Surgery, anesthetic and pain level

[Vargh]

So recently we where talking about the pain mechanic suring surgery and i come with this idea about how we should make it work so you actually need to use them.

 

My idea is patients have a pain level with a pain limit, after that point, the patient will move because the pain is too damn bad so any step you want to make has a 50% chance of failing. So if you use the anesthetic tank the pain level is never going to go up, but with voxes or slimes who can't use the tank you need to apply ether and morphine to go ahead with the surgery, the computer should tell you if the patient is going out of pain killers and give a "high pain level warning" so the surgeon know when to add more of them. And, because ghetto surgery would get really damaged because of this and we all love malpractice, ether could work as a ghetto pain killer for surgery, so you can force feed your patient whisky :ok_hand:

[Valkyrie]

In addition, you could cause long-lasting brain damage or studdering if you operate without anesthetics. I really like the increased failure rate, though.

[ZN23X]

I can see the LRP crowd fighting this to the death but I love it. Add the chance of failure that doing surgery on a non surgery table has when not using some sort of painkiller or sedative

It would make it so not as many people (if any) can say "don't worry...I'm tough...I can handle the pain" when I'm literally cutting thier ribcage or skull open with a freaking saw...

I'm even guilty of it myself when I'm an important role in a busy round but realistically even if the HOS or Captain being asleep for a few minutes on a surgery table does lead to mayhem, isn't that sort of the reward for breaking thier ass? The round will eventually end and a new one begin, life moves on. 

Pretty sure most of us would have a hard time with just the incision being made...

Curious if drunkenness does already act as a painkiller, like, code wise. Be hilarious to see drunken patients going through a surgery.

Edited July 13, 2017 by ZN23X

[Valkyrie]

21 hours ago, ZN23X said:

Pretty sure most of us would have a hard time with just the incision being made...

That, and some involuntary outbursts would make precise cuts nearly impossible. Not to mention the other side effects.

Edited July 13, 2017 by Valkyrie
corrections

[Rurik]

I am completely in favor of this. It never made sense to me how a patient could remain perfectly still throughout all that pain in the first place.

[TwoCam]

As a frequent surgeon, I disagree with this idea. It takes a player out of the round and leaves them staring at a mostly black screen for pretty much no reason, despite the possibility that they may be there for quite a while if they need several long surgeries, which Is quite common (think IB, heart, and ribcage repair, a very common combination.)

Also, surgeons may get dragged off somewhere (they're the target of an assasination, bomb explosion, etc) and then the poor patient has to wait a potentially very long time until someone saves them.

I'm all for increasing the level of RP, but I don't think this is the way to do it, especially not when we've literally got an all-access fridge full of medicine that people shove down their throats despite not being doctors.

[Cyiko]

I'd love this to happen, though only if the resist button starts a long timer to get the anasthetic mask off, similar to getting out of a cryotube so people wont be stuck in there forever

[Rumiluntti]

This is something I have been wanting for a long time.
Also, heart attack from pure pain when?!

[Vargh]

6 hours ago, TwoCam said:

As a frequent surgeon, I disagree with this idea. It takes a player out of the round and leaves them staring at a mostly black screen for pretty much no reason.

That's why you have another tools like Ether, Morphine and Hydrocodone if you don't want to put the patient to sleep because of that.

[GunDOS]

I love this idea, but we're gonna have to fix how morphine works for it to work.

[Althalos]

It'd be interesting if you could involve one person with it in case things are really bad and they need immediate surgery; holding them down while they're trashing about wildly to reduce the failure chance.

Just my two cents.

[KasparoVv]

I support this wholeheartedly, but I can see this being flamed hard by less roleplay-inclined players. (Not that I care for the distaste, personally. This is something that would fit very nicely and has the capacity for proper mechanical depth.)

Edited July 13, 2017 by KasparoVv

[Enginseer-42]

17 hours ago, Valkyrie said:

It would likely cause PTSD and drive you to suicide.

That is literally the dumbest thing I've ever heard. It would be painful yes. But Look on the bright side. Nothing you ever experience will hurt that much ever again.

