Barotrauma The Europan’s Guide to Medicine and Practice (by Dr. Cargo – Ph.D)

The Rules of Practice

 
Rule Number 1 of Practice: Always try to save someone’s life, even if it brings risk to your own. 
 
You, as a medic, should put the health of your crewmates above all else. Every second that passes by where a crewmate’s health is in disrepair, is a second of failure for the Medical Doctor. You should always keep a diving mask on you, but its better to take two, or even more, in the all-too-common situation where a flood or explosion causes multiple people to go unconscious while underwater, you should hastily slap masks onto everyone who is incapable of breathing, and then once everyone is in a stable condition, perform CPR upon them, so they begin breathing again. Sometimes you may even have to sacrifice your diving suit and face certain death, just to save the life of someone else, most commonly, the Captain, or a close friend of yours. This rule doesn’t mean throwing caution to the wind, and jumping into poor situations, such as, running into a reactor fire to save a stunned engineer with 30% burns, instead of just getting a fire extinguisher and putting the fire out first. Or, attempting to perform a check-up on a security guard while he is at arms with a mudraptor. This usually ends with more injuries being added than subtracted. This caution is a good segue into Rule number 2 of practice: 
 
Rule Number 2 of Practice: DO NOT always try to save someone’s life when at risk to your own. 
 
This may seem contradictory, but sometimes, it is not worth putting effort into somebody. Sometimes, you will give up your only diving suit to somebody else, and then that somebody else who survived attempts to revive more people on the ship, but fail due to sheer incompetency. In a situation like this, it will be worth letting one dunderhead die so that you, the medic, remain alive to tend to the people who aren’t naturally selected. You should also know not to heal evildoers, like clowns or criminals, unless they are restrained first, and nobody else is in dire need. It simply makes you look bad, even if they are in handcuffs. You should also carry handcuffs in you in the case of bad actors in need of medical attention. You can easily make handcuffs in your ships fabricator with a simple bar of steel, being made of Carbon and Iron, which are plentiful on most ships. They usually take 9 seconds to make if your weapon skill is sufficient. Or, if your ship doesn’t have a fabricator, you can ask your ship’s security guard nicely, and if he or she is sympathetic, they just might cede you a pair of shackles. It is not necessary to “waste” resources on healing bad actors, but it will be benefit to your medical skill to at least keep them alive. 
 
Rule Number 3 of Practice: Try to conserve medical resources as much as you can. 
 
This one can be a real pain in the a*s. If your crewmates like fighting a lot, or excessively cause ruckus, it will drain your medical supplies faster than a mudraptor melts to raptor-bane. (which is like 10 seconds at worst.) So, as your sub’s medic, it should be your duty to try and keep violence to a minimum, and look for the most peaceful way forward. If diplomacy fails, then you can just bar people off from your medbay until they learn to behave themselves, which may not roll so well with security, but just might teach your crewmates a thing or two about roughhousing. Medicine is expensive, after all. Except Opium, that stuff is dirt-cheap. But more on that later. 
 
Rule Number 4 of Practice: Don’t cry over spilled milk (blood) 
 
Sometimes you’re gonna get a black eye on your medical record: Someone will die and it will be your fault. You need to accept this now, or you will never improve as a doctor. Whether it is bad ship design causing you to not know where your dying patient is, or be it the fact that you performed CPR on somebody with an empty oxygen mask, and didn’t realize until it was too late, you are gonna screw up. No medic is perfect, not even me. Learn to get over the obstacles and keep pushing onward until you reach the next outpost. If you want to be a doctor, but then you fail miserably and want to quit and be security instead, well, that’s your choice. But its like Churchill said, there is no victory without failure. Or maybe JFK. Or Plutarch or something, I don’t know. You cannot learn without messing up, basically, is what I’m saying. No matter how badly you screw it up, there is always a lesson to be learned in the field of medicine. 
 
