Where is the head? A medical doctor guide (updated on 08/01/22)

[Skajaw]

Hello there!

This guide is supposed to give you an idea of how to be(come) a doctor and prepare you for the daily struggle of a medical doctor. I won't point out all chemicals there are, I also won't explain the steps for every surgery, this guide will be long enough. If you need a refresh on that, you can and should use the wiki pages for that. I also want to mention that I am not the best doctor, and never will be. I also do not know everything there is to know about paradise medbay and probably never will. My patients almost always leave healthy so I think I am doing a rather good job BUT if you have complaints, suggestions for improvements or critique cause I am talking absolute BS: feel free to let me know :) But enough excuses, let's do this.
 

 

The Gear

Alright so, you're assigned to medbay as nurse, doctor or surgeon (basically those are the same but I'll say something about that later). The first thing you should do is getting your equipment. In my opinion, preparing as a doc is a personal style, many docs will carry different things on them. But there are some that are mandatory and should always be within reach. Those things are:

 

Spoiler

Medical HUD     

this is a no-brainer, pop this little guy on your eye slot and a healthbar will magically appear over people’s heads (only organic lifeforms!). You can also learn a lot about the condition of a person while locking at that bar or rather at the symbol next to the bar.

-   : This is the "normal" icon, the person is in a stable condition

-    : the patient is in critical condition, which can be shock, cardiac failure, cardiac arrest or starving. You can see how to treat each stage by scanning the person with a health analyzer

- flat line: the patient is dead but can still be revived by using a defibrillator. (No picture available ): )

-    : the person has been dead for at least 5 minutes and can't be revived with a defibrillator anymore. You have to clone them or use strange reagent

-    : The person is sick and has a virus. A health analyzer will tell what virus that is. If the person is obviously sick, but you can't see the virus, its stealth level is to high.

-    : The person is infested with a borer. This icon will only appear, if the borer is in control. An upgraded health analyzer or a body scanner will always notice it. The slug can be removed via organ manipulation surgery on the head. (DOESNT EXIST ANYMORE)

-   : The person is infested with a xenomorph embryo or a terror spider egg. Those are located in the chest and have to be removed via organ manipulation surgery on the chest ASAP.

 

 

 

Health analyzer (with upgrade)   

the health analyzer is maybe the most important tool you have. By scanning a person, you will get a rather large amount of text (depends on the condition of the person) that will tell you the type and the amount of damage a person has suffered for every limb (you can disable that function by using the health analyzer in your hand). It will also tell you if the person is sick, has internal bleeding, infections, fractures, brain damage and many more things. For the more advanced information, you will need a health analyzer upgrade. Every doctor who joins the round as one will start with an upgraded version (can be found in your first aid kit). If you need another one, you have to get a health analyzer and an upgrade from one of the nanomed plus vendors located in medbay.

 

Medical belt 

also a mandatory piece of...clothing is this belt. You can store almost every medical item in there. This includes things such as menders, bottles, patches, pills, the handheld defib, syringes, beakers and so on. You can also store patch packs and pill bottles there, so you don't have to store pills and patches individually in the belt.

 

Nitrile/latex gloves and sterile masks    

the gloves and mask will reduce the risk of causing an infection to the patient during a surgery. Whats the difference between the two types of gloves besides their color? I dont know, the blue ones look better though!

 

Medical hypospray   

this injector can be used to...well, inject people with a set dosis of different, non-lethal chemicals. I usually put epinephrine in it. Alt-click on it to set the transfer amount.

 

Handheld defibrillator  

the last device I will list here is the handheld defibrillator. This little bad boy will get a heart back to work if it stops ( a health analyzer will tell you "The patient's heart stopped") it will also heal  some oxygen damage. Can only be used if the patient is in crit. You have to wait a few seconds after each use for it to recharge.
 

 

These are the things that I find mandatory to carry with me all the time, if you think I missed some stuff or that one of the things listed isn't worthy to be mentioned than that's okay! I could go all out and mention every single convenient item for any situation so I dont have to run to a nanomed, but for starters, this should be enough.

