[Approved] Surgery

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[Approved] Surgery

Postby Rose Greenwood » Mon Jan 22, 2018 5:16 pm

Name: Surgery
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Surgery is the skill associated with treating illnesses, deformities, or wounds by utilizing different surgical methods. These methods can range from carefully administered stitches to the amputation of a major limb. Often these methods involve the use of tools and specialized instruments such as scalpels, forceps, or saws. Skilled surgeons are a rarity within Idalos as it requires access to resources and knowledge in order to be successful in this field. A clean workplace and sterilized tools are a must if the surgeon is to avoid killing the majority of their patients. Although the source of infection is not well understood in Idalos, it is known that patients can become incredibly ill after surgery if the incisions or the surrounding environment are not kept hygienic.

Technique, knowledge and cleanliness are the three pillars of an effective surgeon.



Types of Surgery



Minimally Invasive Surgery *Available at Novice
This type of surgery rarely involves endangering the patient as there is less pain and a lower risk of infection associated with it. Administering stitches or making small incisions to treat illness or wounds is covered under this type of surgery. Examples of Minimally Invasive Surgery would include removal of potentially hazardous growths from the skin, lancing boils, or stitching a laceration.

Amputation * Avaliable at Competent
Amputation consists of the surgical removal of digits or limbs from the body of a patient. Amputation is sometimes the only way to save the life of a patient; either due to gangrene or extreme damage to the limb. With amputation the surgeon should always anticipate the possibility of the patient dying from blood loss during the procedure. Preparations must be made in order to prevent loss of blood.

Invasive Surgery *Avaliable at Expert
Invasive surgery involves any type of surgery that requires highly invasive means in order to treat the patient or diagnose a condition. The chance of infection is very high with this type of surgery so the surgeon must be meticulous in sanitizing the surgical space along with the incision site. Blood loss is also common with invasive procedures. A more common example of Invasive Surgery might include the removal of a tumor or locating sites of internal bleeding that require cauterization or suturing.

Experimental Surgery
*Available at Master
As surgical techniques improve over time the master surgeon can begin experimenting with new methods of surgery that have never been attempted before. As the surgeon is breaking new ground they will be faced with a mixture of failures and successes. However, successfully created surgical techniques will enhance the field in far reaching ways. As surgical technology is still in it's infancy in Idalos, new methods and development to existing methods are being discovered every trial. Innovative masters in the medical field along with those blessed with divine inspiration are working tirelessly to solve health issues that have baffled healers for arcs.


Surgical Skills

*The development of new surgical skills is always ongoing. New skills can be added as the field advances.


Suturing *Avaliable at Novice
Sometimes known as stitching, suturing is the simple act of sewing wounds and incisions closed once they have been disinfected and treated. Suturing greatly minimalizes the chance of a wound becoming infected and helps accelerate healing. A well administered set of stitches will also help prevent potential scaring.

*Note on Suturing: The Raft (Credit to Faith & Padraig) : The Raft is a type of waterproof bandage that was recently developed in Rharne during Zi'da 716. It is made of a gel-like substance that promotes healing and staves off infection when applied. It can be used as a superior replacement for stitches where it is available. Availability for this item will be increasing over time as the formula becomes more well known.

Preventing/Stopping Blood Loss* Avaliable at Novice
There are many methods for preventing blood loss but the most common way is to simply apply pressure to the wound or incision site. This can be achieved with hands or a tourniquet of some kind. Additionally substances with styptic (anti-hemorrhagic) properties can be used to slow or stop bleeding. An example of a simple styptic agent would be cornstarch. In rare cases where hemorrhaging must be stopped quickly and there is no time to use gentler methods, cauterizing can be used to stop excessive bleeding. This method is not always advised since it is often very painful for the patient.

Sanitizing a Wound/Incision Site*Avaliable at Novice
Methods for sanitizing a wound can be incredibly varied depending on the skills of the surgeon. The simplest way to sanitize a wound or incision site is to thoroughly wash the area with clean warm water and a freshly laundered cloth. This method does not guarantee protection from infection but it does remove some of the risk. Other methods can involve the use of herbs with sanitizing properties or other chemical compounds.

