Guide to Medicine

Shamelessly copied from IS12, I salute you. -Clarke

## Equipment and Medicines

The way the equipment, and the drugs administered and used alongside the equipment, works.

### Belt Equipment

Equipment found on medical belts by default.

### Non-Belt Equipment

Equipment found outside of the medical belts, in medical kits or in the med vendors at each base.

### IFAK Equipment

Equipment involving the Infantry First-Aid Kits, or the IFAKs, handed by default to most every soldier.

 **Bandage Pack** | Contains a single bandage, use in hand to open the pack and take the bandage out. Opened packs cannot hold the bandages.

## Diagnoses, Treatment, and Triage

### Diagnosing

#### Methods

You can tell what injuries a patient has through a number of ways, and can tell a patient's injuries a number of ways as well.

* **Examining**

Shift-click to examine a patient. This will show you the person's name (if their face or ID is visible), what they're wearing/holding, if they're stressed, if they are the enemy, and any visible injuries on that person. Not all injuries are visible this way, but certain external or internal injuries may show up when a patient is examined
* **In-Game**

Certain injuries can have noticeable effects in-game, both in what you see involving the patient and what you see displayed in chat involving the patient.
* **Analyzing**

Using a health analyzer on a patient will display a read-out extensively detailing the patient's injuries and conditions.
* **Body Scanner**

A console and machine found in the bunker medbays of each side, accurately displays most all data relating to the health status of the patient, including organ damage.
It's noted here that when diagnosing a patient, the patient may be in a conscious or semi-conscious state. They can help tell you what's wrong with them, and may do it without prompting; this can be useful, especially if internal injuries are present, in saving you time with diagnosing. Sometimes a patient's report on their own health may point to multiple possible afflictions, and it's entirely possible what the patient thinks they're afflicted with may be inaccurate or incorrect to what their actual injuries are. A patient's reaction to their injuries can also be a gauge to the kind of injuries they have, although this can be inaccurate as a patient may underreact or overreact to their injuries.

* **In-Game**, red bruises or black splotches will appear on exposed skin of the damaged body part, darkening in correspondence to the level of damage on the part. Patients with brute injuries may be covered in blood (though this may be other people's blood), and patients who were exposed to gas (with or without a mask), tried to pat someone on fire out, or had been set on fire themselves will usually have burn injuries in the relevant body parts. As the level of pain builds, patients will stutter words, and the chat will show that the patient "is having trouble keeping their eyes open." Brute damage is usually a cause, or at the very least an accompany, of most all other afflictions, internal and external; burn injuries less-so, but they are a cause of infections and high amounts of pain.
* **Examining** will show the level of general injury of the patient corresponding usually to how much total brute damage and burn damage that patient has, though it can refer to the number of (usually related) afflictions the patient may have.
* **Analyzing** will show body parts that have brute damage and burn damage, and the level of injury corresponding to how much brute and burn damage that limb has. The two levels of injury are shown distinctly for brute and burn.

* **In-Game**, a loud "crack" sound will resonate from a person if their bones fracture, and the patient may fall over or drop items they're holding.
* **Examining** shows any body parts with fractured bones.
* **Analyzing** detects fractures in the relevant body parts.

* **In-Game**, a patient may do a number of things depending on what organ or organs are damaged: damaged lungs will cause a patient to cough out blood and gasp for air; damaged hearts will fail to circulate blood and may cause fainting and the effects of blood loss as a result; damaged livers and stomachs will cause vomiting (though if they have no mask it may simply be the stench of dead bodies upending their stomachs); damaged eyes will cause blindness; damaged brains will cause blindness, fainting, and eventually full death if they reach too high a damage. Fractures and shrapnels in the chest and head often cause or accompany damaged organs in their respective areas.
* **Examining** does nothing.
* **Analyzing** may show a number of indicators depending on the damaged organs: damaged lungs usually show as nothing; damaged hearts will cause blood pressure to steadily lower regardless of blood injected and afflicted patients will fail to metabolize injected chemicals; damaged livers and stomachs will cause toxin damage that may display as "Major systematic organ failure"; damaged eyes will show as nothing; damaged brains will show as varying levels of damage to the "Brain activity" stat.

