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Old 09-05-2017, 04:08 AM   #21
malloyd
 
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Default Re: Surgery - How does it work?

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Originally Posted by Wayne View Post
Yes, but you can draw together muscle layers. You can then suture the subcutaneous and skin layers. Very quickly you go from an open wound to a closed wound, the person or animal can walk without fear of the intestines falling out. So an immediate benefit.
That isn't Surgery though. By GURPS standards suturing a wound is First Aid - and that does promptly restore a few hit points.
And yeah, First Aid probably ought to have a default to Surgery, that may be the house rule you need.
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Old 09-05-2017, 04:11 AM   #22
Wayne
 
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Default Re: Surgery - How does it work?

I did quote the rules at the start but I think they are wrong.
Maybe I’m used to non-humans but surgery makes more of a difference than the rules state.
Surgeons have a saying ‘a chance to cut is a chance to cure’.
If something is not a mortal wound or a crippling injury is there any point in surgery? Yes, of course there is.
Does the surgery fix the problem? Yes, of course it does.
Otherwise why would there be surgeons?
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Old 09-05-2017, 05:47 AM   #23
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Default Re: Surgery - How does it work?

Quote:
Originally Posted by Wayne View Post
I did quote the rules at the start but I think they are wrong.
Maybe I’m used to non-humans but surgery makes more of a difference than the rules state.
Surgeons have a saying ‘a chance to cut is a chance to cure’.
If something is not a mortal wound or a crippling injury is there any point in surgery? Yes, of course there is.
Does the surgery fix the problem? Yes, of course it does.
Otherwise why would there be surgeons?
Because surgery fixes problems. It just happens to fix problems other than "low HP." More surgical rules can be found in GURPS Bio-Tech, and additional books have suggested the optional rule that a Surgery roll is required to stop bleeding from the skull, eye, neck, vitals, or veins/arteries (if you use the latter hit location).

In addition, you may want to use an optional rule (from an article by Eric Funk) which was considered during the Bio-Tech playtest. (It didn't make it in, but I've used it frequently enough that I often forget that!) Basically, treat the extra injury from the vitals wounding multiplier as inherently unhealing; e.g., if you take 3 penetrating damage to the vitals, which becomes 9 HP of injury, the first 3 HP are normal but the remaining 6 HP are unhealing. Then the Surgery skill can be used to convert (margin of success + 1) of those HP to normal injury. It's harsh, but realistic. (Note that, even with this rule, the Surgery skill is only used to facilitate healing, not to recover HP directly.)
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Last edited by PK; 09-05-2017 at 11:52 PM.
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Old 09-05-2017, 09:21 AM   #24
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Default Re: Surgery - How does it work?

Maybe a change of perspective will help here.
As a Vet you more a Physician in GURPS terms than a pure Surgeon. Skill names are not the same as an actual profession, instead the names are evocative and meant to be understood by a layperson.

First Aid skill stops bleeding and handles most immediate medical issues. It would cover bandaging, sutures, burn care, splints, etc.
Physician skill takes care of gradual healing and patient care as well as prescribing drugs.
Diagnosis is used to figure out what is wring, though First Aid can do a lot of this as well. Especially things like combat wounds.
Surgery is about cutting into someone to fix internal problems.
As a Vet your likely trained in all the above skills.


I had an open wound for over a year and when the hospital was treating it they billed it as outpatient surgery. But really it was First Aid and Physician skill and I was fully capable of treating it myself once insurance ran out.
I would have to go to a Physician to get antibiotics when it became infected.
However I could and did debreed (sic) and clean the wound myself and bandage it afterwards. I have been trained in First Aid and CPR but in no way would I call myself or say I had surgical training.
Even though I used a scalpel to cut out the dead tissue it was still basic wound care not actual surgery.
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Old 09-05-2017, 09:48 AM   #25
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Default Re: Surgery - How does it work?

Lots of good commentary above, but allow me to add that in most GURPS games, at least most of the ones I've played in, the surgery skill is just a background professional skill, since the part of the injury system it affects are simply not used. Permanent crippling, internal bleeding, appendicitis, etc. just don't happen to PCs.

And that's perfectly ok. Realistic injury modelling is not compatible with the types of shenanigans most PCs get into, at least in the long term.
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Old 09-05-2017, 10:27 AM   #26
Fred Brackin
 
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Default Re: Surgery - How does it work?

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We don't, we take the stitches out about a week or two later. We might send them home on antibiotics and pain relief but that's it.
Having said that, maybe that's all people get after intensive care…
After elective surgery yeah, that's pretty much it.

I had surgery on my neck in 2001 and was let out of the hospital 22 hours after I was left Recovery with some medicine. Later surgeries may have been 2days in but if you can eat, go to the bathroom and possibly walk it's back home you go.

With trauma it's a lot more variable. It varies depending on the trauma but "simple" operations can follow that 1-2 day timeline.

With 1 particular traffic accident I have full details on there were 2 hospitalizations after 1 conventional ambulance trip and 2 patients on the helicopter to the trauma center.

