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[OOC] I didn't know where to put this so it's going here for now. Please excuse any references that don't fit, I made this originally for another server, but I still feel it's a useful resource for anyone interested in medical roleplay. If you spot any issues, mistakes, whatever, let me know. [/OOC]
*In the hospital is several copies of a booklet, containing the information below.*
This guide will cover basic equipment you will need on your person at all times, common injuries including breaks and fractures, and standard medical practice. I'll add more as I go.
Beginning with Basics:
Your standard equipment:-
Regardless of what else you may or may not have, these or something which performs the same function are a must.
Scalpel - This is an item used in almost any time critical procedure you'll ever need to do. These are incredibly sharp tools, usually used for slicing through skin, however, caution is advised. Due to the very sharp nature of this implement, you'll need to be careful you don't cut through something you didn't intend to, such as an artery. I won't go into what you'll need to use this for further as I feel it's rather self explanatory, however if unsure, go ahead and ask someone.
Surgical shears/scissors - These are simply scissors, often considerably sharper than your usual run of the mill scissors. These will usually be used for cutting bandages, cutting through clothing to access a wound and other similar applications. When treating a wounded unit, ensure that you don't try to cut through the armoured part, as this will be a futile task. Instead, cut through a sleeve or the side of the material, where the uniform is not armoured or poorly armoured, and work your way along from there. Remember, it doesn't matter where you cut the clothing, as long as it allows you access to the wound. It is unlikely that a bullet will directly punch through the body armour, but it may still cause internal damage. Note: A scalpel is a more more effective and efficient tool for cutting through skin and using anything else is ill advised.
Tweezers / Forceps - This item of equipment is essentially two pieces of metal, fixed together at one end, the other end able to open and close, commonly used for gripping objects too small for the human hand to grasp, or too far into the body for the hand to reach without causing damage or more discomfort than necessary, for example removing a bullet or fragments of bone from a wound.
Bandages/Gauze - The common bandage is usually used to dress a wound, to keep infection at bay and is to be wrapped tightly around a bleeding wound, to apply pressure and prevent blood from escaping. The more blood that escapes from any single area increases the likelihood that the area in question will need to be amputated (the literal meaning, not the union meaning), or that the patient will pass out and die of blood loss. Patients dying is hardly preferable, so make sure to get a bandage on any heavily bleeding wound ASAP! Once you've got them to a safe place with access to equipment and the full materials available to you (e.g. the medbay), you can focus on dealing with the wound its self, rather than just stopping it from bleeding temporarily. Gauze works in essentially the same way, but offers less chance of adhesion to the wound and can be impregnated with a mixture of zinc oxide and calamine to promote healing.
Needle and thread - These will commonly be used for sewing up wounds, often ones that you yourself have made, for the purpose of fixing something inside the body, usually in this case you will have made a clean, smooth cut with your scalpel, so this won't be an issue, however if the incision is not of your creation, the method is the same. Take the skin either side of the incision and thread it together. If the skin either side does not reach the other, or is very tight, do not attempt to thread the skin together, instead use a skin graft at the medbay. The thread in your needle and thread will usually be degradable, - that is, it can be absorbed by a human body - this is so that you won't have to perform an operation to remove the thread as well as to put it in.
QuikClot - These will normally be in small, marked packets. QuikClot is used to absorb blood and stop it from escaping the wound. Essentially, it's an alternative to bandages/gauze. So, why ever use bandages or gauze? Well, QuikClot, while fast acting is usually not used for large wounds, as carrying around a variety of packets to fit any size wounds would be impractical, but it also gives off a large amount of heat upon reacting with the blood, which will likely cause discomfort for the patient. Be VERY careful that you don't get QuikClot anywhere but in the wound its self. If it makes contact with your eye, for example, it will try to dehydrate that as it would the blood in a wound. Use only a small quantity in a wound, as it will expand rapidly. It is advised to use QuikClot on nothing larger than a gunshot wound. This will usually be used in the field, when you don't have time to properly treat the wound. Ensure that the QuikClot solution is fully washed out before treating the wound.
