Credits

Concept, Research, Creation and Writing Claus Brnich Cover Art Elvira Brnich Editing and Layout Claus Brnich Text Boxes and Borders Elvira Brnich
Thanks to medical illustrator Patrick J. Lynch and MD cardiologist C. Carl Jaffe, MD for sharing their work under the Creative Commons Attribution 2.5 License 2006 with no usage restrictions except to preserve their credit. The heart and the skull on the cover was released by Patrick J. Lynch under this license. A big thanks to the National Library of Medicine for making available many great historical works in the public domain with no restrictions except to say that most of the illustrations in this book are courtesy of the National Library of Medicine. Finally a salute to the long dead Henry Gray for the legendary Grays Anatomy and all the other talented people who through history have contributed to humanitys knowledge of anatomy and medicine.

This book is intended only for use on fictional characters. Do not use to diagnose or treat people.

RadicalApproach.co.uk and DiceSystem.com

We are always open to hear from anyone with ideas related to our books. Writing and roleplaying are creative arts and we can all benefit from sharing and supporting each other. So please respect the copyright, but do not be afraid to ask for permission to use bits of it or any other interesting ideas. If you wish to write free material using Trauma or the Dice System you are welcome to do so as long as you don't reproduce copyrighted text and you agree to the terms as stated on the website. If you, or your company, want to sell material using Trauma or the Dice System you will need to contact us at Dice@RadicalApproach.co.uk. See the website for our usual terms and conditions. 2010 Claus Brnich, all rights reserved.

Table of Contents
TRAUMA 2ND EDITION.................................5

20 - STROKE.............................................................58
HEAD......................................................................59

UNDER THE HOOD......................................................5 TREATMENT AND SETTING.............................................6 DIFFICULTIES...............................................................6 PENALTIES..................................................................6 FATIGUE.....................................................................6

POST TRAUMA....................................................7

IMMEDIATE TRAUMA....................................................7 POST TRAUMA.............................................................7 NPCS AND POST TRAUMA............................................9

TREATMENT.....................................................10

SETTING...................................................................10 PERMANENT IMPAIRMENT............................................10

DIAGNOSIS...........................................................11

ANATOMY.................................................................59 100 - GENERAL........................................................59 101 - EAR................................................................63 102 - EYE................................................................65 103 MOUTH..........................................................69 104 - NOSE..............................................................69 105 - BRAIN.............................................................71 106 CAROTID ARTERIES..........................................78 107 CRANIAL NERVES............................................78 108 JAW...............................................................81 109 SKULL............................................................82 110 THROAT.........................................................83
CHEST...................................................................86

DIAGNOSIS ROLL.......................................................11 MODERN DIAGNOSIS..................................................11 MEDIEVAL DIAGNOSIS................................................16 FUTURISTIC DIAGNOSIS...............................................17

SURGERY..............................................................19

MAJOR SURGERY.......................................................19 MINOR SURGERY.......................................................19 SURGERY PROCEDURE.................................................19 MODERN SURGERY....................................................21 MEDIEVAL SURGERY..................................................25 FUTURISTIC SURGERY.................................................27
TRAUMA EXPLAINED..................................31

0 HEALING TIMES...................................................31 1 FRACTURE..........................................................31 2 BLEEDING ..........................................................34 3 - SHOCK................................................................36 4 - INFECTION...........................................................38 6 BURNS................................................................46 7 SPINE.................................................................49 8 PAIN..................................................................52 9 INFLAMMATION....................................................52 10 COMA..............................................................52 11 EPILEPSY..........................................................53 12 FEVER..............................................................54 13 CARBON MONOXIDE POISONING.............................54 14 DEHYDRATION...................................................55 15 HYPOTHERMIA...................................................55 16 HYPERTHERMIA.................................................56 17 DIABETES.........................................................56 19 BLOOD CLOT....................................................58

ANATOMY.................................................................86 200 - INFECTION.......................................................86 201 - GREAT VESSELS...............................................89 202 - HEART............................................................90 203 DIGESTIVE TRACT ...........................................92 204 LUNGS...........................................................93 205 WINDPIPE ......................................................97 206 BREASTBONE...................................................97 207 RIBS..............................................................98 208 SHOULDER BLADES .......................................100 209 TRAUMATIC ASPHYXIA.....................................101 210 BRONCHIAL INJURY........................................101 211 - PULMONARY CONTUSION.................................101 212 ARDS........................................................102
ABDOMEN.........................................................103

ANATOMY...............................................................103 300 PERITONEUM ................................................103 301 - ABDOMINAL VESSELS.....................................105 302 STOMACH.....................................................106 303 - INTESTINES....................................................107 304 - APPENDIX......................................................109 305 KIDNEYS......................................................109 306 LIVER..........................................................112 307 GALL BLADDER.............................................113 308 PANCREAS....................................................113 309 SPLEEN.........................................................115 311 PELVIS.........................................................116 312 BLADDER......................................................119 313 REPRODUCTIVE ORGANS....................................120 315 DIAPHRAGM..................................................121
3

ARMS....................................................................123

ANATOMY...............................................................123 400 GENERAL......................................................123 401 BLOOD VESSELS............................................123 402 ELBOW.........................................................126 403 HAND..........................................................127 404 NERVES........................................................129 405 WRIST.........................................................132 406 SHOULDER JOINT...........................................134 407 COLLARBONE ...............................................136
LEGS.....................................................................138

ANATOMY...............................................................138 500 GENERAL......................................................138 501 ANKLE.........................................................139 502 BLOOD VESSELS............................................140 503 FOOT...........................................................143 504 NERVES........................................................144 505 HIP JOINT.....................................................149 506 KNEE ..........................................................151
TRAUMA TABLES........................................155

CHEST: SUPERFICIAL WOUND....................................161 CHEST: NASTY WOUND...........................................162 CHEST: GRIEVOUS WOUND.......................................163 CHEST: GRIM WOUND.............................................164 CHEST: MORTAL WOUND.........................................165 ABDOMEN: SUPERFICIAL WOUND...............................166 ABDOMEN: NASTY WOUND......................................167 ABDOMEN: GRIEVOUS WOUND..................................168 ABDOMEN: GRIM WOUND........................................169 ABDOMEN: MORTAL WOUND....................................170 ARM: SUPERFICIAL WOUND......................................171 ARM: NASTY WOUND..............................................172 ARM: GRIEVOUS WOUND.........................................173 ARM: GRIM WOUND................................................174 ARM: MORTAL WOUND...........................................175 LEG: SUPERFICIAL WOUND.......................................176 LEG: NASTY WOUND...............................................177 LEG: GRIEVOUS WOUND..........................................178 LEG: GRIM WOUND.................................................179 LEG: MORTAL WOUND............................................180
ELECTRICITY BURN...................................181

HEAD: SUPERFICIAL WOUND.....................................156 HEAD: NASTY WOUND............................................157 HEAD: GRIEVOUS WOUND........................................158 HEAD: GRIM WOUND..............................................159 HEAD: MORTAL WOUND..........................................160

ELECTRICITY BURN: GRIM & MORTAL WOUNDS.........181 ELECTRICITY BURN: GRIM & MORTAL WOUNDS.........182
WINGS..................................................................183

WING: NASTY & GRIEVOUS WOUNDS.......................184 WING: GRIM & MORTAL WOUNDS...........................185

Trauma 2nd Edition

Under The Hood
This book allows you to peek under the hood of the body and figure out exactly what keeps your characters ticking. More importantly it explains why they stop ticking. Realism is just part of the reason. Players often invest a lot into their characters and may find it both frustrating and boring to have their life snuffed out arbitrarily without proper cause and effect. On the flip side the gory details make defeating enemies all the more satisfying and are great to bring the atmosphere of a bloody battle right into your living room. Only the most devastating wounds kill immediately. Most of the time death is drawn out and agonising. Since there is no real pain suffered, only fictional, this is a good thing as it means that there is time to do something to save the character. If you know why you are dying you might prevent it. Combat wounds seem more real when you can hear the bones cracking and the gritty trauma inflicted when a dagger guts your character is vividly described.

A serious injury or shock to the body. What you hold in your hands is a tome on pain, misery and suffering. It also holds the lore on how to treat the very things it allows you to inflict. It is a book on trauma. This is the second edition updated to be used seamlessly with the DICE system and better handling of many conditions. It is still very much a book that can be used with any roleplaying system with just a bit of tweaking or serve as a reference for writers. Carefully researched the gory and graphical descriptions are based on real medical data. You will find details on treatments and anatomy for every part of the body and its organs, bones, joints, nerves and arteries. Great care has gone into describing hundreds of conditions. All cross-linked using reference numbers in square brackets that correspond to each entry. Luckily you do not need to know it all in advance. At the end of the book trauma tables contain creative descriptions and references to the medical entries for three different types of trauma and five different degrees of severity. Wounds have both short and long term risks and consequences. Sucking chest wounds, internal bleeding, misaligned fractures, infected burns, brain damage, kidney failure and many other complications may develop depending on the damage done and subsequent treatment. Never again will your characters be complacent about combat. Never again will the outcome of even a brief skirmish be certain. Planning ahead, ensuring tactical superiority or perhaps avoiding combat all together may soon seem much more appealing.

Writers Rejoice
All the hard legwork is done. Sure this book is aimed at roleplayers but that does not mean it cannot be worth its weight in gold to writers too. Rather than trying to read unhelpful tomes written for doctors you can now get simple to understand descriptions of wounds and their treatment, risks and complications.

Warriors Rejoice
Warriors can enjoy the graphic detail of the trauma they inflict. They will also be less complacent about their own wounds. Even an innocent stab wound may end up life threatening due to not immediately apparent complications. This encourages a healthy respect for the danger of combat and planning of dangerous encounters.

Healers Rejoice
Surgeons, medics and healers will enjoy a much greater depth of play. More important than ever before and with more difficult choices to make. Amputate the gangrenous limb? Stitch up a sucking chest wound? Risk surgery on a bad fracture or leave the patient with an impairment? No longer are healers relegated to speed the healing of abstract wounds. They become vital in diagnosing complications and treating broken bones, ruptured organs 5

and halting internal bleeding. Surgery can save a character from an otherwise mortal wound and only a competent healer is likely able to prevent permanent impairment from such things as nerve damage.