With that out of the mind, there are usually two things to do when a round starts. Set up the cryocells and the ORs.

Next to each cryocell stands a beaker with cryoxadone (blue liquid) put one beaker in each cryocell and turn on the Freezer unit (the white machine below the cryocell). Also set the temperature to the lowest and dont forget to turn the freezer on.

The surgery tools will be laying on the tables in each OR. We usually get a duffelbag out of the closet und put the tools in there. Put the filled bag on the white table next to the Locker. Get a defibrillator from the locker and put it on the glass table on the outer side of the room. Next you go to the storage room next to the OR and get the Freezer and IV drip and put it in the OR. If you want, you can get an anesthetic tank and a medical mask from the other locker and put them on the surgery table. And this is how you do a basic OR preparation. Again, you can do much more but this is enough to cover the basics. I can recommend you this guide for a more detailed prep.

 

So, now you look like a proper doctor and the preparations are completed. What do we do now? Well, we wait. Medbay can be both, the most busy place on the station or the most boring one. If no one gets hurt, or rather makes it to the medbay at all, you won't have to heal anyone. You could watch the crew monitor and run to people that are hurt across the station, but this would get tedious and is the job of the paramedic. Decorate medbay with a couch or nag the chemist for chemicals he will make anyway. Or get a wrench, unfasten the fridge and break into chemistry nag the CMO for chem access if there is no chemist and make the chems yourself 
 

Before the first patient makes his way into medbay, I want to talk about the assignments of nurse, doctor and surgeon. As I said, these three are basically the same. They have the same access, the same field of work and the same rights. A surgeon still has to work on non-surgery cases and a medical doctor has to do surgery. Those titles are more a RP thing BUT in MY experience, you will have an easier time if you start as a nurse. When I started playing medbay, I played as a nurse and people confronted me with way more patience and kindness. Many people won't expect you to know surgery and rather ask if you are able to do it. Colleagues will come to you and ask if you can handle a more spicy case.
 

 

Treating injuries and some surgery stuff

In this section we will talk about the actual work you have to do: treating patients! And we are lucky, because Bob and Jimmy just came by. Bob has minor bruises and burns all over his body. Jimmy here has a major bruise on his head, and he is bleeding! So now you have to consider: which patient is more urgent to pay attention to? Well this one is easy, of course it's Jimmy. Bleeding isn't just nasty because it'll make the place dirty, it will also lower his total blood level.

There are various methods of how to treat the bleeding. You can either use a Roll of gauze, a brute mender, an advanced trauma or patches and so on and so forth. Or to make it short: a limb will stop bleeding if its brute damage is below 20. There are two things to consider before starting the treatment, which also apply if the person is not bleeding:

Spoiler

- If someone has damage on just a few limbs, but the amount of each is rather high, an advanced trauma kit is more convenient. It will heal 25 damage on the limb you are targeting.

- Menders are better for wide spread damage all over the body. You don't have to target a specific body area. Patches are fine too!

- Of course, the same thing goes for burns as well. There's just no bleeding part.

Sidenote: If you don't want to use a trauma kit because it's to annoying for you or you just don't like them, than that's okay, a mender will also do the work. Play the game the way, it makes the most fun. Cause in the end, fun is the main reason we play this game...right?

So Jimmy has stopped wasting our space cleaner. It's finally Bobs turn to get his burns and bruises treated. We talked about trauma kits and menders, so a mender seems appropriate for Bobs injuries, right? Right, but hold on! All the damage that's spread over Bobs body is pretty low, like 5-10 damage on each limb. If you want to save some units on your menders, two patches can do the trick as well. Put a burn and a healing patch on Bob, and he will be fine in no time. Or you can just pop him into the sleeper and inject him with some saline-glucose. This chem has a 33% chance per tick to heal 2 brute and burn damage, it also has a 33% chance per tick to restore 1cl blood!

This is another thing, each doctor does differently. You can heal someone up to 100% health instantly with menders and kits. Or you use patches and chems that heal overtime and the patient will leave without beeing all green on the healthbar. I'd say both methods are fine and it's up to you if you want to go all out, or be more reserved and use less of the more efficient meds like menders and trauma kits.