Painkillers (Analgesics) - It will always serve you well to have some of these on hand. As the name suggests, they lower the pain your patient feels, however they may also cause the patient to lose consciousness - not a desirable thing at all - as well as relax them and, if you give your patient an overdose, could potentially kill them. Used in moderation, however, these are an excellent tool and will allow your patient to relax, letting you work on them that much easier. Typical painkillers are Oxycodone, Morphine, Codine and Cocodamol. These can be administered in a variety of ways, the most common of which is via a pill/tablet or a syringe. Either is an acceptable method, however a syringe is more likely to be used in the field, as the patient doesn't need to do anything while you administer the painkillers. Tablets/pills are more commonly used as prescriptions for regular pain.
Hemostatic clamp - For such a long name, this is really a rather simple piece of equipment. These are rather similar to tweezers/forceps and may be called arterial forceps or a pean. The main difference is their usage. These are used to close blood vessels, by virtue of squeezing the blood vessel closed via pressure from the prongs (hemo - blood, and static - not moving. They keep blood in). It's not uncommon to have a lot of these over the incision for any large surgery you might be performing, such as opening up the chest.
Asherman's (Chest) Seal - This is another relatively simple tool, but certainly not one to be underestimated. If the patient sustains internal chest damage, usually to the lungs, this causes a sucking chest wound, which is pretty self explanatory. The lung still tries to pump oxygen around the body, but ends up sucking air in through the wound. The pressure of this if left unchecked will often lead to a collapsed lung or lungs. The Asherman's seal sticks to the wound, preventing air from entering, while the one-way valve at the centre (the Cannula) allows air and blood to escape the chest (Pleural space), but not to enter. This uses a pressure sensitive adhesive, so the seal will stick in almost any situation but underwater, and the pad is clear, for easily monitoring the wound.
Antiseptics - These are used for sterilising wounds or equipment as necessary. Try to ensure that you have an antiseptic that kills or destroys bacteria, rather than just slows or stops its growth. Iodine, hydrogen peroxide and ethanol are the main antiseptics you'll use, although some form of antiseptic wipe wouldn't be a bad idea.
Well then, you'll be pleased to know that that's all the basic equipment you'll need in the field (or at least that I can think of), for any additions, contact me at when possible. I'll now run through as many basic procedures you'll need to use in the field that I can think of.
Standard injuries:-
Broken/fractured bone(s) - This is the most common injury I've found so far, and it's one I feel requires a whole lot of detail, due to the number of different breaks/fractures and the complications they can cause. Standard practice for dealing with any bone break, unless otherwise stated, is to move the patient to the medbay, administer an anesthetic of your choosing, then cut open the flesh around the site of the break, using hemostatic clamps as required. From there, any small fragments of bone found are to be removed and the bone moved back into place if necessary. A metal plate or strut should then be inserted to the wound, before surgical screws are drilled through the plate and bone, fixing them together. The hemostatic clamps used should then be removed and the wound sealed back up with needle and thread, before a cast is applied to the break. The healing process should be monitored on an at least bi-weekly basis, if not more often. A CAT scan or x-ray will suffice. The bone will heal naturally, provided it's in the correct location, allowing for an eventual full recovery, although this will take anywhere between weeks and months, depending on the severity of the break/fracture.
(Note: Not all breaks are covered here, but the main ones are.)[PHP][/PHP]
Greenstick fracture - You're rather unlikely to come across such a fracture, as it usually occurs in children, when the bones are soft. This is a fracture where one side of the bone breaks and the other bends away from it, much like what happens if you break a wooden stick, hence the name. Adult bones are more likely to break completely, on account of being more brittle.
Torus/Buckle fracture - Again, you're unlikely to encounter this fracture as it primary occurs in young bones, while they're softer. This is where the bone bends, but does not bend far enough to cause a greenstick fracture. It raises a buckle where the bone has bent. As this is not an actual break of the bone, no surgical action should be taken. A cast and close monitoring of the break will suffice.
Open/Compound - This is a break where the bone pierces through the skin. This lends a possibility of infection, as the wound will have been exposed to the air and potentially a lot of other things that shouldn't be in the body. The only difference in procedure is that you should disinfect the area the bone's pierced and ensure the cast is kept clean, so that bacteria can't breed and cause issues. This is the easiest type of break to identify.