* **In-Game**, a patient's blood will make a light "splatter" sound as it drips out of their bleeding wounds. Drops of blood will appear below the patient's sprite, and patient's standing still will form pools of blood below them, though this may not happen if enough blood is lost and/or if the patient's heart stops. The effects of blood loss may be apparent. Notably, blood trails from dragged prone patients are not necessarily an indicator of bleeding.
* **Examining** will show that a patient is bleeding if naked, or if clothed and bleeding enough, that the patient has "blood soaking through" their worn uniform, regardless of how many separate body parts are bleeding. Arterial/Venous bleeding does not appear when examined.
* **Analyzing** will show if a body part is "[bleeding]" after displaying the level of damage on that body part.

* **In-Game**, a patient's blood will make a loud "pssssh" sound as blood shoots out onto the ground in one of the cardinal and/or intercardinal directions of the patient. The patient's skin will quickly become discolored as the effects of blood loss set in, and the chat will show that "blood squirts from the" artery/vein in the relevant afflicted body part. This is notably useful for seeing where to suture or apply a tourniquet if an analyzer isn't at hand, though the bleeding may not appear if enough blood is lost, if the bleeding part was bandaged, and/or if the patient's heart stops. Blood can also squirt on you if you stand in the spot the blood falls.
* **Examining** shows nothing.
* **Analyzing** will show if a body part suffers "[arterial bleeding]" after displaying the level of damage on said part.

* **In-Game**, a patient may have trouble seeing (partial symptom of caused brain damage), or holding items, and may faint often. A patient's skin may be discolored and grey if severe blood loss has taken place. All bleeding may stop if enough blood is lost, though this could be the patient's heart stopping, whether caused by blood loss or not.
* **Examining** a patient with blood loss will show that they "have pale skin" if their skin is visible.
* **Analyzing** a patient will show their blood level: if it's below 82%, the patient will suffer from blood loss. The analyzer may display "severe blood loss detected" if the patient has lost enough blood, though this only displays below a certain threshold (or maybe if something else is wrong with the patient). Along with this, the blood loss will cause varying degrees of oxygen damage, which may cause brain damage depending on severity.

* **In-Game**, the chat will say that "the shrapnel sticks in the wound" if a person is hit by shrapnel, though it won't display the name of the afflicted person. If you are afflicted, the chat will show as the shrapnel jostles around with your movement.
* **Examining** will show if a patient's body parts have shrapnel lodged in them, and the amount of shrapnel lodged in those parts. If a body part has multiple shrapnel, examination will show the number of shrapnel up to a maximum of three pieces.
* **Analyzing** will show that there is [shrapnel detected] in afflicted body parts, though it will display this regardless of the amount of shrapnel lodged in one body part.

* **In-Game**, a person with acute level of infections may occasionally cough, and if the infection is progressed enough symptoms of toxin damage (vomiting and slowdown) may become apparent. At the highest levels symptoms of organ failure will occur, and limbs will quickly rot causing toxin damage. Presumably.
* **Examining** shows nothing.
* **Analyzing** may detect infections if the infections are acute enough, and patients with infections will have a raised body temperature above the average 37 celsius/98 fahrenheit.