 

How to Revive a Crewmate

 
When somebody is unconscious and not able to breathe on their own due to excessive pain from injuries, it is your job and yours alone to get them back on their feet. This can be as easy as a single syringe, or as brutal and traumatizing as 5 whole minutes of CPR. I know that CPR is your first thought when somebody won’t wake up and you don’t know why, But ~50% of the time I see it, CPR is actually only hurting the patient more. People chalk up their CPR failing to “Not having enough medical skill”, but that is very far from the truth. CPR, no matter how low your medical skill, should be able to revive someone who is not breathing, with the medical skill only making it marginally harder or easier to do it. So, lets go over the reasons why someone is dying, and the reasons why CPR does not work on them. Keep in mind, that sometimes some causes of death will encroach faster than others, and whatever is the most critical injury needs to be tended to first. 
 
Cause of Death #1: Blood Loss 
Probably the 3rd most common cause of death is blood loss, or, the patient not having enough blood in their system for their heart to continue beating. When somebody is afflicted with blood loss, Don’t perform CPR on them. It will only push more blood out of their body, on top of the blunt force trauma it ensues. If someone is dying from blood loss, transfuse them some blood, or a saline solution if no blood is available. But even before that, you should treat their bleeding wounds with bandages or antibiotics. If you are able to solve the blood loss in somebody, but they still aren’t waking up because they are not breathing, THEN do CPR. That is the correct time. 
 
Cause of Death #2: Barotrauma 
Water Pressure – The 2nd most common cause of death, in my opinion. It is extremely dangerous to humans, and will kill them in 5-15 seconds if they are not protected by a diving suit. That being said, if your patient is suffering from Barotrauma, there is not much you can do: Option A is to give them your diving suit and try to find another one. Which, as stated in Rule 2 of practice, may be not such a good idea. Or, Option B is to try and drag them into a room without the risk of water pressure. If one of these methods work for you, then great, you can go back to treating your patient. If not, then hopefully you didn’t give them your diving suit, because whoever is stuck without it is pretty much dead. 
 
Cause of Death #3: Suffocation 
And now, the grand daddy of death in the world of Europa, and your main obstacle in keeping your crew alive, is the oxygen problem. Your patient may not have enough Oxygen in them to remain alive, let alone awake. This is very common, even the most common cause of death among sub crews, but thankfully we have a special tool we can use to combat Low Oxygen: CPR. That’s right, It actually comes into great use when dealing with people who have suffocated to the point of unconsciousness. But there is one important rule to CPR that I absolutely HAVE to cover right now: CPR is useless if the patient has no air to breathe. Just remember that phrase and use your brain a little, and you can end up saving a lot of lives. I have seen WAY too often this situation: Someone in a diving suit is trying to do CPR on somebody without a diving suit. But they don’t realize that the room has no oxygen in it, because a fire in the reactor room burnt it all already. The supposed savior is only pumping smoke and carbon into the bloodstream of the patient, which certainly won’t help. Or, even more common, Someone is performing CPR on somebody else in a room with no oxygen, but the patient’s diving mask has an empty tank of oxygen. There is absolutely no air for the patient to breathe, it is a futile effort. Now, there is a second rule, that applies to not only CPR, but also to medicine in General, you will want to remember this one as well, even if you aren’t being a medic: Look in the patient’s inventory for items which might be useful. This mistake especially gets on my nerves when somebody comes across a dying person with ample medicine in their pockets that can be used to save their life, but instead they try and do CPR in a situation where it doesn’t help. This also applies to the previous situation in an important way: Oxygen tanks! If they have spare oxygen tanks, you can swap one over into their mask, THEN do CPR on them. Or better yet, being a medic, you should have spare O2 tanks on you for this exact type of situation. I will reiterate; sometimes some causes of death will encroach faster than others, and whatever is the most critical injury needs to be tended to first. So if your patient is losing a moderate amount of blood, but is about to suffocate to death from oxygen loss, then solve their oxygen problem FIRST, then their blood problem. There is also a common misconception that giving painkillers to somebody suffocating to death will only make them die. While it is true that Painkillers, being Pomegrenade Extract, Opium, Morphine Sulfate, and Fentanyl temporarily sap oxygen from your system, it is rarely enough to actually kill someone from suffocation. If they are on the brink of death and desperately need as much oxygen as they can to hold onto life, then yeah, hold off on the meds until they are more stable. But in most situations, even if someone is out of oxygen, it is still best to just give them the painkillers for their other ailments, THEN work on their oxygen. 
 