Displaced - This is similar to an open break, but the bone hasn't pierced the skin and has instead simply been moved when the break took place. There will likely be a fairly large bulge in the skin if this break is present, where the bone is pressing against it. Care should be taken to ensure the patient doesn't inadvertently make this an open break by applying pressure to the displaced bone.
Non-displaced - This is a relatively simple break, where the bone lines up and hasn't moved when it was broken. Standard practice should still be followed to ensure this does not become a displaced or open break. This is a rather difficult break to identify, as the bone lines up as it should. A CAT scan or x-ray should identify it, although the patient may not realise the bone was broken before they inadvertently make it a displaced or open break.
Closed - A closed fracture is a broad term for any type of break that doesn't break the skin.
Single - A single is a type of break that only happens in one place on the bone. This will sometimes be called a 'clean' break, as there should be a minimum of complications in repairing it.
Hairline - This is a fracture in which there is only a thin break in the bone. If found, such a break should be monitored closely. A cast may be applied, but discretion should be used. Ensure the patient doesn't apply large amounts of pressure to the bone in question. Do not perform surgery unless the fracture worsens.
Segmental - If a break is segmental, it is broken in two or more places in the same bone. Depending on the size of the area segmented, two or more plates/struts may be required in surgery. Any small fragments of bone should be removed with tweezers.
Comminuted - This is probably the most complicated break you will have to deal with. If a break is comminuted, the bone will be broken in more than two places and crushed. This could be the result of a very hard impact or similar. The crushed bone will need to be removed unless the shards are large enough to drill into place together, although if there are a lot, this will be like trying to assemble a jigsaw puzzle and is not advised.
Spiral - This is caused by a twisting force and can be difficult to treat due to the nature of the break. The bone will need to be twisted back into the correct position before the bone can be set in place. This type of break is usually even more painful for the patient than a more ordinary one, due to the scraping of bone and bone as it's forced to twist unnaturally until the bone breaks. This is usually caused by a foot or leg turning while the patient falls from some great height or at a great speed. The most common way this used to happen is in skiing, where the leg is twisted while the individual falls. A significantly harsh twisting of the arm could produce similar results.
These guidelines should work for any limb breaks or fractures, but injuries to the ribs or spine will be considerably different. Any break that is not 'non-displaced' will be potentially fatal for the patient in the ribs, as it may puncture an organ. Any break to the spine could leave the patient permanently paralyzed. If a rib punctures an organ, take care to remove it then seal the organ with a needle and thread in whatever way possible. As soon as an organ is involved this will become a very messy, dangerous surgery indeed. Loss (collapse) of the organ punctured is likely.
Ballistic wound - This is another very common injury, and while precise treatment based on angle, size, speed and location of the injury will cause a lot of variation in the exact method of treatment, the following should be fairly constant throughout, for punctured limbs. Antiseptic should always be applied to the wound before it's sealed.
If the bullet(s) are still inside of the limb - QuikClot, bandages, or gauze can be used at your discretion to temporarily stop blood loss until you transfer the patient to the medbay. Apply anesthetic, open up the wound with a scalpel, use hemostatic clamps to prevent unnecessary blood loss, remove the bullet(s) using tweezers/forceps. If the bone is broken or fractured, refer to the previous section for standard practice. Remove hemostatic clamps and seal the incision with needle and thread.
If the bullet(s) are no longer inside of the limb - Follow the same steps as above, except without removing the bullet and ensure that both the exit and entry wounds are sealed.
Essentially the same thing must be done in the case of a bullet entering the chest, however the main differences are that a Asherman's Seal is heavily advised, then the patient should be transferred to the medbay for surgery. This done, extreme care must be taken of the organs when removing the bullet, especially if an organ has been punctured. Time is of the essence with a punctured organ, as it's only a matter of time before it collapses if left untreated.
Stab wounds should be treated in a similar way to bullet wounds, with the blood flow stopped by bandages or gauze, with an Asherman's Seal in the case of a chest wound. The main difference is that you won't have a bullet to remove, the size and the nature of the wound. For example, a knife may slice downwards or across, making a longer cut, while a bullet will only penetrate.