That was pretty simple, eh? It do be like that most of the time. But NT doesn't pay you for taking care of little boo boos all day. Well.. sometimes they have to cause nothing happens. But now we got a serious case. This patient is at the edge of dying and the health analyzer states things like:

- Shock and cardiac arrest
- Brain damage
- Internal bleeding (often referred to as IB)
- fractures
- high amounts of burn, brute and oxygen damage
- low amount of blood 70%
 

Oh boy, what the hell am I supposed to do now? Where do I start? I can't tell you the best way, but the way I handle situations like this, so let's break this down. By the way, this isn't to bad yet, it can be waaaay worse, but for starters, this will be enough

First of all, give him some mannitol to heal the brain damage. Almost all critical patients will have oxygen damage, so you can give the patient a salbutamol pill or a perfluorodecalin patch right away. Now the most important thing is to stabilize the patient, means to get him out of crit and make him ready for surgery. How do you treat critical states?

Spoiler

- The state of shock has to be treated with saline glucose or by bringing the patient back to a health amount which is bigger than 0. I honestly never use saline for shock, I just heal all the damage to get the health up.

- Cardiac arrest won't go away even if the patient is at full health! You have to use either Epinephrine, Atropine or Heparin. Be careful though, those meds can overdose very fast and make the patient addictive. Each of those has their own little bonus effects, look up the guide for chemistry on the wiki for more infos. The only thing I will mention here, because it conflicts with our case: Heparin worsens IBs and causes bleeding if overdosed. Our patient has IBs, so don't use Heparin for now.

- Cardiac arrest is, as the name already tells, a heart that stopped beating. This can always occur during a cardiac failure and needs to be treated ASAP with a handheld defib or a normal defib. You can easily spot a cardiac arrest without using an analyzer. The health bar of the person will suddenly decrease and he starts gasping. A health analyzer will say "The persons heart has stopped".

Mannitol, Salbutamol (or perfluo) and a crit-healing chem have been given to the patient. While they do their work, heal the burns and bruises. Always use your handheld defib on cooldown, it's almost never a waste to use it. The healthbar will eventually become green again and the cardiac arrest will fade. By now, the patient is most likely at 65ish%  total blood because he still has internal bleeding.

Blood loss will eventually cause oxygen damage. An amount less than 60% is considered lethal. You cant revive a dead person if the person has no blood at all. I think he needs 25-30% to be revivable. Be cautious of what blood type the patient has, if you give him an incompatible type , he will get heavy amounts of toxin in the body. The blood types are listed on the wiki page. If the amount of blood loss isn't that high, you can also just use iron pills (made by chemistry). Iron will heal 0.8cl blood per tick. Another rule of thumb: 25u iron equals roughly 10% blood.

A person with an IB will cough up blood. That also happens if someone got a ruptured lung. By putting the patient into a body scanner, you can see the location of the IB and the fractures. If you're bad at remembering (like me), you can print it out. You should almost always prioritize IBs over other things, because blood loss will cause oxygen damage like mentioned above. My priority lists would look like this:

1. Necrotic/dead heart
2. Internal bleeding/ruptured or dead lung
3. The rest

As far as I know, fractures won't do any harm if the person is standing still or laying down. A fractured chest can cause a lung to rupture if the person is moving and a broken head can cause blindness and deafness. You may have noticed that I don't have listed the brain. If a patient is braindead, you can heal it with mannitol, I've never had the situation where I had to fix a brain with surgery.

Dead organs (besides heart and lungs) and limbs aren't fatal, but have to be treated eventually.

The steps necessary for each surgery can be found on the wiki. During surgery, the patient might get an infection. Spaceacilin will heal any infection almost immediately. Just get a syringe from the nanomed and use it on the patient. One shot is enough.

Another obvious but important part is anesthetics/painkillers. Surgery hurts, and if the patient is feeling pain, we might slip and do more harm than good. Medical borgs can't slip though, even if the patient is without painkillers and on a bed or laying on a table. Damn cheaters. 