Cause of Death #4: Burns 
Burns are extremely common on Europa. Most Europans grow up without even knowing the concept of warmth, but engineers in coalition subs know the devil of warmth all too well. Burns are the easiest-to-treat injury ever, just slap bandages, or preferably plastiseal on them, and they disappear! The only way people ever usually burn to death on submarines, is if they go unconscious from the shock of burning inside a fire, or if they are caught in an explosion. For the 2nd case, not much you can do, but for the 1st case, you may in one case or another need to drag someone out of a room lest they burn to death. It is easy to get out of hand, but as long as you know where fire extinguishers are, fires won’t be near the top of your list for problems on the submarine. Also, make sure people don’t suffer too-harsh burns trying to repair junction boxes. Getting electrocuted trying to fix junction boxes is the most embarrassing way to die, and the ship’s doctor, the one trying to protect them, will have ample amount of that 2nd-hand embarrassment on their shoulders. Don’t let it happen, just give them some bandages from time to time. 
 
Cause of Death #5: Internal Damage 
Internal Damage is the most broad definition for damage that one can come up with. Internal Damage ranges from Blunt force trauma from falling, to Lacerations from knives, to Bite marks from crawlers, to Gunshot wounds from guns, to Organ failure from antibiotics, to deep-tissue injury from shrapnel of explosions, or even the damage you get from getting chopped up in the ship’s propeller. All of the above can only be solved with Painkillers, and a few other medicines. These being, in order of potency: 
Tonic Water 
Pomegrenade Extract 
Opium 
Morphine Sulfate 
Fentanyl 
Deusizine 
These are what you want to use, from a scale of a boo-boo from falling, to the absolute brink of death when it comes to internal injury. So make sure not to waste Fentanyl on a boo-boo, or to try and treat 135% gunshot wound damage with pomegrenade extract. 
 
Cause of Death #6: Everything Else 
CALYX INFECTION: Treat it with Antibiotics or find Calyxanide to cure it. 
POISON: Treat it with stabilizone, or find an Antidote. 
OVERDOSE: Treat it with stabilizone, or find Naloxone to cure it. 
PARALYSIS: Cannot actually kill you, but vegetates you. Anaparalyzant is the only cure. 
RADIATION: Cure with Antirad or you burn forever. (and ever.) 
 
 

Medicines, Drugs, & Substances Part I

 
This part of the instructions will teach you everything you need to know about your Tools as a physician. Without knowledge of this, you can get nothing accomplished as a Medic. 
 
Medicines 
 
Bandages 
 
 
Bandages are used to patch up bleeding wounds and burns. But it is a straight downgrade to Plastiseal, unfortunately. Still has utility in that you can deconstruct 2 of them to make an Organic Fiber, which can then be formed into a Toolbelt. But if your ship has a decent amount of supplies, there should already be Organic Fiber on board for you to make a toolbelt with. 
 
Plastiseal 
 
 
A better bandage. Simple as. Stock up on a lotta these if you want your crew to live long. 
 
Saline 
 
 
Saline is very useful. It is a straight downgrade to the Blood Bag, although, it gets its usefulness in the deconstructor, since it can make Sodium and Chlorine, The latter of which is useful in many crafting situations, such as Meth or Sedatives. Sodium is also useful for making Cyanide if that is what you want. 
 
Blood Bag 
 
 
Blood Bag is what you use if someone has lost too much blood. And that’s it. It is perhaps the most simple medical tool at your disposal. Again, you will need a bit of this, but not nearly as much as Plastiseal or Painkillers. 
 