Before you do anything to your patient, these are essential:-
Steralisation - This means your tools, surgical table or other platform, hands and your head must not be able to transmit an infection. Ensure that your tools have been cleaned with antiseptic or disinfectant. The last thing you want to do is try to fix one problem and end up giving your patient another in the form of an infection. Your surgical table must also be sterile for the same reason, and with regards to the head, your mouth and nose should be covered and any hair tied back out of your face and covered. Always ensure any wound exposed to the air is thoroughly steralised.
Safety - Any sharp or otherwise dangerous tools should be out of easy reach for your patient. This is to prevent unnecessary injury to either of you, accidental or otherwise. This means scalpels, syringes containing large amounts of any given drug and so on.
Consideration - At the end of the day, you might be helping save their life or saving them a huge amount of unnecessary pain, but that doesn't mean you have to be an arse about it. A considerate medical practitioner is far more likely to have compliant patients than one who treats their patients in a cruel fashion.
Surgery:
Regardless of what else you might need, including a mixture of the above, you will almost always need either a local or general anaesthetic.
Local Anaesthetic - This is used to make an area completely numb, so that you can operate on it without the patient feeling anything while you operate. Lidocaine is a commonly used local anaesthetic.
General Anaesthetic - This is used to render the patient unconscious and unable to feel any pain while you operate. This is good for anything that requires complete precision, such as working on a lung. Etomidate is commonly used.
Brief Blood Vessels:
Blood vessels: These transport blood throughout the body, they come in three main kinds, arteries, veins and capillaries.
Arteries: These blood vessels transport blood away from the heart. The arterial system has the highest pressure of all the different kinds of blood vessels, which is the reason for the 'spurting' most individuals associate with a severed artery. Best practice is to apply pressure if other injuries are present and require more urgent attention. Once the more urgent injuries have been dealt with, suturing the artery to prevent blood loss or clotting agents are advised, such as Quikclot.
Veins: These blood vessels transport blood to the heart. The venous system isn't so high pressure as the arterial system, and as such it can be harder to tell when a vein has been hit, due to the lack of obvious blood squirt or similar. This type of blood vessel should be treated in a way similar to arteries.
Capillaries: These are the smallest blood vessels, which allow water, oxygen, carbon dioxide and other nutrients to be transferred between the blood and surrounding tissues. Due to the small nature of these blood vessels, it is near impossible and highly impractical to attempt to suture them closed. Cauterisation is advised.
*In the hospital is several copies of a booklet, containing the information below.*
This guide will cover basic equipment you will need on your person at all times, common injuries including breaks and fractures, and standard medical practice. I'll add more as I go.
Beginning with Basics:
Your standard equipment:-
Regardless of what else you may or may not have, these or something which performs the same function are a must.
Scalpel - This is an item used in almost any time critical procedure you'll ever need to do. These are incredibly sharp tools, usually used for slicing through skin, however, caution is advised. Due to the very sharp nature of this implement, you'll need to be careful you don't cut through something you didn't intend to, such as an artery. I won't go into what you'll need to use this for further as I feel it's rather self explanatory, however if unsure, go ahead and ask someone.
Surgical shears/scissors - These are simply scissors, often considerably sharper than your usual run of the mill scissors. These will usually be used for cutting bandages, cutting through clothing to access a wound and other similar applications. When treating a wounded unit, ensure that you don't try to cut through the armoured part, as this will be a futile task. Instead, cut through a sleeve or the side of the material, where the uniform is not armoured or poorly armoured, and work your way along from there. Remember, it doesn't matter where you cut the clothing, as long as it allows you access to the wound. It is unlikely that a bullet will directly punch through the body armour, but it may still cause internal damage. Note: A scalpel is a more more effective and efficient tool for cutting through skin and using anything else is ill advised.
Tweezers / Forceps - This item of equipment is essentially two pieces of metal, fixed together at one end, the other end able to open and close, commonly used for gripping objects too small for the human hand to grasp, or too far into the body for the hand to reach without causing damage or more discomfort than necessary, for example removing a bullet or fragments of bone from a wound.