Roleplayers Rejoice
The detail of the trauma promotes roleplaying. A fracture might not heal correctly and give the character a limp for life. A missing ear or nose can become an integral part of the characters personality. It allows for greater depth of description for the acquired quirks and scars of combat veterans. Warriors can pinpoint the exact source of the pain from old wounds and talk about the time when bone was sticking through the skin. Right there under that massive scar on my leg.

ment. For realistic settings this grim fact of life should be welcome. Nothing strikes fear into the heart of a knight as much as knowing that a wound can result in a slow agonising death, and even if he lives result in a long recovery that may leave him crippled. Physical threats take on a more menacing air and the players should be more inclined to plotting, planning and even surrendering rather than suffer debilitating defeat. In a fantasy setting the detailed trauma presents an opportunity for new spells and abilities. Several new spells could be added to cure infections, mend bones and keep the heart beating while it heals. The spells can be as generic or specific as the setting requires. So like for science fiction settings this book opens up a rich new world of possibilies for fantasy and heroic settings.

Everyone Rejoice
Detailed, gory and realistic descriptions of the trauma inflicted is fun. It adds spice.

Difficulties
The difficulties provided in this book are those used for the DICE system. However, they are fairly self explanatory and so it should be able to convert them to appropriate target numbers for pretty much any system. The difficulties are: easy, tricky, hard, severe, extreme and insane. Easy rolls should be almost impossible to fail, while it is nearly impossible to succeed against insane rolls.

Treatment and Setting

Trauma treatments detail how to fix broken bones, injured organs and control infections using medical knowledge and technology known today. Treatment in a futuristic or medieval setting is listed, and spells suggested for fantasy settings. These can be adapted to any world setting.

Penalties
When some conditions impose penalties this is given as a number of penalty dice rating from -1D to -3D. In the DICE system trivial penalties are ignored so a -1D penalty is a serious handicap. A -2D penalty is a great handicap and a -3D penalty is crippling.

Futuristic Treatments
In a science fiction setting bones will still be broken and organs ruptured, but the treatment will be far more sophisticated than today. Bones will still need to be fused back together, bleeding will still need to be stopped and damaged organs healed. However, the methods for doing so will have improved and advanced tools, devices and medicines have been developed. The trauma rules open up a whole new horizon for futuristic gear that was not previously needed. Now devices to regenerate lost blood, regrow nerves, replace kidneys, hearts, livers and lung function, halt gangrene and so on will be highly valued by the players. Cybernetic, or biological grafts, that provide fail safes in the case of various organ failures will also be in great demand by mercenaries and soldiers. In other words the detail of the inflicted trauma creates a foundation for a whole new world of neat gadgets.

Fatigue
Some conditions cause fatigue. This reflects the character having less energy and if it gets severe enough it impairs all actions. The four stages of fatigue used are: fresh, winded, exhausted and drained. When fatigue is increased with +1 it goes from the current stage to the next, like from fresh to winded. When a character reaches exhausted a -1D penalty applies and when drained this increases to a -2D penalty. A drained character who does not rest will eventually collapse. Normal fatigue is recovered by one stage simply by resting an hour or so and a character can recover fully if resting long enough. Chronic fatigue is more serious and lasts a number of days depending on the severity. Like normal fatigue each stage must be recovered in turn until fully recovered: winded 1 day, exhausted 2 days and drained 3 days. 6

Medieval Treatments
In a historic or fantasy setting the results of trauma can be much more devastating due to the lack of proper treat-

Post Trauma
The rules in this book will rarely be relevant in the heat of battle. Damage during combat is handled by the combat system and referred to as immediate trauma. The trauma detailed in this book is only determined and revealed later, usually during healing and recovery, and is referred to as post trauma. This not only helps keep combat fast paced but also realistic. With no time to diagnose wounds in the middle of a fire-fight or while dodging a savage axe murderer. Only after combat, when there is time to stop and examine the wound of a fallen friend or foe, is it time to resolve the gruesome consequences of post trauma. The long term and often life changing or fatal repercussions of bodily damage beyond the immediate trauma. Having said that the post trauma tables do include an evocative description of the trauma inflicted as experienced by the combatants and so can be used to add colour to combat descriptions. To keep combat fast these can be used selectively. For example only for important characters, the players and perhaps exceptional hits.

Immediate Trauma
This is the damage and associated penalties and consequences resolved during combat. The immediate trauma may incapacitate and even indicate that a character is dead. However in most cases, such as when the immediate trauma does not indicate a severed head, the post trauma and its description has the final say. Even so in most cases when the immediate trauma indicates a mortal wound the post trauma will be fatal. Still, maybe the wound was not as bad as it seemed from all that blood and pain. Perhaps that innocent puncture wound, which didnt seem so serious, actually did more damage than was at first apparent. Sometimes the character may die from bleeding, shock or other post trauma effects before the fight is over. Because of this those with medical skills might wish to examine serious wounds during combat. Determine the post trauma effects immediately for those examined. Such an examination will often take some time depending on the wound and require some medical skill to discover anything but the most obvious.

Post Trauma
The post trauma describes short and long term consequences beyond the immediate trauma, further risks and possible complications. The effects from the immediate trauma still holds, but the post trauma explains the underlying damage of the wound. Equally important, the post trauma shows how the wound will heal and any permanent or fatal consequences, if the right treatment is not provided. The post trauma is resolved by looking up the effects in the tables located at the end of this book and determined from four factors:

Type of Trauma Location Trauma Severity A Dice Roll

With each description, a reference number is provided to the much more extensive description of the trauma entries in the book. Each number indicates a specific trauma, anatomical part or condition.

In addition any significant bleeding is also indicated. Bleeding is fully explained under bleeding in the Trauma Explained chapter.

Grievous Wound

Type of Trauma
There are three types of trauma: slash, crush and pierce. Each type has its own column and the three different types of trauma have very different results.

Grievous wounds are truly gruesome and can easily lead to permanent disability or death. Heals to a nasty wound in four weeks.
Grim Wound

Location
The hit locations are; arm, leg, head, chest and abdomen. Each location has its own set of tables. Which of those tables are used depends on the trauma severity. The locations do not differentiate between being hit from the rear or the front. This was done both to reduce the number of locations and because of the often fluid nature of combat. You are about equally likely to hit your opponent in the back as he dodges and moves around. Equally an arrow to the abdomen can damage a kidney and a bullet may damage a lung or the spine, regardless if it enters through the upper back or the chest. The location is very important to the outcome of the injury. A major wound to the head is much worse than the same to an arm or leg. Even mortal trauma to a limb is not usually immediately fatal, but the resulting blood loss and shock quickly kills if immediate treatment is not provided.

A grim wound immediately incapacitates. It is easily fatal and never easy to recover from. Most grim wounds can of course be survived with the right medical treatment but without it the chances of survival are slim. Heals to a grievous wound in five weeks.
Mortal Wound

A mortal wound also incapacitates, but as the name suggests it is often fatal. A mortal wound will usually kill if not treated. Even good and prompt medical attention may fail to save the character's life and often leave survivors crippled for life. With treatment it typically takes about six weeks for a mortal wound to heal to a grim wound.
Extreme Trauma

In some rare cases the damage done is so extreme that it completely destroys a character beyond any hope of survival. Falling into a volcano or standing at ground zero of a nuclear explosion are obvious examples of extreme trauma, but there are many less extreme cases as well. It is left up to you to work out any details. Be creative!

Dice Roll
The actual row used in a trauma table is determined randomly by rolling a die to reflect the unpredictability of any bodily damage. A seemingly mortal wound may not be as bad as the immediate trauma would have suggested. Then again what seemed trivial may quickly turn serious and possibly even fatal. For slash and crush wounds a higher roll generally means a more severe result. For pierce wounds the result is much more unpredictable as something vital may have been punctured in even a small wound, while a deep stab may have missed all major arteries and organs. Either 1D10 or 1D6 can be used. Who rolls the die for post trauma is determined as follows:

Wound Severity
Wound severity is rated as superficial, nasty, grievous, grim and mortal. Obviously more severe wounds have more serious post trauma effects. Each trauma severity has its own table for each location.
Superficial Wound

A wound which causes significant pain and may look bad, but rarely leads to complications. Heals in two weeks.
Nasty Wound

A nasty wound causes significant physical damage and can easily cause damage to important organs. It represents deep cuts and punctures and very hard blows. Nasty wounds often look quite bad and should always be treated properly. In most cases nasty wounds are not fatal but there is always a risk that it can be. Heals to a superficial wound in three weeks.

The players should roll long term effects of anyone they examine, including themselves. This means that doctors and healers will often be the ones to make the roll. Players get to roll post trauma for wounds they have inflicted or for wounds inflicted on them. The game master only rolls when secrecy and uncertainty is important. 8

Interpreting Results
Often the damage will refer to an eye, ear, cheek and so on without specifying left or right side. Often it will not matter which it is and it can be determined randomly or logically, as the situation dictates.

If particularly relevant survival of a NPC can also be determined by chance. Make an attribute roll, typically Spirit, against the difficulties specified below. If successful the NPC survives. NPC Survival Roll Wound Severity Superficial Nasty Grievous Grim Mortal Difficulty Easy Tricky Severe Extreme

One eyed Eric is hit by an arrow in an eye. If the immediate trauma was incapacitating the GM may decide it was Erics good eye which was hit. The incapacitation then makes sense as Eric is left blind having lost both eyes. If the damage was not incapacitating it must of course have been Erics blind eye which was hit, as he was obviously not blinded.
When a player, or important character. is wounded and the GM thinks the post trauma effects may have important consequences on the outcome of the fight the post trauma effects can be checked immediately. This should be avoided as much as possible as it slows down combat. Most of the time the immediate trauma of wounds that are serious enough to cause disabling post traumatic effects will leave the combatant incapacitated anyway.

Reduce the risk according to available treatment. An injured guard on duty is likely to receive prompt treatment and thus more likely to survive than a wounded bandit abandoned in the forest.

Post Trauma Bleeding

Wounds that would cause heavy or massive bleeding will also usually render the combatant incapacitated. Unless someone examines him during combat nobody will know that he bled to death until after the arrows stop flying. In those rare cases when the post trauma effects show that a combatant should have been dead while still fighting it is up to the GM to either modify the result, or the combatant may have been so pumped up on adrenaline that he kept going beyond what would normally be the case.

NPCs and Post Trauma

Post trauma always applies to the player characters. It should also be used for important characters (VIPs), especially those the players care deeply about or attempt to treat. For other characters it is usually not necessary to go into such detail. Unimportant characters (NPCs) can be assumed dead if incapacitated with a grim or mortal wound. Any NPC which receives a grievous wound may also die unless medical care is available.

