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A whole bunch of medical ideas
#1
Oh look it's Mouse with yet another thread.

So medicine on goon is pretty in-depth, apparently more in-depth than on other servers (although I don't play on them so I don't know for sure), and that's a good thing.  It helps make treatment fun.  Still, I feel there's room for improvement or expansion of existing concepts and mechanics and I figured rather than make a bunch of threads I'd make one.

There's, uh, gonna be a lot.

1) Medkits.  Of the six commonly available medkits in the game, three are solid (first aid, brute, and burn) and three are pretty barebones (toxin, oxygen deprivation, neurological damage).  Brute and burn kits both got revamped pretty recently, so there's precedent for changing the contents of medkits.
a) toxin kits - currently, toxin kits have three charcoal pills (50u), two syringes of charcoal, and the obligatory health analyzer.  50u of charcoal, however, is ludicrous overkill.  If you have enough TOX that you need 50u of charcoal to clear it, then you have so much TOX that you're dead without additional treatment.  Also, people keep eating all the pills and it annoys me.   You could just tone the size of the pills down, but I feel like it might be a good idea to introduce additional TOX meds.  Now, not much cures TOX damage among commonly available meds, so there's not a lot of options.  Potassium iodide was reworked to heal TOX recently, and replacing at least one of the charcoal pills with a potassium iodide pill would probably be a good idea.  Epinephrine also treats TOX if you're within a certain health threshold, and when you're treating TOX it's quite common to be treating someone in crit because it's harder to notice.  My suggestion for a reworked toxin kit would be three syringes of charcoal, two 20 or 30u pills of potassium iodide, an epinephrine autoinjector, and of course the health analyzer.
b) oxygen deprivation kits - Current contents are four or five (I forget the actual number) salbutamol pills (20u if I'm not mistaken), and the health analyzer.  Thing is, if you're treating OXY then the patient is almost certainly going to be in crit, and thus potentially in cardiac failure.  Just toss one or two epinephrine autoinjectors in there, easy.  They can also treat OXY on their own, although it's RNG.
c) neurological damage kits - current contents are some mannitol pills and the health analyzer, although there there's not really any other options.  I suppose you could toss in an epinephrine autoinjector just so all the kits have one, but while you can use epi in a pinch to treat or help treat BRUTE, BURN, TOX, and OXY you can't really use it to treat BRAIN.  I'd leave this one as is.

2) Medicine reworks.  Quite a few medicines in the vendors are very seldom, if ever, used.  While I'm not opposed to medicines with only a single real use being in there (spaceacillin and insulin are lifesavers in the rare cases where you need them), there are some that aren't even good at what they're supposed to do.  But before I talk about those I'd like to talk about
a) Synaptizine - Synaptizine was recently added to the vendors.  While it's nice to have a more reliable source of it, it's not really a medical drug.  Sure, it's got a 50% chance of -1 BRAIN, but most of what it does is stun resistance and stamina buffs.  It doesn't really make sense to show up in a nonhacked vendor.  My suggestion would be to either simply require the vendors to be hacked before it became available, or to tweak synaptizine more to make it have a greater medical use.  Google says it's taken from Star Trek, where it was used to treat "neuroleptic shock", which probably isn't a real thing but it clearly has something to do with the brain.  To give it a niche outside of mannitol, perhaps have synaptizine be one of those chems that heals more at a threshold.  If BRAIN damage is greater than some number (70 or 80, maybe?) then it heals BRAIN better than mannitol does, otherwise it's the 50% of -1 BRAIN.  I like the thresholds, which will become apparent later.
b) heparin - In theory, heparin treats blood clots and high blood pressure.  In practice, this doesn't happen much and frankly it's far worse at treating high blood pressure than an IV set to draw or surgery to spill the excess blood.  I can't suggest much here, however, because I'm not entirely sure how it even works now.  Even the overdose appears to be a one time thing, not a constant.
c) proconvertin - Proconvertin is worthless.  5% of -1 BLEED is atrocious even in a vacuum, and styptic and synthflesh will rapidly stop all bleeding.  Now, a buffed version of proconvertin would be useful if internal bleeding was a thing, since topical solutions aren't exactly going to work there, but it's not.  Closest analog would be organ damage, so it might be worth having it treat that.  Honestly I'm kind of at a loss with this one.
d) ammonium bicarbonate (smelling salts) - Mostly a stamina buffer, really.  The threshold where it actually heals is ridiculously narrow (-5 to -30), so it's not even useful in the "pump the patient full of everything and hope for the best" stage of treatment.  Perhaps have it shorten the stun timer on ingest, or flush chems that cause knockouts?  Smelling salts as a ling victim treatment would be interesting.
e) morphine - If you have access to morphine, you're probably in medbay and don't need to worry about the movement slowdown from injury anyways.  Sure, it helps with surgery but that's not that major.  There is precedence for painkillers healing damage (salicylic acid has a 55% chance to heal 2 BRUTE), so why not add some healing as well?  To further cement morphine as more of an emergency thing, perhaps the healing would only occur at a low health threshold (crit, probably).  More options to help stabilize horribly injured patients are always nice.  A sufficiently good doctor is already really only going to lose a patient if they succumb or get a bad rng roll, so I don't see much of a problem with methods for talented doctors to pull people out of deep/mid crit faster.  Patients will die less, yes, but most of those saved lives should be unlucky deaths which simply aren't as fun for anyone.


