
Kidney	Your patient has a kidney and needs it removed or replaced.		Target the chest with Help intent. Use the scalpel, then scalpel, then scissors using the hand of the side in question.	Whether you remove the right or left kidney depends on the hand in which you do the final cut with the scissors.
Appendix	Your patient has an appendix and needs it removed or replaced.		Target the chest with Help intent. Use the scissors three times.
Liver	Your patient has a liver and needs it removed or replaced.		Target the chest with Help intent. Use the scissors, then scissors, then scalpel.
Stomach	Your patient has a stomach and needs it removed or replaced.		Target the chest with Help intent. Use the scissors, then scalpel, then scissors.
Intestines	Your patient has intestines and needs them removed or replaced.		Target the chest with Help intent. Use the scissors, then scalpel, then scalpel.
Pancreas	Your patient has a pancreas and needs it removed or replaced.		Target the chest with Help intent. Use the scalpel, then scissors, then scissors.
Spleen	Your patient has a spleen and needs it removed or replaced.		Target the chest with Help intent. Use the scalpel, then scissors, then scalpel.
Chest Item	Your patient is tired of keeping a terrible secret inside them and wants it removed/replaced.		Target the chest with Grab intent. Use the scalpel, then use an empty hand with Help intent to yank the item out.

Other surgery

Surgery	Scenario	Tools	Procedure	Considerations
Limb replacement	The patient is either an amputee or already underwent limb removal, and wishes to have all of them restored.	OR	Target the missing limb. Attach the corresponding limb and swiftly secure it with either a medical stapler or suture.	There are several options for replacement limbs, but the surgery is the same.
Butt replacement	The patient has no bum and requests a new pair of buttocks.	None	Target the chest. Attach a spare butt (any type).
Butt attachment	The patient wishes to wear somebody's butt as a hat, permanently.		Target the head with Help intent. Ask the patient to put the butt on their head, then use the staple gun.	Once affixed, the butt cannot be removed by the wearer, but it may still be ripped off by external forces.
Mask attachment	The patient wishes to wear a mask on their face, permanently.		Target the head with Help intent. Ask the patient to put the mask on, then use the staple gun.	Once affixed, the mask cannot be removed by the wearer.
Eye replacement	The patient is missing at least one eyeball and wishes to have all of them restored.	None	Target the head. Insert the spare eye (any type).	You have to hold the replacement organ in your left hand to target the left eye socket and vice versa.
Lung replacement	Patient lacks one of both of their lungs and needs it/them restored.		Target the chest with Help intent. Use the scissors, then saw, then insert the new lung(s).	You have to hold the replacement organ in your left hand to target the left lung socket and vice versa.
Kidney replacement	Patient needs a kidney or two restored.		Target the chest with Help intent. Use the scalpel twice, then insert the the new kidney(s).	You have to hold the replacement organ in your left hand to target the left kidney socket and vice versa.
Appendix replacement	Your patient has no appendix and wants a new one.		Target the chest with Help intent. Use the scissors twice, then insert the new appendix.
Liver replacement	Your patient has no liver and requests a better one.		Target the chest with Help intent. Use the scissors twice, then insert the new liver.
Stomach replacement	Your patient lacks a stomach and needs it replaced.		Target the chest with Help intent. Use the scissors, then scalpel, then insert the new stomach.
Intestines replacement	Your patient's intestines are gone and need to be restored.		Target the chest with Help intent. Use the scissors, then scalpel, then insert the new intestines.
Pancreas replacement	Your patient has no pancreas and needs a new one.		Target the chest with Help intent. Use the scalpel, then scissors, then insert the new pancreas.
Spleen replacement	Your patient's spleen is missing, and the patient wants a new one.		Target the chest with Help intent. Use the scalpel, then scissors, then insert the new spleen.
Head reattachment	You are in possession of a detached head in need of a new body.		Prepare a suitable body (human or monkey, not rotten or a husk) on the operating table and behead it. Target the head with Help intent. Attach the severed head, then sew it on with the suture.	The new host can now be cloned.
Skull reattachment	Your patient is missing a skull and likely needs it to get their brain back.	None	Target the head. Attach the skull.
Brain reinsertion	You are in possession of a detached brain and have the body it was removed from.	None	Target the head. Insert the brain.	Requires the body to still have a skull. Requires the body's head to still be cut open. Cut it open if not.
Brain transplant	You are in possession of a detached brain (e.g. from a husk) and want to clone it into a new body.		Prepare a suitable body (human or monkey, not rotten or a husk) on the operating table and de-brain it. After you've done that, insert the new one and clone the whole abomination.
Chest Item Implant	The patient wishes to become a living [noun].		Target the chest with Grab intent. Use the scalpel, then place the item inside the chest, then sew the chest area back together with the suture.	Optionally, you can secure the item before sewing the patient back up by sewing it into the chest cavity with Help intent. Remember to switch back to Grab intent to sew back up. Note that some items cannot be placed inside one's chest.
Item Arm	The patient has an item, wants to replace a hand with it, and is willing to accept the loss of an hand.		Remove the arm in question. Target the limb with Help intent. Attach the item and swiftly secure it with the medical stapler.	The patient can click on the hand slot the item's replacing to do whatever the item does when clicked in-hand (e.g. changing a setting, turning something on/off). Disarming the item arm owner, including shoving them to the floor and shoving them while they're on the ground, may cause said arm to hit the owner, causing whatever effect they usually do on someone. Most items can be made into item arms, save a few such as wizard staves and the nuke operative guns. Experiment!