* **In-Game**, a dead person will most often be prone, unless buckled to something, and unconscious, usually with severe damage and afflictions apparent - though occasionally, wounds will be minor or unseen, usually indicating internal damage to the heart. Arterial/venous and surgical bleeding will stop as their hearts seize up, and normal bleeding will slow. If they're unconscious and not wearing a mask, you won't be able to see their breath fog the air around their head, since they won't be breathing. If fully dead, the patient will evacuate their bowls (usually not seen unless naked) and bladder (seen as pools of urine beneath the patient), and over the course of death will begin to rot, gathering flies around their head and discoloring skin.
* **Examining** at close range will show that a patient "does not appear to be breathing", and if adjacent you will begin to count their pulse: if dead, there will be no pulse, and if the person is fully dead, there will be no pulse and their soul will be departed. After a course of time fully dead, the person will be visibly rotted, with different stages of rot corresponding to time spent fully dead.
* **Analyzing** will show a patient has a BPM of zero, and that the patient is "suffering from cardiovascular shock" and that you should "Administer CPR immediately." Blood pressure will remain stable and usually lower, and chemicals won't circulate, as the heart won't be functioning. Brain damage will accumulate over time while dead; generally, the longer spent dead, the higher the damage of the brain, and the closer to full death the patient is. Fully dead, the patient's brain activity will read as "None - Patient is Braindead."

### Treatment

Most external wounds are treated using the suture, with morphine or another painkiller administered alongside the treatment. Tricordrazine may also be administered to help speed the healing progress, and inaprovaline may be administered to stabilize and partially heal the patient.

If the patient is conscious enough, and/or if you are treating another patient who isn't able to heal themselves, you can ask the former to try to heal themselves using spare equipment. It may also be helpful to administer morphine to keep them standing while filling them with tricordrazine to heal over time, so that they may continue fighting.

When treating a patient, you may want to heal and/or remedy certain afflictions first. Arterial bleeding can cause rapid blood loss, and is usually treated before any other afflictions; shrapnel can cause pain and further damage, and pulling the shrapnel usually causes bleeding and occasionally arterial bleeding, so it is often pulled before bandaging bleeding wounds; bleeding parts themselves can cause blood loss, and are often seen as a priority, but if blood injectors are handy the bleeding can wait for other injuries to be healed.

Fractures, Torn Muscles, and Organ Damage (excluding brain damage if ateopine is present) require surgery to heal fully, though fractures can be splinted to prevent further injury and for the patient to stand.

For this part, a common "primary method" of healing the listed affliction will be written without bullet point, and other ways of healing, accelerating the healing, and/or miscellaneous tips are presented in bullet point below the primary method. In small text below the header, a quick summary of the primary method is written.

* Usually healing brute up to minor level injury will remove most afflictions caused by the damage (especially if coupled with painkiller). If you aren't busy, and the patient is in no rush, you can heal the wound fully, though it may make more sense to work on something else.
* Minor amounts of damage will heal over time, and most food can be eaten to speed up the progress.
* Tricordrazine will heal small amounts of damage on all body parts, you can administer it on its own or form it in a sleeper. Can be useful for healing other wounds while you suture more damaged parts.
* Kelotane will heal most burn damage and will help to prevent infection as the burn wounds heal, but the rate of healing is slow; if the patient has multiple burns on multiple body parts, fully suturing some of the burns (or suturing the severely burned areas) can help to prevent paincrit.
* Trauma Kits can be used to heal small amounts of brute and burn damage and to speed up the progress at which the rest of the damage heals. Can be used on multiple parts on multiple people at the same time, but this will use up the stack quickly, and the healing is slow (and these currently don't heal over time due to a bug).
* Burn Kits can be used to prevent infection in a wound, to heal burn damage, and to speed up the progress of healing. Can be used on multiple parts on multiple people at the same time, though the healing is slow.

* Organ damage will usually be caused or accompanied by a fractured head or upper body, and shrapnel is often a cause for fractures in the first place.
* The fractured bones of prone patients won't move on their own. If the patient is trying to move to the base, you can skip splinting and tell them to crawl there; if transporting a patient, make sure they're lying prone or that you're grabbing them rather than dragging them.
* Splinting a fractured leg or foot will allow the patient to stand, I think.
* Splinted fractures will not heal over time.