Treatment
What follows is a brief overview of treatment in various settings. setting and difficulties and possible treatments adjusted accordingly.

Setting
In the descriptions of possible treatments the terms modern, medieval and futuristic are used. Suggested spells are listed too.

Spells
The suggested spells may be used or ignored in a fantasy setting. They are ranked with a roman number, a higher number indicating a more powerful spell. The spell will cure the condition same as the more mundane treatment. It is up to the setting and magic system used if the healing is instantaneous or gradual. It is unwise to make healing magic too easy as it makes mundane healing skills obsolete.

Modern
Modern treatments are meant to cover those treatments available to us today in the 21st century. Difficulties generally assume treatment in a well equipped hospital of good standard. Difficulties should be adjusted to reflect local variations in standard and facilities. If treated outside of a hospital the difficulties may need to be increased or may stay the same if there is no obvious reason why the location is detrimental to the procedure. With superior technology and medical knowledge the difficulty must be reduced. New technologies may open up for new treatments which may allow treatment of trauma described as untreatable in this book. Inferior technology and medical knowledge will mean an increase in the difficulty and will often mean that no treatment is possible.

Permanent Impairment
Permanent impairment is a penalty that will not reduce without specific treatment. It can be a specific penalty such as 1D. Alternatively it can simply be stated that the impairment is permanent in which case the impairment for that wound severity becomes permanent. If using another system than the DICE system decide upon an appropriate permanent penalty for the wound.

Medieval
Medieval means medical skill such as known by the romans and throughout the medieval times. It is a general concept and does not attempt to be accurate for any specific period but rather a general estimate of abilities in such times. Thus it will need to be interpreted for the specific setting in which it is used. This is the medical knowledge and technology available in most fantasy settings.

Futuristic
Futuristic means treatments in the near future. Perhaps in a hundred years. Future treatment should be extrapolated from current technologies to guess what might be possible. Such treatments are highly speculative and so suggested treatments are kept non-specific such as hightech surgery. It must be decided if this is the right medical technology level for a particular science fiction

10

Diagnosis
The diagnosis is usually assumed to be a part of the treatment roll, but it is possible to make a diagnosis without attempting any treatment. The diagnosis tells the doctor or healer what damage has been inflicted as well as the wider implications, possible complications and the best way to treat it. Most traumas describe the most common methods of diagnosis in a modern, medieval and futuristic setting and a suggested difficulty. Whether a diagnosis roll is needed before treatment can be attempted is up to the GM and can be determined on a case-by-case basis. In a modern or futuristic setting where there are sophisticated tests and scanners a separate diagnosis roll often makes more sense than in a medieval or fantasy setting where treatment is based entirely on external symptoms.

Blood Test
Serologic Test A blood test is often the first test to be used when diagnosing disease. A small sample of blood is analysed in a laboratory. Revealing the presence of many diseases and the function of the organs. Since blood flows throughout the body, transporting oxygen, nutrients and waste products, a blood sample can diagnose many problems.
Uses

Blood tests are often done as a routine diagnostic test to screen for health problems, disease or other substances in the blood. Blood typing tests are used to determine compatibility for blood transfusion [2C]. Electronic counts of red blood cells are used to diagnose anaemia [2B], and measuring of blood sugar can be used to diagnose diabetes [40]. Even some forms of cancer can be detected. Both infections [4] and many diseases can be detected with a blood test, as well as sexually transmitted diseases. DNA testing is also possible with a blood sample. Useful both in forensic science for identification purposes or as part of a diagnosis for genetically inherited conditions.
Equipment

Diagnosis Roll
When a player wishes to make a diagnosis roll without treating the wound the GM should assign an appropriate difficulty based on the trauma and method used. If a suggested difficulty is not specified for the trauma then the table below can be used as a general guideline. Post Trauma Diagnosis Wound Severity Superficial Nasty Grievous Grim Mortal Difficulty Easy Tricky Hard Severe Extreme

Diagnosis Results
A seriously incorrect diagnosis (exceptional failure) results in a wrong diagnosis and any treatment based on this diagnosis will always fail and may even cause more harm than good. The implications will have to be determined based on the trauma that was diagnosed. However, an exceptional success may just reduce the difficulty of any subsequent treatment. The GM should always use his best judgement to decide how the diagnosis, or lack of it, may affect any treatment.

A syringe (needle) is needed to extract the blood. Preferably there should also be sterile alcohol swabs, surgical gloves, surgical tape and so on to keep the procedure clean and reduce the risk of infection. The extracted blood is analysed in a laboratory. The laboratory equipment required depends on the tests to be performed. An electronic machine and computer called an haematology analyser usually analyses the blood and prints out the result.
Techniques

Modern Diagnosis
What follows is a detailed description of a few common tests used when trying to identify or determine the cause of a disease or injury in modern medicine.

Blood is obtained using a syringe and analysed in a laboratory. The haematology analyser usually performs the analysis of the blood sample but it can of course also be done by someone skilled in the correct diagnostic techniques with a chemistry laboratory or a high-end microscope. 11

Radiography
X-Ray Scan, Plain Film, Radiography Radiography is an inexpensive and quick way to gather important diagnostic information. X-rays are beamed through the body and onto a photographic plate. The x-rays are obstructed to different degrees by different types of body tissue. Bones absorb a lot of x-rays and so appear much whiter than softer surrounding structures which are darker.
Uses

It can detect foreign materials in the body that are not seen by radiographs or CT scans, such as wood and plastic. It is very useful for examination of the chest, abdomen, blood vessels in the limbs and evaluation of pregnancies. It can detect abnormalities in the heart, gall stones [307A] in the gallbladder and problems with the kidneys, liver, spleen, pancreas and the aorta artery. It can be used to examine the uterus, ovaries, scrotum and testes. It can determine the size, gender and position of a baby, as well as some abnormalities, and the presence of twins or triplets. Ultrasound scans are not good at penetrating bone. They do not work through air and poorly in gas making it useless to scan the lungs. They also have a very limited depth making it difficult to diagnose fat people.
Equipment

Radiography is excellent for diagnosing fractures. Other than that the chest is the most common site for x-ray examinations. Many lung [204] and heart [202] problems are seen well on x-ray film.
Equipment

The image, or radiograph, is produced by a radiation source that is activated sending x-rays through the body of the patient and into a photographic plate. The photographic plate stores the result on a film cassette or digitally on a computer. In the first case the film must be developed much like a normal photograph.
Technique

The scanner is a small, hand-held device which emits and receives high-frequency sound waves. The received echoes from the emitted sound waves are transmitted to a computer which uses the data to display a two-dimensional image in real time. Any sound with a frequency greater than the range of human hearing, around twenty kilohertz (KHz), is considered an ultrasound. The frequencies used in medical imaging are usually between one and ten megahertz (MHz), well outside human hearing range. Higher frequencies have shorter wavelenghts and so better resolution, but do not penetrate as deep. Ultrasound scans usually use around four megahertz.
Techniques

Clothing, and especially metals, must be removed as they can obstruct or distort the resulting image. Loose-fitting gowns are often used. Usually the chest is pressed against the photographic plate. A deep breath is taken to improve image quality. The technician activates the machine which sends a beam of x-rays through the body and into the photographic plate. The result is recorded and analysed by a radiologist using a lighted view box for film or a computer for digital images.

The quality of an ultrasound scan depends entirely on the skill of the operator to perform the scan and analyse the resulting image. Usually a hand-held device called a transducer or scan head is used. A gel is applied to the skin to ensure good coupling with the scan head which is then placed directly on the skin. The scan head emits sound waves through the body which are reflected by internal body structures as echoes. The echoes return to the scan head which transmits them electronically to a monitor for viewing. As the scan head is moved around the displayed output is updated in real time showing what is under the scan head at all times. The results can also be recorded for later viewing.

Ultrasound
Sonography An ultrasound scan uses high-frequency sound waves to produce images of the organs and internal structures of the body.
Uses

Ultrasound is an effective, simple and cheap method for diagnosing a great many things, and since the images are displayed live the results are immediately known.

12

The scan itself is soundless for normal humans that cannot hear the high-frequency sounds emitted and it is completely harmless. Using a specialised probe it is possible for a special image processing computer to generate a three-dimensional image.

To avoid exposure to the x-rays the technician controlling the machine is usually in an adjacent control room. Only MRI machines are more expensive of the scanner devices listed here.
Techniques

Computed Tomography (CT)

Computerized Axial Tomography, Computer-Assisted Tomography (CAT), Body Section Roentgenography A CT scan is used in diagnosis to create a computer generated three-dimensional image from a series of cross-sectional x-ray scans made along a single axis of the body. The word tomography is greek and derived from tomos (slice) and graphia (describing).
Uses

A normal CT scan takes around twenty minutes during which time it makes a lot of unusual noises. The scan exposes the character to higher radiation doses than during a normal radiography scan but the risk is still very low. Metals can cause errors and distortions on the final image.

Positron Emission Tomography (PET)

Although similar in many ways to a CT scan a PET scan combines chemical analysis with a scan to create a three dimensional image or map of metabolic processes in the body. Although potentially useful in diagnostics, its prohibitive cost often limits its availability to large hospitals or research facilities.
Uses

CT scans is the best method for diagnosing a number of diseases and traumas to the body. In cases of trauma to the head CT scans can detect intracranial bleeding [100A]. It can be used to detect injury to organs after abdominal trauma. It can detect tumours, although MRI is superior. It is very good at diagnosing lung problems such as pneumonia. It can be very helpful in diagnosing infections [4], gangrenes, osteonecrosis [5] and brain infections [100D]. CT scans can also be used to investigate uncertain findings in a normal radiograph. It is especially useful for evaluating complex fractures, such as those in the face and joints.
Equipment

The primary use of PET scans is in the diagnosis and treatment of cancer. It is used to analyse metabolic activity in the brain and show how organs metabolise substances. It can measure the size and effect of a heart attack and assess the effect drugs have on different body tissues. PET scans are often used together with CT scans.
Equipment

A CT machine looks like a huge doughnut which is standing on its edge with a bed in the middle that can move the character, conveyor-belt style, through the machine. An x-ray source on the machine spins around the bed sending out ultrathin x-ray beams. The x-rays pass through the body which absorbs some of the rays depending on the type of tissue they pass through. The amount of x-rays that reach the detector on the other side of the body determines the shade of gray on the computer image. Bone, which absorb a lot of x-rays, looks white while soft tissues appear almost black. An image processing computer creates three dimensional images from the series of cross-sectional slices from each pass of the rotating x-ray beams.