3) More vendor meds.  There's a few chems with medical uses that don't show up in the medical vendors.  They aren't that great, but they're in the game and can be helpful in a pinch.  I don't see the harm in letting them get used for often.
a) Menthol - basically the BURN counterpart to salicylic acid, minus the painkiller effect.  That said, in real life menthol does have some analgesic properties, so perhaps I should have put this in the previous section as well and suggested it get a weaker version of the painkiller effect that salicylic acid has.  As long as I'm making suggestions about menthol, I should add that it should penetrate skin.
b) Ephedrine - While it's riskier than epinephrine and can't fix heart failure, it can heal damage out of crit randomly as well as heal damage in mid/deep crit.  (Epinephrine heals 1 TOX, BRUTE, and BURN between -10 and -65.  Ephedrine heals 1 BRUTE and BURN and has a 50% chance of healing 1 TOX under 0 health, and has a 33%/33%/8% chance of healing 1 BRUTE/BURN/TOX above 0 health.)  It's useful as part of a cocktail when dealing with deep crit patients, and I'd like to be able to use it more in the field as opposed to relying on what sleepers will inject.  Also stimulant use, misuse, and abuse is ridiculously common among medical professionals as a result of extremely long shifts and ready access to medication so there's roleplayer opportunities there.  Maybe require the nanomed to be hacked before it will be dispensed?

4) More ways to cause and cure organ damage.  It's not all that common - short of a shotgun rampage (and the organ damage from that is new as well) you'll basically only ever run into liver failure from drinking or appendicitis from the random event.  There's a lot of poisons in the game, and adding organ damage to them might be a nice way to distinguish them.  In fact, there's a particular one I want to talk about!
Amanitin - Now, causing a stack of TOX when it expires relative to how long it's been in there is a pretty elegant way of simulating how amanitin kills in real life - initial symptoms are relatively mild and will vanish reasonably quickly.  By the time severe symptoms show up, catastrophic organ failure is already underway.  Thing is, we now have organ damage in game, and short of being health scanned you aren't going to be getting messages about organ damage until they're nearly dead.  The way organ damage works essentially replicates the way amanitin works in real life.  Amanitin is essentially the perfect poison to have work via organ damage.  As an added benefit you will no longer be able to forestall amanitin death by consuming more amanitin.

5) Potential medical uses for poisons.  The dose makes the poison, as the saying goes.  Many poisons have potential medical uses, even if dangerous ones, in real life.  Now, I don't necessarily want to go the atropine route where it mainly heals below a threshold and mainly harms above one - poisons in general should remain lethal.  However, I feel adding potential medical uses for some might both give doctors more options for treating things as well as giving traitor doctors an excuse for carrying around that bottle of, say, pancuronium.
Curare and pancuronium - While reading about tetanus in my free time, I learned that curare and related compounds can be used to treat the convulsions resulting from tetanus.  While tetanus isn't in the game, a poison that causes convulsions is: strychnine.  And, wouldn't you know it, you can also treat strychnine poisoning with curare!  So my idea would be to have curare and pancuronium rapidly flush strychnine, like how atropine flushes sarin or epinephrine flushes histamine.  Of course, you'd have to very carefully manage the dose to make sure you don't end up killing the patient.  But hey, if security suspects you and someone who totally isn't you has been penning people with lethal doses of strychnine, you have an excuse for the bottle of pancuronium in your backpack.  Plausible deniability is fun, even for security.