[Buford]

  Wait.. So your saying that every surgery has a chance of failing because of "Pain level." I'm not sure if you are speaking for when they are awake if you are I would agree with this post. 

However if you are saying there should be a "pain level" for when they are put to sleep during surgery I strongly disagree. 

Yes i did get this off of google "Background. Awareness occurs when patients have anesthesia that is inadequate to keep them unconscious during an operation. ... In this situation, the patient may feelthe pain or pressure of surgery, hear conversation, experience air hunger, or have difficulty breathing."

This is the only time people feel pain during surgery is if they have inadequate anesthesia. Surgeries can fail already in the game like when I attached a rotten limb to someone he died and I had to get someone with defibrillators to bring him back.

I would say keep surgeries the same if they are on anesthesia but if they are awake add pain levels and morphine and all that.

[Shadeykins]

Everyone has a relative level of pain tolerance, and while there should be some mechanic to discourage the use of anesthetic I don't think it needs to be 50%.

From personal experience, I had to get a root canal without anesthetic due to an infection (anesthetic wouldn't take) and that's purportedly once of the most painful surgical procedures you can receive (and I am inclined to agree with that statement).

Even if surgical steps just caused pain damage on non-anesthetized people, so they had difficulty standing/moving after the fact.

[McRamon]

Is there any pain impact on surgery success now? Why dont just make something like when red words about pain appear on your screen, surgeon instead of performing another step, damages your organs 

[Buford]

15 hours ago, Shadeykins said:

Everyone has a relative level of pain tolerance, and while there should be some mechanic to discourage the use of anesthetic I don't think it needs to be 50%.

From personal experience, I had to get a root canal without anesthetic due to an infection (anesthetic wouldn't take) and that's purportedly once of the most painful surgical procedures you can receive (and I am inclined to agree with that statement).

Even if surgical steps just caused pain damage on non-anesthetized people, so they had difficulty standing/moving after the fact.

WHAT?????? Discourage anesthetic.. I'm pretty sure a root canal is nothing compared to getting your upper body cut open, your ribs sawed in half, and your organs being messed with. If anesthetic wasn't being used the pain would kill the person. Also they most likely used numbing agents or laughing gas that doesn't put you to sleep with that procedure. 

[Shadeykins]

14 hours ago, Buford said:

WHAT?????? Discourage anesthetic.. I'm pretty sure a root canal is nothing compared to getting your upper body cut open, your ribs sawed in half, and your organs being messed with. If anesthetic wasn't being used the pain would kill the person. Also they most likely used numbing agents or laughing gas that doesn't put you to sleep with that procedure. 

People have gone into neurogenic shock during root canals before, so no - pretty much any overexcitation of the peripheral nervous system can cause you to go into shock if you have poor tolerance. It involves piping gutta percha directly onto a nerve at 300C and it's like getting a blowtorch into your skull. Also, no. They used a local anesthetic which only freezes the gums. Laughing gas can cost upward of a thousand dollars and requires an anesthesiologist on site - neither of which I paid for. This is not to mention that laughing gas is still ineffective if you have an infected nerve (anesthetic will not work on infected nerves, fullstop).

Anesthetic has not always been widely available, or widely used - there have been plenty of horrific surgical practices throughout history that did not make use of anesthetic and were perfectly successful. While plenty of medieval and earlier surgeons made use of various painkillers during procedures, there were many more who didn't. I think one of the most famous examples of this is Phineas Gage, who underwent what was effectively a poor form of brain surgery after having a blasting rod shot through his skull - all without anesthetic.

My primary point here is that while a lack of anesthetic is dangerous (and highly unethical in certain circumstances), it is not a death sentence that makes surgical procedures impossible to perform.

I'm /encouraging/ anesthetic use, I just don't think failure chance should be at 50% for being unable to use it largely because there are several species which can't be properly or quickly anesthetized, and there are also legitimate in-round concerns for not undergoing anesthesia, say as a command member.

50% failure rate is genuinely unusable, because you will fail approximately 50% of the steps - some of which can /break/ additional bones in the body. Not only that, but it makes an entire existing surgical mechanic (ghetto surgery, which already have a 70%+ failure rate in some steps) completely non-viable.