Short lived radiactive particles are created using a cyclotron, circular particle accelerator. An imaging scanner, which like a CT scanner is a ring-shaped machine surrounding a bed in the centre, performs the scan. Meanwhile an image processing computer analyses and stores the results. A monitor is usually used for immediate output and the images often use colour to show the concentration of the tracer in various parts of the tissue.

13

Technique

A short lived radioactive tracer which emits positrons combined with a metabolical molecule, such as sugar, is injected into the character. After a short wait the tracer collects in specific parts of the body. The character is then placed in the imaging scanner which detects pairs of gamma ray photons created by the positrons emitted by the radioactive tracer colliding with electrons in the body. By plotting their origin in the body a computer can create a map which shows in which organs and tissues the injected molecules have ended up. A radiologist or nuclear medicine physician interprets the results.

In cases of trauma to the head MRI scans can detect intracranial bleeding [100A]. It is the best diagnostic device for detecting tumours and brain disorders. It can diagnose spinal disorders, cardiovascular disease and all kinds of nerve damage [102A, 404, 505]. It is very helpful in diagnosing and determining the extent of inflammation, infections [4], gangrenes, osteonecrosis [5] and brain infections [100D]. It can for example determine if bones and organs are affected. MRI scans can also be used to investigate uncertain findings in a radiograph. It is very useful when evaluating complex fractures, such as those in the face and joints
Equipment

Magnetic Resonance Imaging (MRI)

Nuclear Magnetic Resonance (NMR) imaging MRI is a diagnostic scan using nuclear magnetic resonance to produce images of organs and internal body structures. The magnetic resonance is created by powerful magnets and so, unlike radiography and CT scans, there is no harmful radiation. The images are comparable, or slightly better, than those generated by a CT scan. In addition to not being harmful MRI scans also provide better contrast between healthy and abnormal tissue. The generated magnetic field causes some atoms in the body, especially hydrogen, to align with the field. Radio wave pulses are transmitted and by interpreting the subtle differences in the signal they return a picture of the bodys internal structure which can be created by a computer. The images constructed by the computer is twodimensial and can be projected on a screen or stored in a computer for further analysis. By doing repeated scans the computer can build up a three-dimensional image of organs or even the entire body. Clothes and bones do not obstruct the image but metals can cause errors and distortions.
Uses

The MRI machine is large and rectangular with a bed in the middle that can move the character conveyor-belt style, into the machine. Machines are usually completely enclosed with the bed moving into a narrow tunnel in the centre of the machine. Newer machines may however be open-sided, taking less space and making claustrophobic characters feel more comfortable. All MRI machines have the powerful magnets, gradient coils to create a variable field and radio frequency coils to transmit energy and encode spatial positioning. A computer controls the scan and an image processing computer uses Fourier transformations to transform the data into an image on a monitor. Not surprisingly MRI machines make strange noises while working. The room holding the machines must usually be specially shielded since the radio waves used are close in frequency to ordinary radio stations. The technician controlling the machine usually observes the process through a large window in an adjacent control room. Sometimes special body coils are attached to the patient which send and receive radio wave pulses in a small area to improve the quality of the scan. MRI machines are the most expensive technologically advanced scanners listed here.
Techniques

and

The character is asked to lie on a narrow table which slides into a large, hollow cylinder containing the powerful magnets. Special body coils may be placed around the areas of interest to improve the quality of the images. The character is then scanned with radio waves. The returned signal is detected by a receiver which sends the data to a computer. The computer uses the data to create a two-dimensional or three-dimensional picture unhampered by bone or clothes. 14

Like CT scans, MRI is the best method for diagnosing a number of diseases and traumas to the body. Like CT scans it can provide a great amount of detail and therefore make accurate diagnosis possible for many conditions which is otherwise very difficult or impossible to diagnose.

A complete scan, which usually requires several sets of images, can take more than an hour. More powerful magnets and better software and computer hardware may speed up the process. The procedure has no risks but may interfere with pacemakers, hearing aids or any cybernetic devices.

Equipment

Small patches with electrodes that can be attached to the skin. An electrode is a conductor that can emit or receive electric current. The electrodes are connected to a recording device which may print, display or store the results of the test.
Technique

Electromyography (EMG)
A diagnostic technique for measuring the muscle response to nervous stimulation. It is used to assess the health of both muscles and nerves.
Uses

The nerve is stimulated by a weak electric current from an electrode attached to the skin above the nerve, while other electrodes record the resulting electrical activity. The distance between the electrodes and time it takes for the impulse to travel between them is used to calculate te nerve conduction velocity and so the health of the nerve.

EMG is used to diagnose weakness and can distinguish between weakness caused by muscle damage and nerve damage. A nerve conduction velocity test is usually done at the same time as the EMG.
Equipment

A needle electrode and an oscilloscope or speaker is all that is needed. An oscilloscope is an electronic instrument that displays the oscillations of voltage and current. That is it displays a wave representing the current swinging back and forth between a minimum and maximum value
Technique

A needle electrode is inserted through the skin and into the muscle. Electrical activity in the muscle is detected by the electrode and displayed on an oscilloscope or heard through a speaker. The character is asked to contract the muscle by for example bending an arm or leg. The presence, size and shape of the wave on the oscilloscope, represents the ability of the muscle to respond to nerve signals.

Nerve Conduction Velocity Test (NCV)

This test is used to diagnose nerve damage or destruction. It is a test of the speed with which impulses travel through a nerve.
Uses

The test can be used together with an EMG test to differentiate between muscle and nerve damage as well as give some idea of the extent of any nerve damage.

15

Medieval Diagnosis
Any diagnosis in a medieval or fantasy setting is likely to be dominated by religious beliefs, superstition and a lack of knowledge and understanding. The lack of useful diagnostic instruments is only matched by the lack of knowledge. While the modern surgeon can discover a wealth of information before surgery a medieval surgeon does not have this luxury.

Theological Dogma
Only Sinners Suffer - Priest In societies dominated by religious dogmas diagnosis may be based on religious teachings. Disease may be punishment for sins, pain lack of true faith and fevers, brain damage and epileptic seizures signs of demonic possession. Theological diagnosis is more likely to be used for diseases, infections and any illness for which the cause is not understood. Direct physical traumas may be treated as normal and diagnosed based on medical texts and teachings.
Uses

Medieval Medical Texts

You must wear this amulet to ward of the evil spirits - Kings Physician Books are often rare in a medieval or fantasy setting and few books are as valuable as medical texts. Written by philosophers, learned physicians sponsored by nobles or commissioned by a King these rare tomes may hold a large part of all medical knowledge for the period.
Uses

Most theological diagnosis will be useless and increase the difficulty of any treatment and may make things worse rather than better. Sometimes the diagnosis may happen to correspond somewhat with reality and so the diagnosis may not hinder much or even provide a bit of insight. In some fantasy settings the gods may be real and so a theological diagnosis may also be real. In these settings prayer and other religious rituals may indeed cure both illness and trauma.
Equipment

A medical text can contain knowledge on herbal remedies, surgical techniques, sacred rituals, wards and every other form of treatment. How much of the medical text is actually useful and how much is useless superstition will depend entirely on the world setting. Thus diagnosis made from such texts, or the study of such texts, may be anything from helpful to obstructive.
Equipment

The teachings of the theological class, scriptures and religious laws.

Technique

There are unlikely to be many different medical texts and probably not many copies of each book either. Producing a book is expensive, skilled and time consuming work. Different races and cultures may have their own medical books.
Technique

Perhaps only the religious cast is allowed to make a diagnosis or symptoms may be described in scriptures that physicians must follow. Rituals or omens may also be used as a sign from the gods if the patient will live or die, and if it is their will that the illness be treated.

The physicians of Kings might have one or more texts in their possession or direct access to them in a castle library. Great cities or universities, if such exist, may have a copy of one or more medical texts but they are likely only available to specially approved scholars for reading under supervision. Most physicians and healers will only have acquired their knowledge from the teachings of others. They in turn will have learned it from others who may not have seen the actual book either. Such knowledge is certain to be fragmented and often far removed from the original teachings of the text.

Astrological Charts
The planets are aligned - Astrologer Astrology is diagnosis based on the alignment of the planets, the position of the stars, the moon and other signs of the heavens. Astrological charts may dictate treatment for traumas as readily as for disease as certain star signs and planetary alignments may indicate or prohibit various surgical procedures and medical treatments.

16

Uses

Futuristic Diagnosis
As we travel into the future technology and knowledge improves. More advanced scanners and machines will allow much better imaging and analysis of the human body and its physiology. Diagnosis also becomes more automated. Self diagnosis using clever gadgets or installed cybernetic monitors will likely be more common for those who can afford it. Dermal monitors built into the skin able to monitor all vital signs and alert the onset of disease or infection, and show any nutritional deficiencies. Such dermal monitors may also have an interface to allow adjusting physiological parameters and automatically alert emergency response units. Eventually clever software, or artificially intelligent computers, may replace doctors all together. What will be possible in the future is only limited by how far into the future we look and how optimistic we are about it. If we judge by the past the future will hold many new medical wonders and allow surgeons to see things not even known today.

Most astrological diagnosis will be useless and may increase the difficulty of any treatment and may make things worse rather than better. Sometimes the diagnosis may happen to correspond somewhat with reality and so the diagnosis may not hinder much or even provide a bit of insight. In some fantasy settings the stars may indeed affect life and so an astrological diagnosis may actually be effective.
Equipment

Most astrologers will not be viewing the heavens but rather rely on calendars and charts that indicate the planets alignment, position of the stars and phase of the moon depending on the month and day. In fact astrologers tend to rely heavily on parchments and tomes with extensive tables, charts and diagrams to make their diagnosis.
Technique

Hightech Scanners
Scanners more sophisticated than today are a certainty. They will be able to give a more detailed and precise internal picture and likely provide all sorts of advanced imaging enhancement and analysis.
Uses

Tables and charts are usually used along with various tomes and complex rules understood only by astrologers. Urine may for example be collected and its colour compared with astrological charts such as the alignment of the planets to reach a diagnosis and appropriate treatment. Treatment can also depend on under which star sign the patient is born as it may prohibit certain treatments.