Bandages/Gauze - The common bandage is usually used to dress a wound, to keep infection at bay and is to be wrapped tightly around a bleeding wound, to apply pressure and prevent blood from escaping. The more blood that escapes from any single area increases the likelihood that the area in question will need to be amputated (the literal meaning, not the union meaning), or that the patient will pass out and die of blood loss. Patients dying is hardly preferable, so make sure to get a bandage on any heavily bleeding wound ASAP! Once you've got them to a safe place with access to equipment and the full materials available to you (e.g. the medbay), you can focus on dealing with the wound its self, rather than just stopping it from bleeding temporarily. Gauze works in essentially the same way, but offers less chance of adhesion to the wound and can be impregnated with a mixture of zinc oxide and calamine to promote healing.
Needle and thread - These will commonly be used for sewing up wounds, often ones that you yourself have made, for the purpose of fixing something inside the body, usually in this case you will have made a clean, smooth cut with your scalpel, so this won't be an issue, however if the incision is not of your creation, the method is the same. Take the skin either side of the incision and thread it together. If the skin either side does not reach the other, or is very tight, do not attempt to thread the skin together, instead use a skin graft at the medbay. The thread in your needle and thread will usually be degradable, - that is, it can be absorbed by a human body - this is so that you won't have to perform an operation to remove the thread as well as to put it in.
QuikClot - These will normally be in small, marked packets. QuikClot is used to absorb blood and stop it from escaping the wound. Essentially, it's an alternative to bandages/gauze. So, why ever use bandages or gauze? Well, QuikClot, while fast acting is usually not used for large wounds, as carrying around a variety of packets to fit any size wounds would be impractical, but it also gives off a large amount of heat upon reacting with the blood, which will likely cause discomfort for the patient. Be VERY careful that you don't get QuikClot anywhere but in the wound its self. If it makes contact with your eye, for example, it will try to dehydrate that as it would the blood in a wound. Use only a small quantity in a wound, as it will expand rapidly. It is advised to use QuikClot on nothing larger than a gunshot wound. This will usually be used in the field, when you don't have time to properly treat the wound. Ensure that the QuikClot solution is fully washed out before treating the wound.
Painkillers (Analgesics) - It will always serve you well to have some of these on hand. As the name suggests, they lower the pain your patient feels, however they may also cause the patient to lose consciousness - not a desirable thing at all - as well as relax them and, if you give your patient an overdose, could potentially kill them. Used in moderation, however, these are an excellent tool and will allow your patient to relax, letting you work on them that much easier. Typical painkillers are Oxycodone, Morphine, Codine and Cocodamol. These can be administered in a variety of ways, the most common of which is via a pill/tablet or a syringe. Either is an acceptable method, however a syringe is more likely to be used in the field, as the patient doesn't need to do anything while you administer the painkillers. Tablets/pills are more commonly used as prescriptions for regular pain.
Hemostatic clamp - For such a long name, this is really a rather simple piece of equipment. These are rather similar to tweezers/forceps and may be called arterial forceps or a pean. The main difference is their usage. These are used to close blood vessels, by virtue of squeezing the blood vessel closed via pressure from the prongs (hemo - blood, and static - not moving. They keep blood in). It's not uncommon to have a lot of these over the incision for any large surgery you might be performing, such as opening up the chest.
Asherman's (Chest) Seal - This is another relatively simple tool, but certainly not one to be underestimated. If the patient sustains internal chest damage, usually to the lungs, this causes a sucking chest wound, which is pretty self explanatory. The lung still tries to pump oxygen around the body, but ends up sucking air in through the wound. The pressure of this if left unchecked will often lead to a collapsed lung or lungs. The Asherman's seal sticks to the wound, preventing air from entering, while the one-way valve at the centre (the Cannula) allows air and blood to escape the chest (Pleural space), but not to enter. This uses a pressure sensitive adhesive, so the seal will stick in almost any situation but underwater, and the pad is clear, for easily monitoring the wound.
Antiseptics - These are used for sterilising wounds or equipment as necessary. Try to ensure that you have an antiseptic that kills or destroys bacteria, rather than just slows or stops its growth. Iodine, hydrogen peroxide and ethanol are the main antiseptics you'll use, although some form of antiseptic wipe wouldn't be a bad idea.
Well then, you'll be pleased to know that that's all the basic equipment you'll need in the field (or at least that I can think of), for any additions, contact me at when possible. I'll now run through as many basic procedures you'll need to use in the field that I can think of.