* Patients exposed to gas without a mask will ingest and be exposed to chemicals. These chemicals damage their eyes upon exposure, and damage their organs and cause toxin damage while ingested; the sleeper can be used to pump the stomachs of patients to remove these chemicals before surgery.
* If the organs of a patient, excluding their brain, receive too much damage, spend too much time spent outside the patient, or have infections go beyond sepsis++, the organ will suffer necrosis and become useless. The patient will suffer toxin damage and the resulting damage from a lack of that organ, though a transplant can be performed if organs are available.
* If a patient's organs suffer necrosis and a transplant isn't viable, you can hype the patient on the necessary chemicals to counteract the effects. This can keep them decently alive, depending on what's damaged, as long as the chemicals remain metabolized.

* Fully healing the wounds that caused the bleeding will cause the accompanying bleeding to stop.
* You can use a stack of bandages/kits on multiple parts and/or on multiple people at the same time.
* Bleeding will drain blood at a steady rate, especially if multiple parts are bleeding, but this usually takes time, and other wounds can be worked on before the effects of blood loss take place.
* During surgery, an incision will cause a special kind of normal bleeding that is stopped by using a hemostat. This loses blood slightly faster than normal bleeding (presumably).

* Healing arterial/venous bleeding is usually done before healing other injuries, mainly to stop the rapid blood loss, though it can be negated if enough blood injectors are present.
* Suturing an injured body part with arterial/venous bleeding will automatically suture the bleeding before suturing the damage.
* Bandages will (presumably) do nothing to stop the arterial/venous bleeding.

* After administering large amounts of blood, it may take some time before the blood is oxygenated; you may have to administer dexalin or to perform CPR to help remove oxygen damage.

* Removing the shrapnel often causes bleeding and occasionally causes arterial/venous bleeding, though it is usually better to remove the shrapnel even if bandages are not present.
* Examining a patient will show you how many pieces of shrapnel they have and where, though the count cuts off above three.
* Shrapnel often accompanies or causes fractures and organ damage, especially if the shrapnel was in a patient for an extended period or was coupled with extreme and sudden brute damage.
* Make sure that, when removing shrapnel of the head, you aren't pulling teeth by targeting the mouth.

* Bacterial Infections have different stages of progression: Mild, Mild+, Mild++, Acute, Acute+, Acute++, Sepsis, Sepsis+, Sepsis++. Beyond Sepsis++ the infected part of the body becomes necrotic presumably.
* Most infections progress slowly, and can be ignored while practicing, though infections will eventually start to cause toxin damage increasing beyond acute (presumably) and will eventually cause necrosis of infected limbs and/or organs.
* The environment the patient is in can contribute to the chance of infections occurring during injury or surgery, though it may be unoptimized in the current version of this game. Bodies, blood, and patient and/or doctor being covered in blood will increase the chance of infection occurring.

* CPR can resuscitate patients suffering from death, though the process is inefficient.
* If severe organ damage is present before revival, or any of the organs are necrotic, dylovene and/or dexalin may be needed for the patient. If the patient's heart refuses to beat after organs are healed, the heart may be necrotic, and the patient may be unrevivable (for any period more than a few seconds of life) without organ transplant.
* During death, the rate of bleeding and arterial/venous bleeding will slow or stop, since the heart will have stopped. The blood pressure in the body usually also remains mostly stable, and will usually be lower because of the stopped heart. Once revived, the bleeding will start again, and blood pressure may jump up as blood injected before revival becomes part of the patient's blood supply. Make sure to heal bleeding before revival, to administer dexalin if needed and available to oxygenate the blood (new and/or otherwise), and to not administer more blood than needed to save supplies, though usually more blood will ultimately be needed.

### Triage

During the practicing of medicine, it may happen that there will be multiple patients with different injuries on each patient, and different numbers of injuries on each patient. It can be helpful to try to treat certain patients first, usually depending on what afflictions they have and often on what role they are on your team.

A basic "ladder" of importance would be Grunt/Scav, Medic/Engineer, Sergeant, Sentry, Sniper and Captain, try to treat the more limited/useful roles first, although exceptions might occur depending on circumstances.