Just like modern scanners are invaluable in today's surgery, future hightech scanners are sure to be incredibly important to doctors and surgeons of the future.
Equipment

Initially hightech scanners will be large units confined to hospital settings and operated by medical technicians. Later models will grow smaller and become ever more automated and user friendly. Eventually hand held scanners able to analyse the data and suggest a likely diagnosis might result.
Technique

Early models will likely require a high degree of skill and knowledge to operate, and require the patient to be placed in various types of units, equivalent to a MRI scanner in modern technology. Later models will be easier to use until eventually anyone can operate a medical scanner with no prior training or knowledge. The most sophisticated models may be able to provide a diagnosis from only a sweep of the patient without any preparation at all. 17

Nanobots
Engines of Creation - Written by K. Eric Drexler Tiny robots as described under nanosurgery may be able to patrol the body. Monitoring for damage and invading organisms.
Uses

Likewise the scanner may have an inbuilt analyser or depend on sending the scanned data to an online mainframe. It will also likely have the ability to display the result directly to a doctor or surgeon to allow them to make their own diagnosis if desired. The scanner will likely be a single unit. Early versions will likely be large and stationary while more advanced versions may be very small and portable. In a very advanced setting the scanner might be equipped with artificial intelligence and be able to communicate through speech. This will be like having an expert doctor in your pocket, possibly with instant access to all known medical knowledge. The scanner will of course only give a diagnosis of the sample provided, but even more advanced versions may have optical sensors too. They may be able to scan a person to create a virtual map of their anatomy, chemistry and diagnose any detected problems. This is known as a pocket doctor.
Technique

Nanobots would be able to make a more detailed and precise diagnosis than almost any scanner and may even be equipped to repair the damage they encounter.
Equipment

Nanobots are explained in detail under nanosurgery.

Technique

The nanobots could reside permanently in the host body or be injected in a hospital setting. To diagnose a specific location only a small number of nanobots would be required while to patrol and monitor the entire body millions, billions or even trillions of nanobots might be required. Because of their tiny size however they could all be contained inside a syringe with only a few millilitres of liquid.

A sample must be taken and provided to the scanner. A portable version will likely also include some inbuilt method for taking a sample.

Chemical Scanner
A chemical scanner is an example of the type of hightech scanners that may be available in the future. Connected to a computer with a small LCD or similar display it is able to analyse soft tissues and liquids.
Uses

A sample of the chemical, usually blood, is placed on the scanners sensor. The most basic scanners will be able to determine the chemical structure and highlight any abnormal readings. More advanced units will be able to report the presence of drugs, alcohol, disease and other toxins. DNA comparisons and detection of certain genes that may indicate character traits, such as violence, may also be possible.
Equipment

The sophistication of the result depends on the model. Army, medics, scientists and possibly law enforcement will have access to the most advanced versions available. The scanner may depend on a local database or connect to a enormous, continuously updated online database, for an annual fee of course. 18

Surgery
Surgery is the branch of medicine involving cutting and stitching to diagnose and treat trauma, disease and deformity. It is also required to implant donor organs, cybernetic devices and anything else that requires a person to be cut open. It is often useful to divide surgery into major surgery and minor surgery. the patient around the operation site. Infection may also be borne on dust if the surrounding environment is not disinfected or from the surgeons breathing if a mask is not worn. The risk of infection is treated the same as a direct infection risk [4] for any wound. However, it is the environment, type of surgery and its degree of success which determines if an infection takes hold. The base difficulty for any infection resistance roll depends on the environment. Base the difficulty on the table below, but reduce the difficulty by one if the surgery is an exceptional success and increase it by one if an exceptional failure. Infection Resistance Roll Surgery Environment Major Dirty Insane Unclean Extreme Clean Hard Antiseptic Tricky Aseptic Easy

Major Surgery
Major surgery is any surgery inside the skull (craniotomy), chest (thoractomy) or abdomen (laparotomy). Major surgery is usually done under general anaesthesia where the patient is unconscious and performed in an operating room by a team of surgeons. There is a risk that vital organs may be damaged during major surgery.

Minor Surgery
Minor surgery is any surgery where the skull, chest or abdomen are not opened and is generally done under local anesthesia. Minor surgery requires less assistance and can be performed by a single surgeon.

Minor Tricky Tricky Easy Easy No risk

Surgery Procedure
The things to consider before and during surgery:

Diagnosis Infection Risk Complications Anaesthetics

Diagnosis Before Surgery

If not an immediate emergency the patient should be diagnosed and the problem be determined with as much detail as possible. If there is no time for a proper diagnosis the surgeon must make one during the surgery. An accurate and detailed diagnosis may reduce the difficulty of any surgery roll. It may also alert the surgeon to complications which might otherwise be missed during surgery. See the previous chapter on diagnosis.

Dirty: Performed outside in the field or inside with dirty instruments. Unclean: Less than ideal environment, surgeon operating without mask or with dirt under nails. Clean: Clean room, clean instruments and washed hands. Antiseptic: Anti-bacterial washes have been used to wash the site of surgery, instruments and hands. This is the condition in a modern hospital with poor standards. Aseptic: A sterile environment with sterile instruments. The condition in most good modern hospitals. See Modern Surgery for more details.

Complications of Surgery
With any surgery there is always a risk of complications. All complications are derived from the surgery roll. Some depend on the patients ability to endure the surgery and some on random luck. Not every complication needs to be checked every time someone has surgery. Instead the various complications should be used when appropriate to add an element of risk or drama.
Shock

Infection Risk
During surgery the patient is opened up which may allow harmful micro-organisms to enter through the incision. Infectious micro-organisms may live on the operating surface, instruments, surgeons hands or on the skin of

During the operation there is always a risk that the patient might have a heart attack [202C] or go into shock [3]. If the surgery roll was a success any result of shock 19

can be considered to occur at the end, or immediately after the operation. If the surgery was a failure and shock occurs it happens in the middle of the operation. The risk depends on blood loss [2], hypothermia [15] and the pain experienced, as well as the trauma caused and duration of the surgery. Make an appropriate attribute roll to resist shock against a difficulty based on the surgery outcome as shown in the table. If the patient goes into shock consult the rules on shock. Surgery Shock Roll Surgery Surgery Result Major Minor Exceptional Failure Extreme Severe Normal Failure Severe Tricky Marginal Failure Hard Tricky Marginal Success Tricky Easy Normal Success Easy No Risk Exceptional Success No Risk No Risk As surgery patients are often in a weakened state from disease, trauma or blood loss the GM may decide to increase the difficulty of the roll if this is not already reflected in a penalty. If anesthesia is not used and the patient is conscious the difficulty of the roll must be increased. See Anaesthetics below. A blood transfusion cannot reduce the difficulty of the shock roll, but can save a patient who goes into shock as per the normal shock [3] rules.
Blood Clots

Nerve Injury Location Nose Eye Ear Tongue Mouth Face Skull Neck Shoulder & Upper Arm Elbow & Lower Arm Pelvis (spine) Knee and above Knee and below Spine Surgery Success Damaged Olfactory Nerve [107A] Damaged Optic Nerve (temporary blindness) [107B] Moderate Ear Trauma [101B] Damaged Hypoglossal Nerve [107J] Glossopharyngeal Nerve [107G] Moderate Facial Nerve Damage [107E] Damaged Trigemenial Nerve [107D] Damaged Accessory Nerve [107I] Damaged Brachial Plexus Nerve [404A] Damaged Radial or Ulnar Nerve [404C] Damaged Sciatic Nerve [504C] Damaged Femoral Nerve [504A] Damage Tibial or Peroneal Nerve [504E] Partial Cord Damage [7E] Failure Severed Olfactory Nerve [107A] Severed Optic Nerve (blind) [107B] Severe Ear Trauma [101C] Severed Hypoglossal Nerve[107J] Glossopharyngeal Nerve [107G] Very Severe Facial Nerve Damage [107E] Severed Trigemenial Nerve [107D] Damaged Vagus Nerve [107H] Severed Brachial Plexus Nerve [404B] Severed Radial or Ulnar Nerve [404D] Severed Sciatic Nerve [504D] Severed Femoral Nerve [504B] Severed Tibial or Peroneal Nerve [504F] Complete Cord Damage [7D]

If blood clots [19] are not actively prevented following surgery, either through drugs or through activity and care, there is a small risk of blood clot following major surgery.
Nerve Injury

Nerve injury is a only risk when doing surgery near a nerve. Facial surgery, neck surgery, arm and leg surgery and especially spinal surgery all carry a risk of nerve damage. Deep surgery that goes close to the bone has a much greater chance of causing nerve injury. If the GM deems that there is a risk of nerve damage the nerve is injured on a surgery result of a marginal success or a normal or exceptional failure. The type of nerve injury depends on the location of the surgery as shown in the table below. It also depends on how badly the surgeon damaged the nerve. If the surgery was a success the damage is not quite as serious as if it was a failure.

Anaesthetics
Surgery is painful and so requires some sort of anaesthesia to block that pain. Operating without anaesthetics or similar sedatives is possible but not usually recommended. It dramatically increases the risk of shock. If no anaesthesia is used the patient must be held down with strong hands and the difficulty of the shock roll is increased by three, but not beyond insane. With mild anaesthesia like alcohol the patient might still need to be held, but the pain is somewhat numbed by being drunk and the difficulty is increased by two. A more portent, 20

but still less than perfect, soporific only increases the difficulty by one. Modern anaesthetics keep the patient completely sedated and the shock roll difficulty is not increased. Knocking the patient out is of course possible, but there is no safe way of doing so and can lead to further injury. It also leaves the risk of the patient regaining consciousness during surgery which will increase the shock roll as if no anaesthesia was used. In rare cases the patient may be immune to the pain in which case anaesthesia might not be needed.

