Surgery & Procedures

Some treatments are not a progress bar, they are played. Suturing, IV and IO access, the field procedures, the chest procedures, skin grafts and every operation at the surgery table are short hands-on minigames with a mistake counter.

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🧵 SuturingCopy Anchor Link

Patient Care → Suture Wound on a deep wound (level 2+), once the bleeding is controlled.

Drag from the upper mark straight across the wound to the lower mark, one stitch at a time.

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💉 IV accessCopy Anchor Link

IV medicines and blood transfusions need an IV line. The first time you give one, you place the line:

1. Tourniquet: hold E to tighten the strap above the elbow and press SPACE to tie it when the tension is in the green. Too loose and the veins do not fill, too tight and it cuts off the arm: both are mistakes.
2. Click one of the veins you can see.
3. Clean the site: hold the left mouse button and rub the alcohol pad over the circle until it is clean.
4. Press SPACE when the needle angle is in the green band (15–30°).
5. Hold SPACE to push the needle in, and let go as soon as blood shows in the chamber.
6. Hold E to slide the catheter into the vein. The tourniquet comes off once the line is in.

Steps 1 and 3 can be switched off with Config.Procedures.ivPrep = false in shared/config/treatments.lua; the game then starts at the vein. Minigames can also be turned off for the whole server (Config.UI.minigames = false) or for one department (easy mode).

A placed line stays in for 30 minutes. Every IV drug or bag given during that time goes straight through it, and each one keeps it in for another 30 minutes.

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🦴 IO accessCopy Anchor Link

A downed patient gets an IO line instead of an IV when you carry an io_needle, a needle drilled into the shin, for when no vein can be found. $180, the needle is used up.

1. Click the flat inner face of the shin, two finger widths below the bump under the kneecap.
2. Move the mouse to bring the drill square to the bone, then click.
3. Hold SPACE to drill, let go the moment the bone gives way.
4. Hold F to flush the line.

The line stays in just like an IV line. 3 mistakes and the attempt fails, nothing is used up.

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🚑 Field proceduresCopy Anchor Link

Played at the roadside. Each allows 3 mistakes, and a failed attempt costs the patient, see Treatments.

SplintCopy Anchor Link

1. Hold the left mouse button on the hand or foot and pull it slowly to the right to straighten the limb.
2. Move the splint so it reaches past the joint above and below the break, then click.
3. Tap SPACE to wrap it on.

Pelvic binderCopy Anchor Link

1. Drag the binder (or W / S) until it sits over the hips, then press E.
2. Hold SPACE to pull the strap. Keep it in the green, then press E to clip it.

IntubationCopy Anchor Link

Unconscious or sedated patients only. Advanced airway permission (rank 1).

1. W / S moves the blade in and out, hold the left mouse button to lift. Bring the vocal cords to the middle of the screen.
2. Keep the view, move the tube tip between the cords and click to pass it.
3. Hold SPACE to inflate the cuff into the green, then press E.

A failed intubation uses up the kit.

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🫁 Chest proceduresCopy Anchor Link

In hospital only. Chest procedures permission (rank 2). Same 3-mistake limit. See Trauma & Life Threats.

Chest drain, $600Copy Anchor Link

For a collapsed lung.

1. The arm is up. Click inside the safe triangle: below the armpit, between the two muscle edges, above the nipple line, between two ribs.
2. The nerve and vessels run under each rib, click right on top of the rib below.
3. Hold W to slide the tube in until the depth is in the green, then press E.
4. Press Q to unclamp the drain and watch the bottle.

Pericardiocentesis, $800Copy Anchor Link

For blood around the heart.

1. The needle goes in just under the breastbone. Turn it with A / D to point at the left shoulder, then press E.
2. Hold W to advance, S to pull back. Stop as soon as the tip is in the black fluid, never touch the heart.
3. Hold SPACE to draw the fluid off. The heart comes back towards the needle, ease back with S.

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🔥 Skin graftCopy Anchor Link

Excision & Skin Graft · $1,500 · hospital · Surgery permission. For a deep burn (level 2+), on an unconscious or sedated patient.

1. Hold the mouse at the left edge of the lit strip and draw the blade across at a steady speed. Too slow digs in, too fast leaves dead tissue.
2. Same steady pass along the thigh to take a thin sheet of skin.
3. Move the graft over the wound bed so it covers all of it, then click.
4. Click each marked point to staple the edges.

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🏥 The surgery tableCopy Anchor Link

Station: Surgery Table · $2,500 · Rank 3+ (Surgery permission)

The table looks at the patient and builds an operation plan, one procedure per problem, each played as its own minigame, one after another.

If there is nothing to operate on, the table tells you so and nothing is charged.

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🎯 Bullet extractionCopy Anchor Link

1. Hold SPACE to open the wound, keep the tension in the green band until it is fully open.
2. Hold the left mouse button on the green mark and guide the forceps to the bullet without touching the wound edges.
3. Keep the forceps on the bullet and hold SPACE to grip it.
4. Slowly pull it back out through the green mark.

Pull too fast and the bullet slips out of the forceps. Touch the edge and the wound bleeds.

Result: foreign body removed, wound closed.

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🔩 Fracture fixationCopy Anchor Link

1. Hold the left mouse button on the green mark and cut along the line.
2. Drag the plate onto the bone so it bridges the break.
3. Hold SPACE to drill each screw, let go while the depth is in the green band.

Too shallow and the screw will not hold. Too deep and you drill through the far side of the bone.

Result: the fracture is plated and screwed, healed on the spot, no cast needed.

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🩸 Bleed repairCopy Anchor Link

Done through a catheter, the way a real interventional radiologist would.

1. Hold W to advance the catheter. At a branch, pick the way with A / D and press W. SPACE shows the vessels again.
2. Hold SPACE to inject contrast and watch where it leaks.
3. Click the dark pool where contrast leaks out of the vessel.
4. Press SPACE when the marker is in the green band to place the coil.

Result: the bleeding vessel is sealed with a coil.

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⚠️ Mistakes & complicationsCopy Anchor Link

Each procedure counts its own mistakes. 5 mistakes and it fails.

Stopping the operation before the first procedure starts does nothing to the patient.

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📺 The theatre TVCopy Anchor Link

While you operate, an imaging screen next to the table shows your procedure live to everyone in the room, handy for training and for families waiting outside the glass.

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⚙️ SettingsCopy Anchor Link

shared/config/treatments.lua → Config.Procedures

Failure costs per treatment are the failure field in Config.Treatments.