This is why I encouraged a lower number than 50% (Maybe 10%), and for it to apply stamina damage so the person is slowed down post-surgery from the pain for a duration.

Edited July 15, 2017 by Shadeykins

[Rumiluntti]

Not all surgery should be absolutely impossible to do without anestesia.
I have dug out glass from a wound and then stitched it, it was on my leg. No problems.
I still wouldn't be too happy if someone cut me open and gave my liver a hug.

Would take a bit of balancing on the pain levels for each surgery step.

[Buford]

6 hours ago, Shadeykins said:

People have gone into neurogenic shock during root canals before, so no - pretty much any overexcitation of the peripheral nervous system can cause you to go into shock if you have poor tolerance. It involves piping gutta percha directly onto a nerve at 300C and it's like getting a blowtorch into your skull. Also, no. They used a local anesthetic which only freezes the gums. Laughing gas can cost upward of a thousand dollars and requires an anesthesiologist on site - neither of which I paid for. This is not to mention that laughing gas is still ineffective if you have an infected nerve (anesthetic will not work on infected nerves, fullstop).

Anesthetic has not always been widely available, or widely used - there have been plenty of horrific surgical practices throughout history that did not make use of anesthetic and were perfectly successful. While plenty of medieval and earlier surgeons made use of various painkillers during procedures, there were many more who didn't. I think one of the most famous examples of this is Phineas Gage, who underwent what was effectively a poor form of brain surgery after having a blasting rod shot through his skull - all without anesthetic.

My primary point here is that while a lack of anesthetic is dangerous (and highly unethical in certain circumstances), it is not a death sentence that makes surgical procedures impossible to perform.

I'm /encouraging/ anesthetic use, I just don't think failure chance should be at 50% for being unable to use it largely because there are several species which can't be properly or quickly anesthetized, and there are also legitimate in-round concerns for not undergoing anesthesia, say as a command member.

50% failure rate is genuinely unusable, because you will fail approximately 50% of the steps - some of which can /break/ additional bones in the body. Not only that, but it makes an entire existing surgical mechanic (ghetto surgery, which already have a 70%+ failure rate in some steps) completely non-viable.

This is why I encouraged a lower number than 50% (Maybe 10%), and for it to apply stamina damage so the person is slowed down post-surgery from the pain for a duration.

Oh I thought you were talking about discouraging the use of anesthesia yea I don't think it should be at 50% either. Also the brain doesn't feel pain it's common for brain operations to have little or no anesthecia, and I've had laughing gas when I got my wisdom teeth removed. Advanced medical practices only started making progress during the renaissance. In the medieval ages the western world was heavily influenced by religion, and effective medical practices were scarce. For instance some "doctors' in the medieval ages sought common practice to slice open someones arm in order to bleed out all the "bad" blood during the plague or even for other illnesses. During the renaissance the most brutal surgeries ever performed were usually amputations in which the majority of people did not survive. They did not do any surgeries which involved opening up the ribcage and medieval age surgery wasn't a thing and when it became a thing the western world was close to the renaissance anyways so it's classified as renaissance surgery. Because of the lack of anesthesia, proper medical tools, and a sterile environment caused patients to die during surgery procedures (Which were highly experimental). Dissecting corpses was new during this time and even though it was allowed was frowned apon so it wasn't practiced as commonly as it is today.

Surgery is a pain in the ass as it is when someone is dying one time it took me and another doctor (me keeping the patient alive and another performing surgery) just to keep the patient alive we used 3 blood bags 4 charcoal and 3 surgeries 2 trips to cryo and 1 defib session just to keep him alive. Do not make surgery under anesthesia harder then it actually is NOTHING should be changed for surgery under anesthesia.