6) More healing under/over/between health threshold stuff.  I ended up covering all the examples/suggestions I had earlier but I just want to reiterate that I like this and I think it makes doctoring more fun.

I may edit this post or make a new post in the future, it's quite possible I've forgotten some of the things I wanted to suggest/talk about.
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#2
While we're on the subject, maybe a way to dispense specialized meds besides the first-aid kids? Currently getting things for medical boils down to "click thing on really unsorted list that has basically everything". That's a pain in the ass with the sheer amount of medical items, and you often need one of them right away. IE just a wall-mounted machine that refills your auto-mender or dispenses patches when clicked, no UI. Stuff along those lines.
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#3
I remembered some of the stuff I wanted to put but forgot when I was actually writing the thread so here's a bit more.

7) Nuke ops high capacity autoinjectors should be the same color as the regular emergency autoinjectors.  It makes it a lot harder to treat people in combat when you have to mouseover every autoinjector to know which one it is, and combat medic is already a pain in the ass.

8) Make blood move from your bloodstream to your bloodstream faster.  Hold on, let me rephrase that.  Make blood (the reagent) move from your bloodstream (your internal reagent container) to your bloodstream (your blood total) faster.  That's still not great.  Anyways, blood transfusions are kind of tricky to use well, to the point where it's probably better to just go with filgrastim and saline.  Blood leaves the blood bag a whole lot faster than it gets added to your blood total, which means that a blood transfusion is not actually a particularly fast way to get blood back in your veins.  I don't have the numbers so I don't really know quite how it works (I'm not even sure if, after everything is done and there's no more blood in your reagent container, there's a 1:1 ratio between "blood injected in you" and "blood regenerated"), but I do know that people tend to overshoot dramatically, keeping the blood pack in until the patient is at a safe level of blood.  Which is how it should work, but in practice this just results in someone with a healthy blood level and a whole lot of blood in their reagent container, which will, over time, push their blood level to dangerously high levels.  Knowing the actual numbers as to how this works would help, but I don't and they're not on the wiki so the best I can do right now is type blood way too much and confuse myself.

9) Bandages should be more useful.  They're cool, still included with medical stuff (the nukeops combat medic gets two full rolls, for instance), and are never, ever used.  Because, as I noted earlier, styptic powder and synthflesh will rapidly heal all bleeding.  In addition, in any situation that you could bandage someone, you can also use a suture.  Sutures are infinite use and, in my experience, suturing seems to complete faster than bandaging does, especially if the person being sutured is on a bed or operating table.
One possibility here is to make it so suturing only works in situations where you could perform surgery.  If someone's standing up they're just squirming too much to safely stitch them up.  Of course, that doesn't really deal with the styptic/synthflesh issue, and I'm not totally sure how to go about doing that.  Possibly introduce a bandaged status effect that heals BLEED over time, so people will be resistant to bleeding after being bandaged.  Perhaps it could also heal some BRUTE over time, giving you an option for dealing with minor injuries that you don't want to waste a patch on.  Bandage yourself up and let natural healing take over.  Wouldn't really get doctors to use them more, what with automenders, but maybe staffies will find a use for them then.
That said, you could always just treat bandages as obsolete and relegate them to the dusty first aid kits.  As neat as they are, this might be the best solution.
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#4
I made a few PRs addressing some of these things!

https://github.com/goonstation/goonstation/pull/1244
https://github.com/goonstation/goonstation/pull/1243

Any thoughts?
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#5
Gerhazo brought it up over there that pentetic acid is way too good to be in a common medkit and I agree. I'd replace it with a syringe of charcoal or a charcoal autoinjector myself. If your synaptizine change goes through it might be worth putting an autoinjector of that in the neurological damage kit.

Not sure I agree with synaptizine's OD injecting people with raj. I'm not totally convinced people pumping themselves full of it would be a problem in the first place (How often do you see someone fill themselves with perf, and that's easily synthesized en masse?) and a secret chem is a bit too punishing and/or exploitable.

While I like the idea of something that cuts down on death rolls, I don't think morphine is the right drug for it. One idea would be to have that not be a drug but rather a function of the sleepers/portamedbay. If you want a drug, however, in real life there's research into ways to cool bodies down without ice crystals forming in the cell, in order to drastically slow down metabolic processes. Some new derivative of cryoxadone, or simply cryoxadone itself as long as you're really cold, would work.

Menthol doesn't necessarily need a TOUCH effect to be used in patches, since it will still introduce menthol into your bloodstream.

Overall very nice, though.
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