Antibiotic Glue 
 
 
Antibiotic Glue is a straight upgrade to plastiseal in the bleeding department, being able to patch even the worst bleeds with just one use. Although, you will burn through these fast, and speaking of burns, they do nothing against burns, unlike plastiseal and bandages. It will also cause organ damage if improperly used. 
 
Painkillers 
 
Tonic 
 
 
Tonic Liquid is the least effective painkiller, only able to heal the mildest injuries, such as 4% blunt force trauma from falling, 2% lacerations from a failed mechanical repair, etc. It is best advised to save these up for crafting in the Fabricator instead of using them. Although they do have the added bonus of slowing down metabolism, allowing chemicals to persist longer through your body. 
 
Pomegrenade Extract 
 
 
Pomegrenade Extract is a mild painkiller with no addictive qualities, but will sap oxygen from the patient’s body temporarily. Although, to suffocate someone to death using Pomegrenade Extract is a tribulation. Don’t worry about accidentally killing someone with this. 
 
Opium 
 
 
Opium is the most basic Painkiller you can find. It will moderately treat internal injuries and burns, and it’s cheap. Only use on patients with light-moderate injuries, as anything higher will be a waste, and you will want to move onto Morphine/Fentanyl. You should fabricate this into Morphine if you want to improve your Medical skill. 
 
Morphine 
 
 
The Bread and Butter of Medics everywhere, Morphine is the definitive Painkiller, with two doses being able to heal someone fully at maximum efficiency. It will be the answer to most of your problems as a medic. 
 
Fentanyl 
 
 
Fentanyl is the most powerful painkiller, besides Deusizine. It will solve most injuries with just one dose. Be wary of Overdosing while using Fentanyl; perhaps keep a syringe of Naloxone on-hand. 
 
Drugs 
 
Tobacco 
 
 
While not advisable to their health, Tobacco is the token choice for most Captains. It helps keep one’s mind level against insanity. 
 
Ethanol 
 
 
Ethanol is a 90% Alcohol cleaning agent, but it finds much greater use in the Medical Fabricator, as it helps you to make Sedatives and Painkillers. Drinking not advisable, as it can easily lead to Alcohol Poisoning. Alcohol Poisoning is treated the same way all other poisons are; with Stabilozine 
 
Methamphetamine 
 
 
Meth will make anyone who takes it go really fast. It comes at a cost to one’s health, though. 
 
Steroids 
 
 
Steroids do not actually heal the patient, but it will temporarily invigorate them, preventing death even at its brink. A favorite by security in combat situations. Can also be used to temporarily stabilize a victim of Poison. 
 
Hyperzine 
 
 
A personal favorite of mine, Hyperzine is the drug that you inject when you have no other options. Someone can be a second away from death, and Hyperzine will make them not only stand up, but go faster, become stronger, and be more efficient. It is the most powerful stimulant. 
 
Deusizine 
 
 
Deusizine is both a stimulant and a painkiller, with potency only matched by Hyperzine; It will cure Oxygen deprivation, Blood loss, and almost all your internal damages. The only drawback being that it cannot heal burns, only exacerbating them in the process. In any situation without burning, it is an absolute lifesaver. 
 
Chloral Hydrate 
 
 
A sedative made of Chlorine and Alcohol. Now I already know what you are thinking – “I can use this in my Syringe gun and knock people out!” right? Wrong. While normally knocking someone out for ten seconds, through the syringe gun, Chloral Hydrate can only knock someone out for five seconds, which may be the difference between life and death. It is best to opt for a Stun Gun instead of a Chloral Hydrate-loaded syringe gun if a ranged non-lethal option is what you are looking for. Still, do not underestimate Chloral Hydrate, it will put someone to sleep fast if you can get an injection off. 
 