One was a "lap belt" injury with a rupture in the small intestine. Certain to lead to infection if untreated but only a relatively small loss of HP. surgery was performed to remove the bad section (c. 4 inches) and splice the remaining length of intestine back together. Hospitalization was short.

The first helicopter evac was for a ruptured diaphram plus a shattered femur. Probably a lot of lost HP too. 2 surgeries each of 6 hours length were performed. The first repaired the diaphragm and no doubt prevented eventual death. The second repaired the leg bone that would never have healed without surgery. The patient eventually walked again (with a limp). She was released from the ICU after 1 month but still needed a very long recovery time.

The other helicopter evac was for a probable large loss of HP but they thought that there was only an ankle fracture. They missed another intestinal tear and then spent 4 months fighting infection. Surgeries were performed many times to help fight the infection but I never heard of any that would have been anything like HP repair.

As a personal opinion relatively few instances of HP loss in Gurps that are not accompanied by crippling injuries are represented by large, gaping wounds. Simple suturing without reconstruction probably is First Aid. If the victim of the injury would heal without serious intervention then surgery probably can't help.
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Old 09-05-2017, 10:28 AM   #27
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Default Re: Surgery - How does it work?

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I'm obviously at odds with everyone else.
I don't know about that. I think you're right on target that Surgery could – and realistically should – do much more. But the game's injury rules only have so much detail, and they're (understandably) weighted toward downplaying the chances of complications and crippling. Where healing is concerned, the rules treat a 20-point "gaping wound" injury as nothing really different from ten 2-point injuries. And so on.

In short, it's unavoidable that a world with cinematic, simplified injury will lessen the impact of surgery. If I wanted to bring surgeons back up in importance, I'd switch on all the more detailed injury rules, and bring in the various uses for Surgery found in in BS, Low-Tech, Bio-Tech, people's house rule ideas, etc.

Hey, speaking of vets and surgery... Years ago, on the TV show Prison Break, an escaped convict gets a hand lopped off, and looks for a doctor to reattach it. He finds one... who explains he's a vet. The convict forces him to perform the reattachment anyway (with, IIRC, limited success).

I know, it's TV. I make no assumptions that I can run to the vet's office when I lose a body part. But out of curiosity: Does typical training for a vet actually extend to reattachment surgery?
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Old 09-05-2017, 10:49 AM   #28
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Default Re: Surgery - How does it work?

GURPS doesn't go into when a wound heals by second intention because it doesn't go into individual wounds. Whether you've lost 10 HP to one dolorous stroke or to 10 individual pokes, you've lost 10 HP. You don't have one big hole in your body and you don't have 10 small cuts and you don't have a hojillion scratches. You have 10 HP lost.

GURPS doesn't cover whether a Physician taking care of you to give you extra HP recovery rolls is binding your wounds to keep the edges pressed together to aid in healing, stitching them up, monitoring you for infection and draining the wound while applying topical or internal antibiotics, or monitoring your nutrition stress and activity levels and telling you to eat more protein or stop jogging.

GURPS also doesn't really cover how bandages heal 1 HP or a First Aid roll heals 1d6-odd HP. There's some hands waved around and some mumbling about treating shock, but if I've been axed in the torso for 6 HP (a Major Wound I might add), and someone uses First Aid to bandage or stitch me up and they roll 6 HP recovered, GURPS says I've got my HP back and I can go right out to a martial arts tournament as if nothing happened.

If I said "Great! I can just make it to my martial arts tournament in an hour if I run!" to my surgeon after he stitched that axe wound up, he'd probably fire me as a patient and make me sign out AMA to cover his ass for liability. (A vet would have me put in a small kennel cage to enforce rest, but same difference.)

An actual surgeon has Diagnosis, First Aid, Physician, and Surgeon and uses any or all four skills. He might be doing simple wound closure, or a D and C on a cyst, or extracting debris from a wound and that could involve First Aid, Physician, or Surgery, or all three. [1]

A vet has one skill (Veterinarian) which does the job all four ways, which muddles the issue.


[1] I know two people who wound closure of 5 or six stitches with enough First Aid knowledge to do basic sterile conditions and aftercare, but Sewing skill for the actual suturing. Which is basically TL 5 or TL 6 care for that injury but apparently that's good enough for some people.
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Old 09-05-2017, 11:09 AM   #29
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Default Re: Surgery - How does it work?

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A vet has one skill (Veterinarian) which does the job all four ways, which muddles the issue.
I think Kromm or PK has said that veterinary surgery is actually using Surgery skill.
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Old 09-05-2017, 12:19 PM   #30
Ulzgoroth
 
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Default Re: Surgery - How does it work?

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Because surgery fixes problems. It just happens to fix problems other than "low HP."

More realistic surgical rules can be found in GURPS Bio-Tech. In particular, there is an optional rule for internal bleeding and internal wounds, which can only be healed after you first use Surgery to "convert" them to normal damage. (Without that, they will never heal.) However, even then, the Surgery skill is used to make healing possible -- it does not restore HP, because that would be completely unrealistic.
There is? Where? I'm sure I've never seen that and can't find it in my copy...
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