Edited July 15, 2017 by Buford

[Shadeykins]

1 minute ago, Buford said:

Oh I thought you were talking about discouraging the use of anesthesia yea I don't think it should be at 50% either. Also the brain doesn't feel pain it's common for brain operations to have little or no anesthecia, and I've had laughing gas when I got my wisdom teeth removed. Advanced medical practices only started making progress during the renaissance. In the medieval ages the western world was heavily influenced by religion, and effective medical practices were scarce. For instance some "doctors' in the medieval ages sought common practice to slice open someones arm in order to bleed out all the "bad" blood during the plague or even for other illnesses. During the renaissance the most brutal surgeries ever performed were usually amputations in which the majority of people did not survive. They did not do any surgeries which involved opening up the ribcage and medieval age surgery wasn't a thing and when it became a thing the western world was close to the renaissance anyways so it's classified as renaissance surgery. Because of the lack of anesthesia, proper medical tools, and a sterile environment caused patients to die during surgery procedures (Which were highly experimental). Dissecting corpses was new during this time and even though it was allowed was frowned apon so it wasn't practiced as commonly as it is today.

All depends on what you refer to as the medieval period, dissection of corpses was certainly frowned upon in ancient times but that is not to say it wasn't practiced. Field surgeons were also highly desired and instrumental in refining the understanding of anatomy (whereas scholars who shied away from human cadavers were typically clueless). I digress though, we're a little off topic.

[Allfd]

There are some things in the pipeline that if finished and merged will give the ability to implement some of these ideas.

 

I have gotten to play around with some of them and they are very neat.

[ZN23X]

Not sure if anyone mentioned this. If you get a surgery done without painkillers you get a red text message that says "THE PAIN IS SO MADDENING YOU FEEL LIKE YOU MIGHT PASS OUT"

How hard would it be to add a mechanic that literally just makes people pass out from the pain?

Also sort of like the idea of being in a bit of pain after surgery regardless of of you were put out or not. Fairly normal after being cut open. Even if you are "super tough" and can bear with the pain of the surgery, you'd still be in pain while recovering.

It'd give painkillers a more normal use. Done with surgery? Here's some antibiotics and painkillers.

Edited July 16, 2017 by ZN23X

[SomanB]

Hi, I'm calling from the land of Real World Medicine! It's time to share some stories about surgery, and how it might relate to our 2D spessfart simulator.

 

To start, there are quite a few levels of anesthesia out there. There's local, which we all know from dentistry, various levels of sedation, and general "put you to sleep" anesthesia. There's also the always fun "twilight" anesthesia, where you get dosed with meds that just make you forget whatever pain you're feeling when the surgeon cuts on you.

 

Full on, crack open your chest open heart surgery DOES happen without anesthesia.  Most times, it's emergency "you are going to DIE" surgery, but there are some specific instances where due to the patient's clinical profile, they cannot tolerate anesthesia but the surgery MUST be done.  It's not pretty.  It's considered a last resort, Discussed at length with the person involved, and the vast majority of people choose not to go through with it.  Those that do tend to end up with PTSD and years of counseling afterwards

 

As for SS13, I feel there's room on both sides to make this happen. Tossing someone on the table and cutting should work, but it should come with a massive set of downsides for the rest of the round.  Cap bleeding out, code red station emergency, then yeah, toss em on the table, save them, deal with the issues later. Sec officer wants an implant HUD but "lel no gas U might be tator", not so much.

[Regen]

What I think we should do is look at the bigger picture, drop the static 50%, I can already tell you it's not going through, lets rather look at what we can do to introduce pain as a whole.

Halloss was a thing before, I wasn't particularly a fan of it, but I'd like for us to branch out on a much better pain system

For instance, right now a stun baton just stuns you and applies a set amount of time, having a pain system would be more intricate in the way that you'd get X amount of pain, translating to the same effect of a stun baton, perhaps with some added effects like dropping whatever item you're holding etc, so the effect would be the same, but we'd be given more leeway on how we can tackle resistance to it.
Having painkillers in you could slow you down, but also make you less affected by tasers, stun batons etc, these are all things we have in game already, but it's not a connected system.

 

For surgery it'd be the same, you would use the patients pain level as a method to determine how difficult the surgery is, if the patient is in squirming pain it's harder to get a clean cut, thus a bigger chance for failure.