Beds and tables? Yes, you can perform surgery on those too, the chance of slipping will be higher though. The only 100% chance for a non-borg player to never slip during surgery is when the patient lays on a surgery table and is asleep.

For anesthetics, we have the anesthetic tanks and the medical masks. Put them on a patient, set the internals and its goodnight for the patient. It's super easy but it takes some time to put the things on the person and to get it off again. Also remember: If someone has a dead lung, anesthetics wont work.

Painkillers are mandatory for vox and plasmamen, since they can't use other internals than the ones they already have. The options we have here are ether, salicylic acid, morphine and hydrocodone.

Spoiler

- Ether: Will make the person fall asleep after some time and is non-addictive. It takes a rather long time until it kicks in and the patient won't be able to wake up until its completely gone. I never use it and never saw anyone using it (for surgery).

- Salicylic Acid: A painkiller with a 15% chance of failure. I also've never seen anyone using it.

- Morphine: This is the classic painkiller for vox and plasmaman if you don't have hydrocodone. It works instantly but has a high chance to cause an addiction. If you give to much, the person will fall asleep. During a surgery with morphine, there is a 1% chance for you to slip.

- Hydrocodone: This is the best one you can get. Though you also have a 1% chance of doing mistakes, it will kill all pain, works instantly and is non-addictive. It can only be made by chemistry, so nag your chemists if you don't have any. Most chemists will make it eventually though.

 

Toxin damage and chemicals in your blood...oh and there is cellular and genetic damage too!

There are many things that can cause toxin damage. The three most used chems for healing toxin damage are:
 

Spoiler

- Charcoal: the classic one. Someone has some toxin damage and nothing else? Give him some charcoal and he is good to go. Heals 1.5 toxin damage with each tick and has a 50% chance to remove 1u of any other chem in the body.

- Cryoxadone: this is the blue liquid we talked about at the beginning. Cryocells have this and it heals 3 toxin damage per tick. Cryoxadone only works in cold environments like the cryocell or space.

- Pentetic acid: this is the boss of toxin damage healers. Pentetic acid heals 4 toxin damage per tick and also heals 70 radiation per tick. You have to use it carefully though. Pentetic acid will purge EVERY other chemical (4u per tick). If you have a critical patient and you want to use pentetic acid, wait for the patient to become stable. It will purge epinephrine and friends faster than you can use your health analyzer to watch it doing so. It's also the best way to get rid of radiation or any other dangerous chemical in the body like spider venom, cyanide, alcohol etc.

 

I already spoilered some possibilities of getting toxin damage. Radiation, spider venom, cyanide (or any other toxins) but there are some other, common possibilities such as:

Spoiler

- Wrong blood type: If a person gets the wrong blood type, the blood will become toxin and deal heavy toxin damage.

- If a Vox doesnt wear theri mask and breathes oxygen, they'll get toxin damage.

- Alcohol overdose: To much alcohol will deal toxin damage eventually.

- Blob: some blobs, or rather their minions can cause toxin damage.  It depends on the type of blob.

 

To get rid of chemicals in the body, you can also use the sleepers dialysis function. Put a beaker into the sleeper and press activate. You have to empty the beaker when its full. Another chem you can use is calomel. It purges 5u of any chem per tick, but deals 5 toxin damage per tick if the health of the person is above 20. I hardly see it beeing used by docs, which is a pitty, its a really good chem.

With toxin damage dealt, we have two types of damage left, those are more rare but still exists. 

Spoiler

Cellular damage: I only know of two possibilities to get this kind of damage. Someone who gets revived by Strange reagent (often refered to as SR) or by a slime that attacks you. There are only two chemicals which heal cellular damage. One of them is cryoxadone, we already talked about it. The other one is rezadone. This one is pretty rare, chemistry needs stuff from botany or spacecarps to make it. 1u will heal all cellular damage instantly though, it's the best you can get.