Treating Broken Bones
*Available at Competent
The setting of bones typically involves the surgeon manually manipulating the fractured bone in order to align the pieces that have been damaged and dislodged. This skill can take both a fair amount of strength and a delicate touch to accomplish successfully. Once the bone has been set it can then be set into place for healing by either a brace or a cast. Immobilizing the bone after being set is of utmost importance if the limb is to heal correctly. If treated by an unskilled surgeon, sometimes the bone can grow back incorrectly and become malformed. In this case another more capable surgeon should be tasked with re-breaking the bone in order to set it correctly.

Sedation *Avaliable at Expert
Sedation involves the use of chemicals to induce unconsciousness in patients. Sedation is typically used to render the patient unconscious so surgery can be performed painlessly. Use of sedative chemicals or compounds must be done with extreme care since these substances can very easily kill a patient if given in excess. Additionally the surgeon must take into account that their patient may wake up during surgery if they do not give them enough of the sedative to begin with.

Blood Transfusion *Available at Master
This skill is a rarity among surgeons in Idalos as it has only recently been discovered and successfully tested. The master surgeon is only able to successfully utilize this skill due to their ability to ensure completely sanitary conditions during surgery. Additionally the surgeon must have the skills to ensure that the blood type of the patient matches the blood type of the donor. It is now understood that not all blood is the same; if incompatible blood is used then the patient can become extremely ill or potentially die. Typically tools such as needles and tubes are required to accomplish a successful blood transfusion.




Complementary Skills

Endurance: Endurance will aid in keeping a tired surgeon on their feet.

Discipline: Allows the surgeon to stay focused; in the heat of a battlefield or during a delicate procedure.

Detection: The surgeon is better able to notice changes in vital signs and locate problems during surgery

Gardening
: May provide the surgeon with knowledge associated with plants and their uses as sedatives or antibacterial cleaning agents.

Medicine: Assists with diagnosing problems that may require surgery.

Needlecraft: Suturing is made cleaner and more uniform; enables the surgeon to leave fewer scars.


Chemistry : Useful in creating chemical agents for use in sterilizing tools and the surgical work space. Additionally, chemistry is key in creating sedatives and painkillers that can be used to reduce the physical stress of surgery.

Alchemy: Much like chemistry, alchemy can be used to create a great variety of substances that can be used as sedatives or painkillers. Beyond that the alchemist can create equipment that may better serve the surgeon that normal surgical tools.
Alchemy:



Novice: 0-25

The Novice surgeon is capable of performing minimally invasive surgeries. Infections can be very common if the novice does not work ceaselessly to keep themselves and their tools clean. Due to inexperience, patients are more prone to bleeding excessively under the care of this surgeon. Some might consider it preferable to avoid treatment altogether rather than face the scalpel of the novice. Suturing is done with little concern for preventing scars, so stitches are often messy and lacking in uniformity. At this level the surgeon only understands the very basics of preventing blood loss. The use of tourniquets is sloppy and ends up failing half the time. The novice is only versed in sanitizing wounds and work areas with boiled water and freshly laundered cloth. The use of chemical agents for cleaning is typically beyond the knowledge of this surgeon.

Competent : 26-50

At Competence the surgeon has become much better at keeping their workspace and tools sanitary. Now patients run a much lower risk of become ill from infection following their surgery. Now that the surgeon better understands the importance of a clean workplace they may now begin using antiseptic components and chemicals to further prevent the chance of infection. The risk of blood loss has lowered and the surgeon has become competent at stopping blood loss more easily should it occur. The competent surgeon can now successfully amputate fingers and toes to prevent conditions such as gangrene or frost bite from damaging the limbs. Keep in mind that amputations will be painful since the surgeon does not yet understand the delicate nature of using sedation on their patients. Attempts to amputate larger limbs will almost always result in death. Stitches will now be more uniform and straight, allowing wounds to heal cleanly and lessen the chance of scaring. Competent surgeons can now successfully set bones and prepare them for healing with the use of a cast or brace. Due to inexperience these surgeons may run the risk of incorrectly aligning bones from time to time.