Haloperidol 
 
 
Haloperidol is a drug administered to cure Psychosis. Although Tobacco and Ethanol are good for resisting the effects of Psychosis, wherever it may come from, Haloperidol is the definitive answer to stop it in its tracks, and regain the sanity of whatever patient. 
 
 

Medicines, Drugs, & Substances Part II

 
Poisons 
 
Raptor Bane Extract 
 
 
This, as opposed to Chloral Hydrate, is the perfect weapon to load in your syringe gun. It is a potent toxin against Mudraptors, which nobody wants to get close to. This extract will melt away your mudraptor problems in 10 seconds or less per syringe. Problem is, shooting it at anything but a mudraptor will not kill it, but rather make it a little sick. To source Raptor Bane, ask one of your ships assistants to start a Raptor-Bane nursery. Once you have made enough extract, you can arm an entire dive crew with syringe guns full of this stuff. 
 
Morbusine 
 
 
Morbusine is a potent toxin which slows the victim down and saps the oxygen from their body gradually. While effective, it is a pain in the neck to manufacture, needing 2 Deusizines and some Sulphuric Acid. 
 
Sufforin 
 
 
Sufforin is my personal poison of choice; it is fast acting like its brother Morbusine, less of a chore to manufacture, and does more or less the same job, just without the oxygen deprivation. Would recommend using in the Syringe gun. 
 
Cyanide 
 
 
Cyanide is the best choice of poison for beginners. It is slower-going than Sufforin and Morbusine, but it is laughably easy to manufacture, only one step above Chloral Hydrate. Would also recommend using in the Syringe gun. 
 
 
 
[Note: While there is no penalty of using these poisons in Syringe Guns, it is smarter to just treat the person you want to poison, and slip the poison in with normal treatment. To shoot poison at someone with a syringe gun is suspect, and bound to have security track you down. Although, the syringe gun is still the best option with poisoning moving targets or non-human enemies.] 
 
Radiotoxin 
 
 
Radiotoxin is perhaps the weakest poison. It is quite slow-going, and is a hassle to manufacture, requiring both Uranium and Thorium to make one syringe. But it has great utility – It is the only poison that can kill a Moloch, Matriarch, or any other lifeform with just one syringe. While the other poisons will eventually stop working when dealing with a Moloch, Radiation Poisoning will stick around until its victim is dead. Note that Radiotoxin, much like Chloral Hydrate, suffers a 50% effectiveness penalty when shot through the Syringe Gun, but it may just be worth it, as shooting a Moloch or Matriarch with a syringe of Radiotoxin is perhaps the most cost-effective way of killing one, short of chopping it up with the ship’s propeller. Its still useful with killing humans too, although with its ability to cause burns, it is more noticeable to the victim than all the other poisons, leaving you more likely to be called out. 
 
Paralyzant 
 
 
Paralyzant is a scary chemical, as once it is injected into somebody, they are doomed to face paralysis, where they cannot move or act. They can breathe, but not much else. There is only one cure, as well as an obscure treatment not likely to be found on any ship. 
 
Deliriumine 
 
 
Deliriumine is non-lethal, but causes persistent insanity in the victim, with even Haloperidol only temporarily treating it. Very annoying to get hit by. 
 
Antitoxins 
 
Stabilozine 
 
 
Your go-to antitoxin. It will treat any poison, be it Sufforin, Cyanide, Radiation, or even Alcohol Poisoning. But it cannot do anything against Paralyzant. 
 
Antibiotics 
 
 
Antibiotics is a treatment to Velonaceps Calyx ‘Husk’ Infection, but comes at the cost of Organ Damage, even Organ Failure if taken in multiple doses. 
 
Calyxanide 
 
 
A better antibiotic. Will kill most Calyx infections with just one dose, and does not cause Organ Damage of any kind. Only drawback is the cost of manufacturing, requiring husk eggs themselves to make. 
 
Naloxone 
 
 
Naloxone is the antidote to opioids. It is what you use when somebody is overdosing on Opium, Morphine, or Fentanyl. Overdosing is a very quick death mind you, so you must be quick with the Naloxone if you wish to save a life. 
 