Standard injuries:-
Broken/fractured bone(s) - This is the most common injury I've found so far, and it's one I feel requires a whole lot of detail, due to the number of different breaks/fractures and the complications they can cause. Standard practice for dealing with any bone break, unless otherwise stated, is to move the patient to the medbay, administer an anesthetic of your choosing, then cut open the flesh around the site of the break, using hemostatic clamps as required. From there, any small fragments of bone found are to be removed and the bone moved back into place if necessary. A metal plate or strut should then be inserted to the wound, before surgical screws are drilled through the plate and bone, fixing them together. The hemostatic clamps used should then be removed and the wound sealed back up with needle and thread, before a cast is applied to the break. The healing process should be monitored on an at least bi-weekly basis, if not more often. A CAT scan or x-ray will suffice. The bone will heal naturally, provided it's in the correct location, allowing for an eventual full recovery, although this will take anywhere between weeks and months, depending on the severity of the break/fracture.
(Note: Not all breaks are covered here, but the main ones are.)[PHP][/PHP]
Greenstick fracture - You're rather unlikely to come across such a fracture, as it usually occurs in children, when the bones are soft. This is a fracture where one side of the bone breaks and the other bends away from it, much like what happens if you break a wooden stick, hence the name. Adult bones are more likely to break completely, on account of being more brittle.
Torus/Buckle fracture - Again, you're unlikely to encounter this fracture as it primary occurs in young bones, while they're softer. This is where the bone bends, but does not bend far enough to cause a greenstick fracture. It raises a buckle where the bone has bent. As this is not an actual break of the bone, no surgical action should be taken. A cast and close monitoring of the break will suffice.
Open/Compound - This is a break where the bone pierces through the skin. This lends a possibility of infection, as the wound will have been exposed to the air and potentially a lot of other things that shouldn't be in the body. The only difference in procedure is that you should disinfect the area the bone's pierced and ensure the cast is kept clean, so that bacteria can't breed and cause issues. This is the easiest type of break to identify.
Displaced - This is similar to an open break, but the bone hasn't pierced the skin and has instead simply been moved when the break took place. There will likely be a fairly large bulge in the skin if this break is present, where the bone is pressing against it. Care should be taken to ensure the patient doesn't inadvertently make this an open break by applying pressure to the displaced bone.
Non-displaced - This is a relatively simple break, where the bone lines up and hasn't moved when it was broken. Standard practice should still be followed to ensure this does not become a displaced or open break. This is a rather difficult break to identify, as the bone lines up as it should. A CAT scan or x-ray should identify it, although the patient may not realise the bone was broken before they inadvertently make it a displaced or open break.
Closed - A closed fracture is a broad term for any type of break that doesn't break the skin.
Single - A single is a type of break that only happens in one place on the bone. This will sometimes be called a 'clean' break, as there should be a minimum of complications in repairing it.
Hairline - This is a fracture in which there is only a thin break in the bone. If found, such a break should be monitored closely. A cast may be applied, but discretion should be used. Ensure the patient doesn't apply large amounts of pressure to the bone in question. Do not perform surgery unless the fracture worsens.
Segmental - If a break is segmental, it is broken in two or more places in the same bone. Depending on the size of the area segmented, two or more plates/struts may be required in surgery. Any small fragments of bone should be removed with tweezers.
Comminuted - This is probably the most complicated break you will have to deal with. If a break is comminuted, the bone will be broken in more than two places and crushed. This could be the result of a very hard impact or similar. The crushed bone will need to be removed unless the shards are large enough to drill into place together, although if there are a lot, this will be like trying to assemble a jigsaw puzzle and is not advised.
Spiral - This is caused by a twisting force and can be difficult to treat due to the nature of the break. The bone will need to be twisted back into the correct position before the bone can be set in place. This type of break is usually even more painful for the patient than a more ordinary one, due to the scraping of bone and bone as it's forced to twist unnaturally until the bone breaks. This is usually caused by a foot or leg turning while the patient falls from some great height or at a great speed. The most common way this used to happen is in skiing, where the leg is twisted while the individual falls. A significantly harsh twisting of the arm could produce similar results.