Expert: 51-75

The possibility of infection has reduced to the point that patients often survive surgery without any complications. The expert surgeon is absorbed with cleanliness. Blood loss and scarring from incisions or stitches are a rare occurrence. It is at this stage that the surgeon is capable of successfully amputating any limbs with little difficulty. Additionally the expert surgeon can begin experimenting with more invasive surgeries. Invasive procedures will be met with many difficulties as the surgeon learns techniques associated with such risky operations. At this level the surgeon can use sedation to make the surgery much less painful for their patients. From time to time the surgeon may administer the incorrect dose of sedative and run the risk of killing their patient or allowing them to wake mid-surgery. Setting bones has become commonplace for the expert surgeon. Only rarely does the surgeon mistakenly misalign a fractured bone.

Master: 76-100

Through careful preparation the master surgeon is capable of maintaining a pristine clinical environment that guarantees the complete prevention of all infections. The chance of blood loss is almost completely mitigated due to the sheer skill of the surgeon. If blood loss occurs the master surgeon can easily stop the blood flow with very little effort. With the perfected use of sedatives they have rendered surgery nearly completely painless. Patients rarely if ever run the risk of dying from sedation or waking up during surgery. The master surgeon never scars or maims their patients as they have an incredibly delicate touch and impressively nimble hands. The technique used in setting bones has become perfected as the master surgeon is always successful in setting a fracture. Blood transfusion can be accomplished at this stage, although this procedure will always carry the risk of the patient dying or become very ill the surgeon does not take every precaution. All forms of surgery come easily to this surgeon. As such, the master can begin developing new surgical techniques via experimentation. Experimental surgery will be fraught with trial and error but through careful study and experience the master surgeon is capable of pushing the field ever forward.
Credit: Rose Greenwood
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Surgery

Postby Rose Greenwood » Mon Jan 22, 2018 5:17 pm

I feel like I need to beef up a few descriptions and maybe add a few more types of surgeries and skills. Let me know what you guys think and please feel free to give me your suggestions.

EDIT: Also I want to add a complimentary skills section. I know Medicine will be there but let me know what else might work well with Surgery.
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Surgery

Postby Faith » Mon Jan 22, 2018 5:37 pm


Hi Rose!

Sorry - you must think "Oh no, not her again!" - but just a few things, really. And again, just my thoughts.

1. Again, I really like the write up - how you've done it is well written. I haven't read it with a "proof reading" head on - but would be happy to. In answer to your question of what skills are associated - I can only speak from my experience of playing Faith.
Endurance - surgeons spend hours on their feet - endurance helps
Discipline - keeping focused on what they're doing, even in a raging battle.
Detection - tiny details, careful measurements.
Needlecraft - stitching :)

2. In this post of my CS, I keep record of Faith's medicine / surgery stuff. The two things that might be of interest to you there are "The Raft" - that's something that she created with Padraig, It's a clear sort of "gel-like" bandage replacement. It gets put on the skin, then it dries to a sort of rubber/skin consistency. It's waterproof, the ingredients fight infection and it holds wounds together which would traditionally need stitches. Also - there's the whole "blood transfusions" thing too - now, that's definitely a very high level skill but Faith based her whole Charter in Medicine around it. Might be of interest to you - both of these things are things she's shared with both the academic community AND the Order of the Adunih, so they should be getting more and more available. Note, though - that blood typing is a GM Capstone of hers and we don't yet have a means of working that out.

I hope those help - please feel free to ignore!

~Faith.
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Surgery

Postby Rose Greenwood » Mon Jan 22, 2018 5:58 pm

Actually I was really thinking of your PC when I decided to write this. So I was really hoping we could hammer this out together. I would love to add some specifics like you mentioned in your CS. I'll take a look tomorrow. Cheers!