Outside of this, a quick way to see who can wait and who cant, would be severity of wounds, a guy lying on the floor, barely moving and coughing blood takes far more priority over a guy moaning over his "mortal injuries" from falling into the trench, despite whatever the latter tries telling you.

Outside of that, the sleepers in the Main Medbay and the Left/Right Trench bays can be used to inject medicine and slow down the speed of patients dying using stasis, use it well and you can keep patients waiting for longer than usual, although still not for long.

**Make sure to suture torn arteries and bandage bleeding wounds, bleeding out is the biggest danger in warfare, especially out on the front, medics especially should consider suturing and bandaging wounds before dragging wounded back.**

## Surgery

Notably, the hemostat is optional as the second step in most surgeries, though a patient will lose blood at a not-insignificant rate from the special type of bleeding the surgery inflicts. You may want to skip it when operating on a single patient but use it when operating on yourself and/or on more than one patient.

The chest of a patient only needs to be fractured to access the organs behind the bone, and the bonesaw by default is simply used to cause the fracture. Before or during surgeries for accessing the upper body's organs, you can **kick** a patient's upper body; target the chest, enable the button that says **kick** at the bottom of your game screen, and press the middle mouse button with your cursor over the patient. If the patient's chest isn't fractured, you can kick it to eventually fracture it yourself to skip using the bonesaw.

Anesthetics are not necessary for surgery, and morphine can be optional, though the pain can cause shock if other injuries have already caused pain.

Healing medicines administered before the surgery can heal damage while you operate, though tricordazine can close the incisions before you finish the steps needed to heal, presumably if the damage is low enough on the body part being operated on.

* Hemostat (Optional, prevents special type of bleeding)
* Retractor
* If head or upper body, Trauma kit/Bandage to check for organ damage, stop if no attempt to heal organs is made (Optional, fractured heads and chests often cause and/or accompany organ damage)
* Fix-o-vein, torn muscles, do before healing fractures if fractures also present
* Bone Gel, fractures, applies gel
* Bone Clamp, fractures, clamp in place, has chance to fail
* Bone Gel, fractures, finishes and seals bone
* Cautery or Trauma Kit (Both will close incision, trauma kit helps to accelerate healing, using kit may be unnecessary if immediately followed by suturing)

* Hemostat (Optional, prevents special type of bleeding)
* Retractor
* If head or upper body and not fractured, Bone Saw
* Trauma Kit or Bandage (both presumably work)
* Bone Gel, if head or Upper Body
* Bone Clamp, after previous
* Bone Gel, after previous
* Cautery or Trauma Kit (Both will close incision, trauma kit helps to accelerate healing, using kit may be unnecessary if immediately followed by suturing)

* If attaching limb, use prosthetic/limb while targeting missing limb

* Hemostat (Optional, prevents special type of bleeding)
* Retractor
* If head or upper body and not fractured, Bone Saw
* To separate organ, scalpel
* To remove separated organ, hemostat
* To transplant organ, organ
* To connect transplanted/separated organ, fix-o-vein
* Trauma kit/Bandage to check for organ damage, stop if no attempt to heal organs is made (Optional)
* Bone Gel, if head or Upper Body
* Bone Clamp, after previous
* Bone Gel, after previous
* Cautery or Trauma Kit (Both will close incision, trauma kit helps to accelerate healing, using kit may be unnecessary if immediately followed by suturing)

## Analyzer Data

The health analyzer, when used on a patient, shows a number of stats and values related to that patient's health.