Genetic damage: Well, its not "damage" per se. If you get powers from genetics, your genes can become unstable. If they get to unstable, you can die. 1u of mutadone will reset your genes and nullifies all given powers by genetics (wont heal genetic adjustments you made during your character creation).

 

Reviving People

There are four common ways to bring a person back to life.

Spoiler

- Defibrillator: If the persons time of death is less than 5 minutes, you can revive them with a defib. There are some conditions though, refere to the wiki to read them all

- Cloning: If the 5 minutes are over, or you cant revive the person with a defib for whatever reason, cloning is the next method. The body must have a brain or it wont work. Put the body in the cloner and press scan. If the player is inside his dead body, you can clone him. However, you cant clone vox and slime people. They are unclonable period. You can clone plasmamen, but its annoying. Plasmamen will start combusting when their skin comes in contact with oxygen, and a cloned body will always be naked.

- Strange reagent: SR is a wonder drug. You can revive almost anything with it. Pets, people, other organic lifeforms. It is also the only way to revive slime people and vox after the 5 minutes are over. SR can be very nasty though, it has its downsides.

With more time passed, SR will cause organ damage when used. It will randomly cause organ and limb necrosis and genetic damage. Another point to be wary of, and listen carefully on this one: If the corpse has suffered more than 150 points combined of brute, burn and cellular damage, the body will explode. This is a beginner mistake and it happens every now and then.

- brain transplant: take out the brain via organ manipulation surgery on the head, put it into another body and defib it. Or you give the brain to robotics so they can put it into a borg or IPC.

 

Advanced tips and suggestions

I think we covered most of the stuff you need at this point. I just want to give you some "advanced" or more like good to know knowledge. Also some dos and dont's. Those are in no particular order.
 

Spoiler

- Always inspect a person first. If the healthbar is barely scratched and it says "he has minor bruises" you already know that you can heal him with a mender or just put a patch on him. No need for health analyzer, a bit of a time save.

- I often see people dragging braindead patients to cloning. Its true you cant revive a person who is completly braindead. Just give him mannitol and try a few more times. Even if the patient dyes immediately, the mannitol will cicle for a short time, enough to make the person stay alive eventually.

- If someone has an IB, and you cant locate it (no scanner, no power or whatever) Just try to start a surgery on each limb. If the option "Internal bleeding" shows up, you've found one! It wont show up if the limb doesn't have one.

 

- All brains fit in all bodys. You can transplant a vox stack (thats what their brain is called) into a monkey. No problem. Do they want that? Probably not.

- If you're about to SR revive a slime person which has been dead for a very long time, you can cut of his limbs (legs and arms) before doing so. This will save you time on the debridement surgerys you'd hat to to and slime people can regrow their limbs. Also Slime nuggets are adorable. This may not be the most ethic friendly procedure.

Another thing I want you to always remember: Lets say you're in the middle of a surgery. The patient is in crit, lots of IBs, fractures and dead organs. You're overwhelmed, panicking and the clown starts honking a ballad of death through the other side of the window: ASK FOR HELP. It's not a shame to ask on the med radio for someone to help you out. Just say something like "can someone please help me in OR1, i am having some problems here" and i gurantee you, at least one person will show up and help you out. Most people are so damn proud and think they can handle everything, but stay silent when they need to open their mouth. The time you spend on a patient is not just your time, its also the patients time not beeing able to participate in the shift.

The last thing i want to mention, and this is personal, so forgive me my choice of words. If you see a doctor who is working on a patient: DON'T.FUCKING.DRAG THE PATIENT.AWAY. We get it, you are bored, you want action and you want to show off how good you are. But this one, this is a dick move. Some people are not that fast and some might do things in a different order. Just let them do their damn job. So, i am not perfect either, I may do this once in a year or so, not intended of course. If you ever see me doing this, I hereby allow you to scream at me for doing this and beat be half to death. No ahelp whatsoever, promised. I deserved it.

Damn, this got way longer than I thought it would. I hope this will help some people and I hope i didn't wrote to many wrong things :D Thanks for reading!

Edited August 1, 2022 by Skajaw
Some additions, removed bone mending skip of organ manipulation