Morbusine Antidote 
 
 
Cures Morbusine Poisoning. 
 
Sufforin Antidote 
 
 
Cures Sufforin Poisoning. 
 
Cyanide Antidote 
 
 
Cures Cyanide Poisoning. 
 
Antirad 
 
 
Cures Radiation Sickness. 
 
Anaparalyzant 
 
 
The only cure for Paralysis. (other than an obscure substance known as Hallucinogenic Bufotoxin.) 
 
Deliriumine Antidote 
 
 
Cures Deliriumine Poisoning. (but no other type of Psychosis.) 
 
[Note: When carrying poisons around on the sub, make sure you also have the Antidotes for said poisons, just in case of an accident] 
 
 

Medicines, Drugs, & Substances Part III

 
Chemicals 
 
Alien Blood 
 
 
Alien Blood is used in a Medical Fabricator to make Blood Bags. If the necessary materials for a Blood Bag are not present, then using Alien Blood in a transfusion is a viable option, but will cause psychosis in the patient. 
 
Adrenaline 
 
 
Used to craft Fentanyl when combined with Morphine and Ethanol in a Medical Fabricator. 
 
Sulphuric Acid 
 
 
Burns upon ingestion. So don’t drink. Used in a Medical Fabricator to make Sufforin and Morbusine. (But, as previously stated, Morbusine is expensive to manufacture, so just stick to Sufforin.) 
 
Flash Powder 
 
 
A useful ingredient made of Magnesium and Potassium, which can work as a makeshift grenade if thrown. Can be fabricated into many things, among them is Sufforin when combined with Sulphuric Acid. 
 
Liquid Oxygenite 
 
 
Will temporarily reverse the effects of Oxygen Deprivation (allowing you to breathe in water without a mask) at the cost of some internal damage. I highly recommend using this as ammunition in your Syringe Gun. Not for the internal damage, but because it is volatile, and tends to explode upon impact. This will make your Syringe Gun effectively into a Grenade Launcher. 
 
Calyx Eggs 
 
 
The most vile thing ever. Your first impulse upon seeing this should be “How do I get rid of this?” Thankfully I will tell you right now: Shove it into a medical fabricator, and combine it with Antibiotics and Stabilozine, and you’ll create Calyxanide, the enemy of Calyx. The faster you get rid of Calyx Eggs, the better it will be for your entire crew. 
 
Substances 
 
Aquatic Poppy 
 
 
A plant that may be deconstructed, yielding Opium. 
 
Sea Yeast Shroom 
 
 
An odorous plant that may be deconstructed, yielding Ethanol 
 
Slime Bacteria 
 
 
A plant that may be deconstructed, yielding Antibiotics 
 
Fiber Plant 
 
 
A plant that may be deconstructed, yielding Organic Fiber. 
 
Organic Fiber 
 
 
Used to fabricate toolbelts and bandages – very useful. 
 
Elastin Plant 
 
 
A plant that may be deconstructed, yielding Elastin, a very useful crafting tool 
 
Elastin 
 
 
Elastin is used to make Plastiseal and Antibiotic Glue. Note that the recipe to make plastiseal is one elastin and one bandage, effectively doubling the mileage of a bandage, on top of the extra efficiency of plastiseal compared to bandages. So, if you have elastin, you should use it as much as you can to make a lot of plastiseal. Having a large surplus of Plastiseal at any time can and will save your entire crew. It is also useful for making Antibiotic Glue, but that is more expensive and is burned through quicker, as previously stated, so only use elastin to make antibiotic glue if you are out of bandages and the Organic Fiber with which to make bandages. Making plastiseal is also an easy way to increase Medical skill. 
 
Adrenaline Gland 
 
 
An organ of a Thalamus that may be deconstructed, yielding Adrenaline. 
 
Swim Bladder 
 
 
An organ of Hammerheads that may be deconstructed, yielding Stabilozine and Saline. 
 

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