These guidelines should work for any limb breaks or fractures, but injuries to the ribs or spine will be considerably different. Any break that is not 'non-displaced' will be potentially fatal for the patient in the ribs, as it may puncture an organ. Any break to the spine could leave the patient permanently paralyzed. If a rib punctures an organ, take care to remove it then seal the organ with a needle and thread in whatever way possible. As soon as an organ is involved this will become a very messy, dangerous surgery indeed. Loss (collapse) of the organ punctured is likely.
Ballistic wound - This is another very common injury, and while precise treatment based on angle, size, speed and location of the injury will cause a lot of variation in the exact method of treatment, the following should be fairly constant throughout, for punctured limbs. Antiseptic should always be applied to the wound before it's sealed.
If the bullet(s) are still inside of the limb - QuikClot, bandages, or gauze can be used at your discretion to temporarily stop blood loss until you transfer the patient to the medbay. Apply anesthetic, open up the wound with a scalpel, use hemostatic clamps to prevent unnecessary blood loss, remove the bullet(s) using tweezers/forceps. If the bone is broken or fractured, refer to the previous section for standard practice. Remove hemostatic clamps and seal the incision with needle and thread.
If the bullet(s) are no longer inside of the limb - Follow the same steps as above, except without removing the bullet and ensure that both the exit and entry wounds are sealed.
Essentially the same thing must be done in the case of a bullet entering the chest, however the main differences are that a Asherman's Seal is heavily advised, then the patient should be transferred to the medbay for surgery. This done, extreme care must be taken of the organs when removing the bullet, especially if an organ has been punctured. Time is of the essence with a punctured organ, as it's only a matter of time before it collapses if left untreated.
Stab wounds should be treated in a similar way to bullet wounds, with the blood flow stopped by bandages or gauze, with an Asherman's Seal in the case of a chest wound. The main difference is that you won't have a bullet to remove, the size and the nature of the wound. For example, a knife may slice downwards or across, making a longer cut, while a bullet will only penetrate.
Before you do anything to your patient, these are essential:-
Steralisation - This means your tools, surgical table or other platform, hands and your head must not be able to transmit an infection. Ensure that your tools have been cleaned with antiseptic or disinfectant. The last thing you want to do is try to fix one problem and end up giving your patient another in the form of an infection. Your surgical table must also be sterile for the same reason, and with regards to the head, your mouth and nose should be covered and any hair tied back out of your face and covered. Always ensure any wound exposed to the air is thoroughly steralised.
Safety - Any sharp or otherwise dangerous tools should be out of easy reach for your patient. This is to prevent unnecessary injury to either of you, accidental or otherwise. This means scalpels, syringes containing large amounts of any given drug and so on.
Consideration - At the end of the day, you might be helping save their life or saving them a huge amount of unnecessary pain, but that doesn't mean you have to be an arse about it. A considerate medical practitioner is far more likely to have compliant patients than one who treats their patients in a cruel fashion.
Surgery:
Regardless of what else you might need, including a mixture of the above, you will almost always need either a local or general anaesthetic.
Local Anaesthetic - This is used to make an area completely numb, so that you can operate on it without the patient feeling anything while you operate. Lidocaine is a commonly used local anaesthetic.
General Anaesthetic - This is used to render the patient unconscious and unable to feel any pain while you operate. This is good for anything that requires complete precision, such as working on a lung. Etomidate is commonly used.
Brief Blood Vessels:
Blood vessels: These transport blood throughout the body, they come in three main kinds, arteries, veins and capillaries.
Arteries: These blood vessels transport blood away from the heart. The arterial system has the highest pressure of all the different kinds of blood vessels, which is the reason for the 'spurting' most individuals associate with a severed artery. Best practice is to apply pressure if other injuries are present and require more urgent attention. Once the more urgent injuries have been dealt with, suturing the artery to prevent blood loss or clotting agents are advised, such as Quikclot.
Veins: These blood vessels transport blood to the heart. The venous system isn't so high pressure as the arterial system, and as such it can be harder to tell when a vein has been hit, due to the lack of obvious blood squirt or similar. This type of blood vessel should be treated in a way similar to arteries.
Capillaries: These are the smallest blood vessels, which allow water, oxygen, carbon dioxide and other nutrients to be transferred between the blood and surrounding tissues. Due to the small nature of these blood vessels, it is near impossible and highly impractical to attempt to suture them closed. Cauterisation is advised.