Other useful and common tools are forceps, scissors, shears and saws. Very high frequency ultrasound can be used to break up kidney stones or be used on the brain or inner ear where great precision is required. Electrocautery is another modern alternative, where a small probe with an electric current is used to burn a blood vessel, to seal it off and so stop the bleeding. A heart-lung machine is needed for heart surgery. It takes over the functions of both heart and lungs during the operation.
Anaesthesia

Modern Surgery
The uses for surgery in medicine are almost endless. Tissue can be removed, wounds closed and blockages opened. Skin grafts, artificial or real, can be implanted to replace burned, diseased, infected or damaged skin. Surgery can be used to help diagnose a problem by opening up the patient to have a look or by removing living samples for a biopsy. In an emergency after a major trauma there may be no time for a diagnosis and the surgeon must open up the patient and quickly identify and repair damage to organs and stop bleeding Transplants of organs. The liver, pancreas, kidney, lung and heart can be transplanted. Bone marrow can be transplanted to restore immune defence. A transplant is only possible if drugs are available after the surgery to keep the body from rejecting the foreign organ. The drugs must be taken daily and supress the immune defence. Bones can be cemented together, or replaced by metal rods, and joints replaced with metal or plastic parts. Plastic surgery can be used to reconstruct facial features, reduce scarring and improve appearance.
Equipment

Local anaesthesia blocks the pain at site of the surgery while the patient is awake, while general anaesthesia puts the patient to sleep, oblivious to any pain. Local anaesthesia is used for minor surgery, while major surgery requires general anaesthesia. Local anaesthesia drugs are injected under the skin at the site to be cut. Larger areas of the body can also be numbed by injecting anaesthesia into the nerves that supply the area. The lower body for example can be numbed by injecting drugs into the spinal cord in the lower back. Limbs can be numbed by trapping the drug within the veins in the limb by constricting blood flow where the limb joins the body. This can be achieved with elastic bandages, blood pressure cuffs or other devices that compresses the veins. General anaesthesia is given intravenously or inhaled. The drug circulates throughout the bloodstream, rendering the person unconscious. General anaesthetic slows breathing and affect the vital organs, such as the heart. Hearth rate, hearth rhythm, breathing, body temperature and blood pressure is therefore monitored in case of complications. Such complications are rare if the administering doctor is skilled in anaesthetics.
Managing Infection

A scalpel is the standard cutting device. It is a small, straight knife with a thin, sharp blade. Lasers are even better than a scalpel at making a thin and precise cut and can be used both to remove tissues or weld tissues together. Lasers are especially useful in eye surgery. Stitches, or sutures, using fine thread is commonly used to close wounds. However, medical glues and surgical tapes, if available, may be faster and more effective. Surgical staples for example can join blood vessels much faster than stitching.

Surgery is usually antiseptic or aseptic to avoid infection. Antiseptic surgery uses anti-bacterial washes kill bacteria, while aseptic surgery uses sterile instruments in a sterile environment to keep dangerous micro-organisms away. For aseptic surgery, heat sterilisation can be used on instruments. Disinfectant agents can also be used such as chlorine dioxide (ClO2), gluteraldehydes or even alcohol if nothing else is available. Radiation can also be used. The operating surface will also need to be clean. 21

The skin where the incision will be made should be cleaned with germicidal scrubs and alcohol and any hairs removed. The hands of the surgeon and nurses must be washed with a bactericidal scrub. A sterile gown must be worn with both sterile surgical gloves, caps, shoe covers and a mask.
Technique

Field Surgery
In remote and wild locations, on the field of battle, in poor countries, when a fugitive or when civilisation collapses surgery may have to be performed outside of a hospital setting. A prepared surgeon will make sure to bring a field surgery kit. Below is listed what such a kit may contain.
Field Surgery Kit

An incision is made in the skin and the surgeon cuts through the layers of the dermis to get to the desired tissue or organ. Diagnostic scans, such as radiography, ultrasound, CT and MRI can give the surgeon a much better insight into the problem and so improve the chances of success. In the most advanced facilities the surgeon may even have guidance from live, three-dimensional images from such scanning devices during the surgery. This can usually be reflected in reduced difficulty.
Operating Room

Some form of operating table and very good lighting is required. If the operating table is inconvenient or the lighting is poor the GM should increase the difficulty. Monitors to display vital signs, an instrument table and an anaesthetic machine are usually used. Excess blood and fluids can be removed with a suction machine to make it easier for the surgeon to see clearly. Intravenous fluids are also provided to the patient. The access to or lack of such things may affect the difficulty and feasibility of any operation.
Operating Team

For a major surgery a team of doctors usually work together with the help of nurses. A chief surgeon directs the surgery with one or more assistant surgeons. An anaesthesiologist controls the supply of anaesthetic and monitors the patients condition. A scrub nurse passes the instruments to the surgeon, while a circulating nurse passes any extra equipment. A good or bad team can decrease or increase the difficulty.
After Care

Unless glue or self dissolving stitches were used the stitches and any staples will need to be removed. The operation site should be checked to see that it has healed properly. Demanding physical activities, even climbing stairs, should be avoided immediately after surgery. To reduce risk of infection the site of the surgery is covered with antibiotic ointment and dressed in sterile bandage. The bandage absorbs leaking fluids and so needs to be changed.

Several disposable scalpels or scalpels with replaceable blades of different sizes. Disposable scalpels are usually made from plastic with an extensible steel blade and are discarded after a single use. Scalpels are used for cutting through skin and muscles and have different shapes depending on their purpose. A pack with a variety of different sized needles. These can be reused in an emergency after being sterilised in boiling water. A small standard needle holder used for grasping a needle when sowing (suturing). Three or more packs of suture thread of silk or nylon for closing wounds and blood vessels. Optional surgical staple gun may also be included to quickly seal a wound. One curved and one straight hemostat. A special clamp resembling a pair of scissors, but used to compress blood vessels to stop or reduce bleeding during surgery. Surgical scissors for cutting tissue. Tissue forceps with teeth. A hinged instrument used for grasping and holding tissues when fingers are too large to grasp or for holding several things at the same time. Disposable razor for removing body hair at the surgery site. A 100 ml bottle of some antiseptic solution, like betadine alcoholic solution. A couple of small 25 ml bottles containing mastisol or some other medical adhesive to secure difficult dressings. Several reusable plastic vials of local anaesthetic, like 20 ml of Lidocaine Hydrochloride, which can be used for minor surgery. Injected at the site of the surgery 15-30 minutes before the operation and effective for 1 2 hours. A couple of 5 ml syringes, primarily for injecting the local anaesthetic Plenty of bandages and dressings, as well as general pain killers such as Ibuprofen and Tylenol (acetaminophen). Several pairs of disposable surgical gloves and preferably also a surgeons mask.

22

Other Useful Kit

Uses

Other useful instruments might include:

A saw for amputations. A tourniquet for stopping severe bleeding. Sterile eye pad Antibiotic ointment A scrub or brush to clean the site of a wound if clogged with dirt or mud. Antihistamine to counteract the physiological effects of allergic reactions and colds. Dentistry instruments Water disinfection tablets Thermometer for taking temperature Waterproof matches, safety pins and duct tape for general purpose use. Blanket for keeping patient warm and comfortable. Splint kit Sunscreen Sterile eye wash Plasters and elastic dressings.

Microsurgery is essential when transplanting body parts or reattaching limbs, hands and fingers to ensure blood vessels, nerves and other tissue is correctly connected. Thus ensuring the survival of the body part and also increasing the level of function regained after surgery. It is also essential when repairing nerves, especially in the face where damaged nerves can cause disfigurement and pain. It can also be needed when operating on the brain, during plastic surgery, when repairing a hand or other delicate work. Microsurgery can, for example, be used to attach a big toe in the place of a crushed thumb to keep the hand functional. It can increase the chance of success of skin grafts for burn victims, replace a damaged section of the esophagus with a section of the intestines or any number of equally amazing things.
Equipment

Microsurgery

Obviously the most important instrument of microsurgery is the microscope. Usually a high quality optical microscope with a floor or table stand is used. Surgical loupes, magnification lenses worn around the head, can also be used. Equally important is the nearly invisibly thin surgical stiching threads (suture threads) and needles thinner than a human hair. In fact the needles are so thin they have to be held with special instruments. Most other instruments of surgery are also used during microsurgery, but in much smaller versions. Such as micro-forceps, micro-scissors and microvascular-clamps. In a more technologically advanced surgery, robot assisted microsurgery with telemanipulators and programmable controls might be available.
Techniques

Modern:

Reattach Ear (easy) 1-4 hours Reattach Nose (tricky) 2-4 hours Reattach Finger (tricky) 2-4 hours Reattach Hand (hard) 10-12 hours Reattach Arm (severe) 10-14 hours Reattach Leg (severe) 10-14 hours Nerve Repair (varies) Delicate Surgery (varies) Microsurgery is not possible. Robot assisted microsurgery with more advanced imaging techniques and sophisticated instruments will be one or two levels lower difficulty. See nanosurgery for the truly amazing advances. Regrow II (fuses ear) Regrow III (fuses finger) Regrow IV (fuses hand, arm, leg)

Medieval: Futuristic:

Spell:

Time is of the essence as body parts start to die when removed from the body and the chance of successful reattachment decreases. While depending on temperature, and how cleanly the body part is stored, twelve hours is usually the maximum for a reasonable chance of a successful re-attachment. Microsurgery, Time Detached Hours Surgery Modifier Less than 2 -1 Difficulty 2-5 0 6-8 +1 Difficulty 9-12 +2 Difficulties 13+ Impossible, or at least insane 23

Surgery where a microscope is required is called microsurgery. It is a special form of modern surgery and usually used for operations where incredible precision is required, such as when dealing with blood vessels, nerves and other minute body structures.

In cold climates, or if the limb is refrigerated, the times indicated above can be up to five times longer. Microsurgery for limbs and hands is both difficult and time consuming. Teams of experts performing painstakingly slow and detailed work from morning to evening. The surgeon will often be sitting with the arm resting on a pillow for stability. Looking through the microscope at blood vessels and nerves and sewing them back together. Difficulties also assume a fairly clean cut and will increase if this is not the case. For example if the limb was torn off in an explosion the difficulty will probably be one or two levels higher. Microsurgery, Condition Conditions Surgery Modifier Only one surgeon +1 Difficulty Poor or no assistance +1 Difficulty Rushed (minimum hours) +1 Difficulty Poor Environment/Tools +1 Difficulty Standard Environment/Tools 0 Excellent Environment/Tools -1 Difficulty Surgical Cut -1 Difficulty Clean Cut 0 Messy Cut +1 Difficulty Very Messy Cut +2 Difficulties
The Result

For nerve repair any success will allow the nerve to heal, but a marginal success may leave the character with some impairment. A typical microsurgery, if there is such a thing, might go something like in the example below. Although a hand is used in the example the procedure applies to the re-attachment of any body part. Larger limbs will of course take much longer. The times given assume one or two experienced surgeons and a team of skilled assistants in a well equipped hospital.