**Brain activity**

The level of damage to the brain of a patient. An indicator of how close a patient is to being completely unrevivable. The level of damage increases as long as the patient is dead (and/or possibly deoxygenated), and players who have ghosted while in a critical state, or those who received too much brain damage, will automatically be listed as "brain dead" in this stat; brain dead players are totally unrevivable.
**Pulse Rate (BPM)**

The rate in beats per minute (BPM) a patient's heart is beating. A BPM of zero doesn't necessarily mean the patient is unrevivable or unconscious.
**Blood pressure**

Shows how much blood a patient has in percentage and volume, and the pressure of the patient's blood. Below 82% a patient will start suffering from noticeable effects of blood loss.
**Body Temperature**

The internal temperature of the patient in celsius and fahrenheit. A temperature well above 36 degrees celsius/97 degrees fahrenheit is an indicator of bacterial (or viral) infection, or the patient being on fire.
**Blood Type**

Shows the patient's blood type.
**Radiation**

Stat that changes if the patient is irradiated, and will show the level of radiation in the patient if they are (presumably).
**Overall Status**

If the patient has certain things wrong with them, or enough specific things wrong with them, the analyzer will display data that can indicate an underlying issue.
**Major systematic organ failure detected.**
An indicator of toxin damage caused alongside organ damage, though it's only an indicator of organ damage and toxin damage, and does not show if only organ damage is present. Often seen in gas victims not wearing a mask as the chemicals they've ingested cause toxin and organ damage.
**Severe oxygen deprivation detected.**
An indicator that the patient has deoxygenated blood, usually seen in people who's lungs have been healed but have yet to oxygenate their blood, or in patients who are underwater. After some time the body will oxygenate the blood, though dexalin can speed the process.
**Severe anatomical damage detected.**
Presumably an indicator that the patient has a large amount of brute damage (though this can simply be a bunch of minor wounds in every part of the body)? Or maybe an indicator towards internal organ damage? If a scanner does show this, and the chest has received injuries, it's usual that the organs have been damaged in any case.
**Infections detected,**
Indicator of (usually progressed) bacterial infection in the patient, a result often of unclosed incisions and untreated burn wounds. Not an indicator of viral infections, presumably.
**Patient is at serious risk of going into shock. Painkillers .**
Indicator that some level of pain medication should be administered, less the patient fall unconscious or suffer cardiac arrest.
**Patient is suffering from cardiovascular shock. Administer CPR immediately.**
Shown when the patient's heart has a BPM of 0. Ateopine is usually used for starting a stopped heart, but CPR can be used on its own to inefficiently revive one, presumably.
**Specific limb damage**

Possibly shares a slot with **Overall Status**, the damage values inflicted onto and recorded of a patient. Rather than talk of the damage types, the levels of damage is listed:
**Minor**: Will cause pain, and multiple body parts with minor damage will stack the pain, but low enough that some form of pain medicine should be all the treatment really needed to ignore, or tricordrazine/food to treat fully.
**Moderate**: Can be ignored, more often than not warrants treatment. Mutiple afflicted parts can cause good deal of pain.
**Significant**: Warrants treatment. Good deal of pain alone.
**Severe**: Warrants treatment, usually causes pain at levels exceeding that what morphine can remove.
**Critical**: Slightly below irreparable, presumably.
**Irreparable**: Highest damage level, healable only by suturing. Does not require amputation.
**Reagent scan**

Shows the chemicals that the patient has in their stomach, in their bloodstream, and that is currently being metabolized by the patient. If the scanner isn't able to identify a chemical, it will read as "unknown substance detected".
## Ateopine Mixes

Using injectors on beakers will fill the beaker with the contents of the injector; you can then mix other reagents in the beaker to either create another chem or to create a mix of chemicals that may perform multiple functions when injected into a patient.

Though syrettes cannot draw directly from beakers, the chems may be mixed in a morhpine ampoule and drawn with a syrette from that presumably. Syringes can also be used and the container containing the mix can be fed directly to the patient if the patient isn't wearing a mask.

For this section the chemical being talked about will be listed before describing specific reactions and/or techniques involved with mixing certain different chemicals.

**ateopine**
Since ateopine in any concentration will cause a stopped but still functional heart of the patient it's circulating in to beat again, ateopine may be diluted with other chemicals in a beaker in order to limit the amount used per patient on injection I think. Inaprovaline will stabilize critical patients and will reduce brain damage but has a chance to close surgical openings.