Other Ailments

As an MD, you will likely encounter a wide variety of oddities which require special attention. Don't make the mistake of viewing them as an isolated condition. The treatment should always be flexible enough to handle any ailments and other underlying conditions at the same time. If these go unchecked, chances are the patient will simply relapse.

A penlight can be helpful for diagnosing some ailments. Shine one in a patient's unobstructed eyes to observe.

• Pupils (very) constricted: Patient is (overdosing) on morphine or space drugs.
• Pupils (very) dilated: Patient is (overdosing) on atropine, antihistamine, methamphatamine, crank, bath salts, or cat drugs.
• Right pupil doesn't follow light and/or dilated: Patient has brain damage.
• Left pupil doesn't follow light: Patient is having a stroke.

Likewise, a stethoscope can also be used to assess certain conditions. Use it on the patient's chest on Help intent and patiently wait for a description to appear:

• "Coarse crackling noises" - One of patient's lungs has more than 50 lung damage.
• "Distorted, high-pitched wheeze" - Patient has been coniine, sarin, or strychnine in their system, which are all poisons!
• "Extremely slow breathing interspersed with what sounds like light snoring" - Patient is sleeping.
• "Faint whirr of an airpump" - Patient has just one cyberlung.
• "Fast breathing" - Patient has some sort of stimulant inside them. The stethoscope cannot detect every single stim, but it can detect: crank, energy drink, epinephrine, methamphetamine, and stimulants.
• "Fluid sloughing around inside...interspersed with crackling noises" - Patient is suffering from respiratory failure!
• "Hyperventilation" - Patient has 20-60 OXY.
• "Hyperventilation with an irregular pattern" - Patient has 60-80 OXY
• "Low-pitched wheezing" - Patient has histamine, possibly indicating they are having a severe allergic reaction.
• "Normal breathing" - Patient has less than 20 OXY and no respiratory problems.
• "Nothing on the left/right" - Patient is missing a lung.
• "Nothing...other than a faint lub-dub from the heart" - Patient is missing both lungs.
• "Pronounced whirr of two airpumps" - Patient has two cyberlungs.
• "Slightly slow breathing" - Patient has cannabidiol, diphenhydramine/antihistamine, or less than 25 units of ethanol inside them.
• "Twitchy, labored breathing interspersed with short gasps" - Patient's has more than 80 OXY, for whatever reason.
• "Very slow, shallow breathing" - Patient is either on some sort of heavy sedative, namely either ether, haloperidol, krokodil, or morphine, or is mildly drunk (> 25 units of ethanol inside them).

Conditions you may come across:

Condition	Common causes	Notes	Treatment
Shock	Critical health, severe blood loss.	If not addressed promptly, the patient's condition can continue to deteriorate with an increasing chance of developing cardiac failure.	Inject saline either manually or with the sleeper control panel. Medibots may also be of help. Stabilize the patient with CPR or epinephrine if required.
Cardiac failure	Untreated shock, heart damage.	A major emergency that, if left untreated, will rapidly lead to the death of your patient by cardiac arrest. Note that shock and cardiac failure are, to a degree, independent from the patient's overall health. Even somebody with full HP will eventually suffer from cardiac arrest without epinephrine, so you can't ignore these conditions.	Epinephrine can be sufficient, provided the patient's health isn't worse than -60%. In acute cases, atropine should be administered instead.
Cardiac arrest	Untreated cardiac failure, poisons such as initropidril, defective cyberheart.	Also known as heart failure, the final stage of the struggle with death, so to speak. The patient falls fully unconscious as they suffer rapid brain damage and suffocation damage. If they aren't already in medbay, it is rare for patients to survive the encounter.	Apply a defibrillator. It has a high probability of curing cardiac arrest, makes the patient briefly immune to entering cardiac arrest once again due to untreated damage, and makes further attempts at defibrillation more likely to successfully bring them out of arrest. Administering atropine and epinephrine can contain the damage and very rarely cure arrest. Combine with mannitol to handle the brain damage and salbutamol and perfluorodecalin the suffocation. If a defib is unavailable, one should find sources of harmful electric shock, such as powered wires, electrified grilles, TeslaBuddies, arcs from APCs that appear when too much power is in the grid, and shocks from doors. Stun batons can work, but not tasers. Similar to the defib, electric shocks can cure heart failure, render patient briefly unable to enter arrest again, and make further defib attempts more successful, but the success rate is usually lower.
Cardiac abscondment	Certain poisons, heart removal.	Indicated by "Subject has no heart" on the health analyzer's readout. The patient's heart is missing, plain and simple. While you can prolong their suffering with cardiac stimulants, this can only be a temporary measure at best.	Stabilize the patient with epinephrine or atropine. Combine this with salbutamol and mannitol to address the escalating suffocation and brain damage. Transplant a replacement heart as soon as possible.
Blood clot	Coagulants such as proconvertin.	[data missing]	Inject Heparin, which will increase bleeding but dislodge blood clots.
Stroke	Untreated blood clot.	[data missing]	[data missing]
Anaphylaxis	Wasp stings, allergic reactions, poisoning.	The patient is full of histamine and rapidly accumulating brute, toxic, and suffocation damage.	Inject diphenhydramine/antihistamine. This has a high chance of blocking the histamine's effects and fairly quickly expels it out of the patient's system, which is key, in addition to reducing histamine production caused by the allergy traits. Inject epinephrine as well for severe cases. Epinephrine makes the effect of having large (40+ units) amounts of histamine less severe and slightly helps with getting rid of histamine. Purgatives such as pentetic acid and calomel can also prove useful for flushing out the histamine.
Hyperglycaemic shock	Excess sugar (around 200+ units).	A hyperglycaemic patient may fall into a diabetic coma. Scanning the patient with a standard health analyzer won't show anything, but you can deduce why they're collapsing and unconscious by using a reagent scanner.	Inject them with insulin, which will dramatically increase the depletion rate of sugar.
Radiation sickness	Exposure to radstorms, blowouts, cerenkite ore, radium, being shot by a rad-bow.	Radiation sickness usually isn't obvious at a glance, but a health analyzer will reveal the extent of the contamination. As long as the patient is irradiated, they will accumulate toxin damage every second, with more damage per second at higher doses, occasionally suffer burns, and may even randomly mutate.	Potassium iodide, basic anti-rad medicine. Trivial to synthesize in chemistry, should you have to. Pentetic acid is superior in every aspect, healing toxin damage too.
Neutron radiation sickness	Exposure to blue radstorms, handling neutronium	While the patient is irradiated, they suffer some TOX and a smaller amount of BRUTE every few seconds and may develop a random mutation; the more irradiated they are, the more damage and the greater the chance of mutating. The damage and chance of mutation is higher than the effects of standard radiation sickness. The patient usually cannot tell if they have neutron radiation unless they have a health implant, and it is usually difficult to tell at a glance, but a health analyzer will indicate the presence and severity of the radiation.	Potassium iodide directly clears away neutron radiation and heals some TOX. At low levels of radiation, it alone is sometimes sufficient enough to treat the damage. Pentetic acid cannot cure neutron radiation, but it is superb at healing TOX, albeit at the cost of causing BRUTE Styptic powder, administered topically, is the go-to medicine for fixing BRUTE Mutadone will get rid of any mutations induced by the radiation.
Genetic defect	Exposure to large doses of radiation, imperfect cloning cycles, unstable mutagen.	Note that some jobs, such as the chef, may spawn with a mostly harmless mutation.	Administering mutadone will gradually remove one mutation (good or bad) per life cycle. (This may also come in handy to stop a cloaked, superfarting geneticist.)
Addiction	Taking addictive drugs.	Addiction functions similar to a non-contagious disease. When scanning the patient, the health analyzer will tell you to which substance (methamphetamine and nicotine are common) they are addicted to and the stage of withdrawal. With each progressive stage, the symptoms become worse: falling over, vomiting, shaking and so on.	If they still have the chemical in their veins, you can try flushing it out. Ask the patient to hibernate a minute or two in a sleeper, which should cure all addictions. Otherwise, they can either keep taking the drug for temporary relief, or they'll have to tough it out and wait until they overcome the addiction. You can offer a bed in medbay until they no longer feel reliant, but this is more for their safety, as withdrawal makes them very weak and open to mugging/assault. Chronic jitteriness can be fixed with 5 units of morphine or haloperidol.

Viruses

Main article: Virus

There are many different types of viruses on the station, each with its own effects and possible cures. Some of them will always follow the same pattern, whereas pathology research may synthesize unique diseases every shift. Using a medical analyzer on someone who is infected will display specific information. For minor protection, wearing gloves and a biosuit is recommended. It doesn't hurt to have a syringe of spaceacillin on hand either. You may come in contact with:

Food poisoning

The most common condition you will encounter, which is caused by eating bad food. The patient can drink chicken soup, take Robustissin, and/or take a nap by falling asleep in medbay or any other bed.

Robotic transformation

The patient has nanomachines in their bloodstream. If nothing is done, their flesh will eventually rip apart to reveal a cyborg. Treat with electric shocks (see cardiac arrest).

MRSA

The patient is suffering from an aggressive bacterial infection. Fairly harmless in its early stages, but later on the accumulating toxin and burn damage can be lethal. As the bacteria are resistant to antibiotics, more than one syringe of spaceacillin may be required.

Kuru

This fatal condition can be caused by cannibalism, eating brain burgers or exposure to prions. There is no known cure, so scan them with the cloner before they inevitably die.

Grave fever

Transmitted by vampires. It must be quickly counteracted with spaceacillin to prevent the patient from rotting away.

Clowning around

Usually the result of Admin screwery or rainbow fluid ingestion. Without some spaceacillin, this virus gradually turns the patient into a clumsy clown.

---