Up to two hours are spent in preparation, where the character is prepared for surgery. This includes stopping bleeding, which is best done by applying microsurgical clamps to bleeding vessels. Dead tissue and dirt is removed from the severed hand. All bones, tendons, nerves and blood vessels that need to be reconnected are identified. If preparations were done well it should take less than an hour to match up the parts, rejoin the bones in the arm and hand and then reconnect the tendons with surgical stitches. The more tendons are reconnected the better the outcome for the hand. On average, around 24 tendons will usually be reconnected for the hand. The major and most difficult part of the operation can easily last for six hours and involves the restoration of blood flow and reconstructive microsurgery. Major arteries, veins and nerves are repaired, which often requires grafts. Grafts are replacements for damaged sections, taken from other parts of the body. This re-establishes circulation and the cold and pale hand turns warm and pink. Finally the wounds are closed up by stitching the skin of the hand to the skin of the arm. Often the skin is damaged, or dead, and has to be replaced with skin grafted from other parts of the body. This means that closing up can sometimes take as much as two hours.

The more blood vessels are attached the greater the chance the body part will survive. The amount of feeling and function restored depends on the accuracy of the nerve repair. This is all determined by the degree of success from the microsurgery.

Exceptional Failure: Fails to attach the body part and the patient goes into shock [3]. Normal Failure: No function in the limb and gangrene [4B] develops in the next 1D12 days. Marginal Failure: The body part attaches but does not get enough blood. Not only paralysed but also bluish with ugly spots. It develops gangrene in 1D12 months. Marginal Success: Body part is healthy but numb. It will gradually regain some reduced function over the next 1D12 months. Tasks involving the body part should have their difficulty increased. Normal Success: Body part is healthy and regains some limited sensation and most of its function over 1D12 months. Tasks involving the body part may have a slight difficulty increase. Exceptional Success: Body part is healthy and in 1D12 months will be fully functional although some sensation may never be regained.

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Depending on the success of the surgery it should take about four weeks before the patient is well enough to leave hospital. After that possibly over a year of rehabilitation and physical therapy. Even then any but an exceptional surgical successes will result in only partially regained function and feeling in the hand.

cauterization to stop bleeding, the last by pressing a hot iron to the bleeding wound.. Superstition and misunderstanding are also great obstacles to the medieval surgeon. Rituals, ineffective herbal remedies and misguided treatments such as blood letting do nothing to help the patient, but may weaken him and make his condition deteriorate. Yet, despite all this some surgeons manage to save and improve lives either through luck or brilliance.
Equipment

Medieval Surgery
Pain and infection are the primary causes of death in medieval surgery. This is rarely understood with healing more of a mysterious art than a science, dominated by rituals and poorly understood techniques. Often handed down through oral tradition. The few surgeons who do come to realise these simple facts become the masters of their art. Through such simple things as cleanliness, the use of wine as antiseptics and drugs to ease the pain, the chance of survival can be dramatically improved. Even so medieval surgery is still largely limited to minor surgery. The removal of arrows and amputations, and whenever something more complicated is attempted the patient's life hangs by a thread, at the mercy of microbes and matters beyond the medieval surgeons understanding.
Lack of Knowledge

The scalpel has been available in surgery since ancient times. In early times it would be made from bronze while later models were made of steel, although often with a bronze handle. Medieval scalpels are similar in shape and function to modern scalpels. When a scalpel is not available the surgeon may use a knife for the same purpose. Threads and needles are also needed and usually work well, although not as fine as in modern surgery. Other useful and common tools like forceps, bone drills, hooks, scissors, shears and saws are also typically available, but this depends on how advanced medicine is and well equipped the surgeon is. Hooks, for example, were common even in ancient times and are still very much in use in modern surgery. Blunt hooks are used for raising blood vessels and sharp hooks used to hold and lift small pieces of tissue to be extracted, or to cut along the edge of a wound. Bone drills were also used in ancient times to remove infected and diseased bone tissue, especially from the skull. Also useful for removing foreign objects lodged in bone. Portable medicine chests were used in antiquity and may also be used in fantasy settings. A small chest containing anything from scalpels and hooks to ointments and herbs. Divided into compartments and made from bronze or wood with a hinged lid that may have a solid lock on it. The lack of equipment in a medieval or fantasy setting is most felt when it comes to lack of scanners and other diagnostic tools. The modern surgeon can discover a wealth of information to reduce the difficulty of surgery before the operation, while the medieval surgeon must discover the damage during surgery. Medicines are usually restricted to herbs and potions. If these actually provide some medical value depends on the world setting.

In most medieval societies anatomical knowledge is very poor and physiology often misunderstood. Even such basic things as, the purpose of breathing, the function and location of the various organs, and so on, are typically missing from the surgeons knowledge. Not surprisingly, this also means that diagnosis and treatment is usually equally misguided. Blood may be checked for foaminess, hotness or taste and excreta may be inspected. Sometimes these things may provide some useful clues to the condition, but more often they have little relation to the ailment. Observation and physical examinations have more relevance but lack of anatomical knowledge usually prevents a full understanding. Even so certain conditions such as fractures and even gangrene are usually recognised by an experienced surgeon and can often be effectively treated, even if the method is crude by modern standards. Most experienced surgeons will know how to use ligatures, bandages or

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Anaesthesia

Equipment

Anaesthesia may not always be available and so the increased risk of shock means only simple minor surgery is likely to succeed. In some cultures potions may be available to partially, or fully, drug the patient and alcohol is often available.
Limitations

Sharpened flints or any other sharp-edged object can be used to perform a primitive surgical operation. Flint or bone saws are ideal for amputations. Pain control may range from soporific potions and alcohol to holding down the patient and enduring the pain. Perhaps the most sophisticated anaesthetic is the use of ethyl ether, a distillation of ethyl alcohol with sulphuric acid to be inhaled. It is also known as sulphuric ether and is highly flammable. For the lucky patients where the primitive surgeon is aware of the benefits of a clean operation boiled water and wine are most easily used.
Technique

Most major surgery is not possible in a medieval setting. Any surgery in the abdomen has a high risk of causing deadly peritonitis and any surgery that penetrates the skull risks equally deadly brain infection. Surgery in the chest is usually not possible due to the lack of a heartlung machine. Because of these limitations the body cavities, skull, chest and abdomen, are usually considered forbidden to surgeons. Even so the finest surgeons may have some success. Especially skull repairs and pressure relief from intracranial bleeding are often risked due to the otherwise high mortality, but infection risks are high.
Managing Infection

The operations may be ritualistic, especially if the surgeons knowledge of anatomy is limited. In primitive cultures, if written texts are not available, the reasons behind the methods passed down through generations are easily forgotten. If the methods of pain control are poor the length and type of operation that can be performed, without the patient going into shock, is usually limited to minor surgery. Cleanliness is of course very important in surgery to avoid infection. It is also something often overlooked and easily forgotten in primitive surgery. The use of boiled water or wine to clean wounds and basic cleanliness, such as washing the hands, lowers the risk of infection, improving the patients chances of survival. The ability to control bleeding is also very important of course. If threads or strings are available they can be used as ligatures to tie off bleeding vessels. However, even the basic anatomical understanding to realise the benefit of a ligature is beyond most primitive surgeons.

Medieval surgeons are not always aware of infection or the benefit of clean surgery. They have a high mortality rate. In more enlightened surgeries the risk of infection is still quite high but if they keep their tools and environment clean then there is at least hope. Sterilisation of instruments can be done with wine and alcohol, or over an open flame.
Technique

Medieval surgery is primarily minor surgery. Cutting through the skin to remove objects, sew together damaged blood vessels or tissue, correct fractures and sometimes to relieve pressure in the skull. Mostly it is about amputating crippled or gangrenous limbs.

Primitive Surgery
Primitive surgery is any surgery without proper surgical instruments and often without proper surgical and anatomical knowledge. It is surgery as performed by very simple and primitive cultures or when surgery is performed under less than ideal circumstances without proper tools and equipment.
Uses

Spells & Healing Magic

If powerful magic exists there is almost certainly going to be spells to heal broken bones, stop bleeding, cure infections, mend organs and regrow nerves. Less powerful magic may be able to encourage healing, reduce healing times and slow infections but may be unable to cure the most serious afflictions.
Power Level

Circumcisions and amputations are often performed with primitive surgery. Emergency removal of foreign objects such as arrows and bullets is also likely to be under primitive conditions.

For every trauma healing spells are suggested. The spells can be incorporated directly into the existing magic system or be used as guides. Each spell is followed by a roman numeral which indicates a spell power level from 26

I to IV. Spells at different power levels can be considered separate spells, or the same spell but requiring more spell energy or more difficult to cast. Spell Power Level Numeral I II III IV
Spells

The power level of the spells provided for each trauma can optionally be used to determine the difficulty for healing that complication with magic as follows: I. II. III. IV. Basic Spells: tricky Intermediate Spells: hard Powerful Spells: severe Godlike Spells: extreme

Power Level Basic spells Intermediate spells Powerful spells Godlike spells

Futuristic Surgery
The surgery of the future is difficult to predict. It will likely be more efficient, faster, safer and at the cutting edge of science and technology. As surgery and medicine improves, people will live longer and eventually most traumas and diseases will be curable. Nanotechnology, and probably other fantastic techniques and technologies we are not yet even aware of, will likely make death a temporary handicap. As long as the deceased has not been dead for too long and the brain is not destroyed the body can be regenerated or the mind uploaded into a computer, android, cybershell, clone or any number of other amazing constructs. This may eventually lead to a future where trauma and disease are no longer feared and death is only an inconvenience. This is not the level of technology assumed in this book, although it may be mentioned occasionally in treatments. Instead this book assumes a slightly more near future medical science, although it does not attempt to define it exactly. Rather leaving it up to be worked out depending on the world setting.
Future Technology

Below is a list of the various spells used to diagnose and treat different traumas. The exact details must be decided by the GM to fit inside the framework of the magic system being used. Some may be discarded and new spells added as the GM sees fit. The selection of spells was chosen to give some diversity but without creating too much complexity.