EDIT: Complimentary Skills Added : Many thanks Faith!
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Surgery

Postby Rose Greenwood » Tue Jan 23, 2018 9:02 am

Hey Faith, I've been reading up on your threads about blood transfusion. I know your PC has transfused blood/platelets with the aid of Famula but do you have an example of this being achieved using normal medical tools?

Btw I added a section under Suturing about The Raft :) Let me know if this will work.
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Surgery

Postby Faith » Tue Jan 23, 2018 9:13 am

I love the bit about the Raft - thank you.

I'm glad you like the complementary skills - they're the ones I've found happen - I'm sure there might be others but those are the ones that have worked for Faith.

As for and example thread. Yes indeed! this one with Ronan - hope that helps!

I really like where you've gone with this write up. Umm, trying to think of techniques - one of the things that Faith has done is cure "The Rot" - that was done by cranial acupuncture with sub-zero instruments (lots of threads! all linked here ) - so it's a pretty specialised technique.

Then, I guess the only other thing (and I don't know where it fits) is the beginnings of Epidemiology that she's been studying. Patterns of diseases, etc that led to the cure of Lightbane (also linked in that post from my CS above) because she found out the cause. Don't know if that sort of thing fits in Surgery, really, but just trying to think of things that might get included.

I wonder whether the setting of broken bones and / or treatment of severe burns might fall under the surgery skill?

Would you like me to have a "editing" proof read?
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Surgery

Postby Rose Greenwood » Tue Jan 23, 2018 9:25 am

Go right ahead and give it a proof read. Thanks! I know I can sometimes get tangled up in the correct phrasing of an idea, so there will probably be a few things to refine. Not to mention grammar/spelling mistakes.

I could definitely see where setting broken bones might fit. I'll add it to the write-up. Treating burns may fall under Medicine since they might be treated with medicinal compounds rather than surgery. I'll also take a look at the Rot cure. I've read it in the past, but not in depth. Thanks!



EDITS: Also have you thought about having the Raft added to the Price List or to the First-Aid kit? Not sure if you have done so yet. But it seems crazy useful.

As for The Rot, it may simply fall under Invasive Surgery. Let me know what you think.

Thanks for these suggestions!
-Treating Broken Bones has been added.
-Blood Transfusion has been added at Master
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Surgery

Postby Faith » Mon Feb 12, 2018 6:06 pm


Hi Rose!

So, I've been thinking about this in terms of longevity of the site / write up etc. Surgery - like all skills, I guess - is one of those things where people will continue to push the boundaries and where new things will happen.

I wonder, then, if it might be worth considering, at Master level, having "Cutting Edge Surgery" (probably very badly named!) or "Experimental Surgery" or something like that. The sort of surgery which isn't a known technique, basically?

What are your thoughts? Just an idea - and I'm certainly not married to it.!

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Surgery

Postby Rose Greenwood » Mon Feb 12, 2018 6:48 pm

Hi Faith, thanks for the great feedback. I am totally on-board with adding that skill, It would certainty facilitate new methods. I'll probably go with Experimental Surgery.
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Surgery

Postby Maltruism » Tue Feb 13, 2018 1:26 am

Hey there.
I'm impressed with how fast you added in the proposed changes to your text. :D

I'd give a nod to chemistry and alchemy as being able to give beneficial properties to both the damaged bodily structures being operated on, and the equipment being used. As well as being the source of the sedatives, analgesics and sterilizing agents used.

I'm also thinking that rather than try to guess what other sort of higher-level techniques may or may not be reasonable to consider adding references to, I'd go with a sort of disclaimer comment after the "Experimental Surgery" entry, like:

"Although medical technology on most of Idalos is still largely unenlightened; new techniques, and enhancements to existing techniques, are being explored and developed every trial. Innovative Masters of this and other medical skills, as well as those blessed with divine inspiration, are inventing new approaches to numerous health issues that have stymied healers for arcs.

It gives a sort of nod to the maxed-Master level being where Grand Master innovations are likely to come into play; as well as Blessings granting skills not likely to be known to mortal medics.
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