Healing Vision Diagnose Bloodmagic I, II, III, IV Stop bleeding Purify I, II, III, IV Cure infection and disease Regrow I, II, III, IV Heal tissue and organ damage Soothe I, II, III, IV Reduce pain and halt shock Cleanse I, II, III, IV Dispel poison and gas Arouse I, II, III, IV Awaken and revive

The more severe the post trauma, the higher the power level of the spell required. Lower level version can however partially heal the trauma. Bloodmagic II for example can stop some and moderate bleeding completely, but it can also reduce the severity of heavy and massive bleeding by two degrees. However, if massive bleeding is reduced in this manner to moderate it cannot be further reduced, unless a more powerful version of Bloodmagic is cast. It is otherwise treated exactly as if it was moderate bleeding.
Spells as Difficulties

It will be down to the world setting to define the technology, but a few possibilities directly related to medicine and trauma are mentioned here. Transplants from cloned body parts grown outside the body may make it possible to replace any organ in the body without risk of rejection. Cryobiology, and more specifically cryonics, may be able to not only preserve body parts at very low temperatures but suspend a person for later revival. This could allow critically ill patients to be suspended until they can be treated. The most obvious method would be to freeze or vitrify the patient to be later revived using advanced nanotechnology, but many other possibilities may present themselves with future technologies. Uploading a persons mind into another body might also be a viable way to rescue someone from a body traumatised beyond repair. The mind could be recorded and transmitted into another living organism or into an artifi27

As with Witchcraft magic in the DICE system there may not be healing spells as such but skills which reflect magical ability. In this case the difficulty of healing any wound is based on the wound severity. Usually starting at tricky for a superficial or nasty wound, and then increasing one difficulty for each severity beyond nasty.

cial construct, either an android body or as an electronic being existing online as an entity in a virtual online world. With nanotechnology or very advanced medicines and not least better medical understanding cancer will likely become curable at any stage. If such treatment becomes available to everyone or only to a rich few would depend on the world setting. Panimmunity might make disease and infection very rare or even impossible. Regeneration techniques might allow missing limbs and body parts to be regrown. Alternatively artificial replacements might be used and these may be far superior than the original parts they replace. Such technologies can be biological grafts designed to become a part of the body or cybernetic components integrated with the biological parts. Whether such a person would be considered a cyborg would depend on society but also perhaps on the percentage of the body that remained unmodified. Genetic engineering will likely be commonplace to prevent hereditary defects and promote desirable traits such as intelligence and good health. Gene therapy may also be used in adults to cure certain conditions or to augment or transform living beings. Nanobots would be especially powerful instruments to redesigning a person. Nanosurgery is discussed in greater detail below, but nanobots would be able to rewire the brain for more efficient thinking, strengthen muscles, fight infections or perfectly heal traumas.
Equipment

hospital there will likely be sophisticated methods, such as nanotechnology, to prevent infection. Sprays may instantly sterilise wounds, and tools and people may even have been genetically modified, or vaccinated, to make them immune. Infection is therefore only a risk when these things are not available to the patient, such as among the poor.
Technique

In a futuristic setting machines and robots are likely to perform the majority of the surgery. Surgeons are more likely to be directing or overseeing the operation, possibly controlling it through a virtual reality interface. Medical microbots, or even nanobots, may be released into the wound and work to repair the damage. This is discussed in greater detail under nanosurgery.
Operating Room

Futuristic operating rooms are likely to be full of strange machines and weird, scary looking electronic tools. The really sophisticated ones however may just as likely be very sparse, possibly designed to reassure the patient, with all the technology hidden.
Operating Team

If the doctor is still directing the operation and not some artificially intelligent surgeon program, then his team likely consists of robots and machines.
After Care

Hospitals will likely have more gadgets and machines and use clever computers to analyse the patient and guide the surgeon. Eventually those computers may become clever enough to perform their own diagnosis and completely replace the surgeon. Surgery may also become more feasible outside a hospital setting. Smaller and cleverly designed instruments will likely allow for portable microsurgeries ideally suited for warfare and remote locations.
Anaesthesia

It is not unreasonable to think that patients may walk out of the hospital fully recovered after surgery.

Nanosurgery
"There's Plenty of Room at the Bottom" - Richard Feynman
Modern: Medieval: Futuristic: Not possible. Nanosurgery would seem like magic. Reattach Ear (easy) 0.2 - 2 hours Reattach Nose (easy) 0.2 - 2 hours Reattach Finger (easy) 0.2 - 2 hours Reattach Hand (easy) 0.5 3 hours Reattach Arm (easy) 1 - 4 hours Reattach Leg (easy) 1 - 4 hours Nerve Repair (varies) Delicate Surgery (varies) Regrow II (fuses ear) Regrow III (fuses finger) Regrow IV (fuses hand, arm, leg)

Anaesthesia is likely to be quick, effective and very safe. Like in modern surgery pain can probably be prevented locally but with much greater ease and precision.
Managing Infection

In the future infection from surgery in a hospital setting is unlikely. Even when surgery is performed outside a

Spell:

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Nanotechnology holds perhaps the most exciting promises for the future. As the name implies nanotechnology is on the scale of nanometres. Smaller than a single micrometer. This allows the manipulation of individual atoms and molecules to build or reconfigure structures at their most basic level. Nanosurgery is the microsurgery of the future, and makes the delicate scalpels and suture threads used in microsurgery seem like butcher tools. Nanobots (nanorobots, nanoids or nanites) are the tools of the nanosurgeon. From 0.5 to 3 micrometres to allow them passage through the capillaries, the smallest of the bodys blood vessels. Built in large numbers from carbon in factories using parallel fabrication and specialized for various medical purposes.
Uses

This would require very advanced nanotechnology indeed, but if possible only 5 millilitre of nanobots could replace the bodys entire 5.4 litres of blood. However, the 5 ml would likely contain a staggering five trillion nanobots. This would likely be extremely expensive. Given the fabulous manufacturing capabilities of nanotechnology money may have become irrelevant in the most utopian of futures, or the few people who control it will have become insanely rich and powerful in the most dystopian.
Equipment

The tiny nanobots travel along capillaries to enter and repair living cells. This makes it possible for the nanosurgeon to not only heal any trauma, but also to reverse ageing, heal disease and improve the body to make it stronger and better than before. Nanobots designed to patrol the bloodstream, to seek out and destroy harmful bacteria, viruses and even hostile nanobots. Such nanobots can cure even the most severe blood poisoning (septicaemia) in hours or less, halting septic shock. The most advanced models can even enter dead tissue to fight off and cure gangrene and every other type of infection. Other nanobots can work as super efficient clotting agents to stop bleeding in as little as a second, hundreds of times faster than normal. When detecting an injury in the blood vessel, the tiny, spherical nanobots unfurl a fibre mesh immediately halting bleeding. Anyone with these very advanced nanobots would be practically immune to bleeding and never go into shock from blood loss. Even bleeding from a severed artery would be stopped, but this might not prevent death as the disruption of blood to the bodys organs or brain would mean oxygen starvation and massive cell death. With the most advanced nanotechnology the functions of the body could be replaced with nanobots. For example red blood cells could be replaced by nanobots several hundred times more efficient. The most sophisticated models might even perform secondary tasks such as monitoring vitals or patrolling for invading organisms, cancers and hostile nanobots. They may also make bleeding a thing of the past by detecting traumas and alerting repair nanobots of the problem while diverting away from the damage.

Nanobots are introduced into the bloodstream in a hospital setting and controlled by powerful computers able to coordinate the swarms of tiny machines. Guided to the trauma or location of an infection the nanobots individually engage and destroy each bacteria or repair trauma to individual cells. This ensures not only perfect healing, but also avoids any side effects from collateral damage. It requires a large swarm to achieve a repair in a reasonable time, but it also means that virtually no recovery time is required after surgery. The patient is able to walk out of the surgery. Specialised nanobots in a hospital setting may leave the body once the job is done to be collected for reuse or disposal. Other nanobots will however stay for longer periods or even permanently. They may assist a poorly functioning organ, protect against disease, act to speed healing and stop bleeding, constantly rejuvenate the body by repairing DNA damage and so on. The number of useful tasks a permanent swarm of nanobots could perform is nearly endless and largely limited by imagination and technology. For early nanotechnology an external controlling computer may be needed to control the swarm of nanobots. Later versions may overcome this by forming a wireless network on which they run their own virtual computer. Still the nanobot swarm would likely have to be refilled every few days, weeks or months to replace damage and lost machines. Once nanotechnology is advanced enough the nanobots can likely reproduce within the host, making them a symbiotic part of the host. There are many potential sources of energy for nanobots such as magnetic fields or using heat, oxygen or other fuels from the host body. Ultrasound is one of several possibilities for nanobot communication. The nanobots may be equipped with all sorts of surgical instruments from manipulators to lasers and different models might have different forms of propulsion depending on their intended environment and the sophistication of nanotechnology.

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Techniques

Ideally nanobots enter the body by injection into the bloodstream using a syringe. More advanced nanotechnology will enable nanobots with propulsion that allows them to enter through the mouth, ears, eyes and other openings. The most advanced nanobots will be able to enter the body through the skin and can be applied as a cream to be absorbed or even sprayed into the air to enter everyone in a room or area. A surgical nanobot will either be programmed for certain behaviour or guided by a human surgeon or mainframe computer. Early models will depend almost entirely on a skilled surgeon who must instruct them at every turn based on sensory data transmitted from the nanobots to some form of display or virtual reality simulation. The more advanced the technology gets, the more autonomous the nanobots get and more advanced models will be able to carry out a number of tasks based on periodic instructions from a doctor or mainframe. The most advanced nanobots will form their own virtual computer through a form of distributed computing and be able to determine their own actions depending on their mission inside the host body. Nanobots could be distributed throughout the body of the host to monitor vitals and provide a detailed diagnosis. Very advanced fully automated nanobots might be able to make their own diagnosis and instruct other models of nanobots to take appropriate action. Less advanced models would simply transmit the data to a computer and it or a doctor would make the actual diagnosis. Like for microsurgery, when attaching body parts the difficulty and probability of success is affected by the time the body part has been severed from the body. However, due to the much greater ability of nanosurgery to restore even partially dead limbs to health the time scale is quite different. Nanosurgery, Time Detached Hours Surgery Modifier 0-8 0 9 - 12 +1 Difficulty 13 - 24 +2 Difficulties 25 - 36 +3 Difficulties 37 - 48 +4 Difficulties 48+ Success is unlikely In cold climates, or if the limb is refrigerated, the times indicated above can be up to five times longer. The exact duration of nanosurgery depends on the extent of the damage, sophistication of the nanobots and size of the swarm. Thus early or cheap nanotechnology will usually take the maximum time indicated and possibly even

longer, while for the most advanced complete recovery will rarely take more than an hour for most cases.
The Result

The result of any nanosurgery is usually as good as new and sometimes better. The patient will typically be able to walk out of the surgery and immediately use the attached limb.

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Trauma Explained
"The art of medicine consists of amusing the patient while Nature cures the disease." -Voltaire This chapter explains the details and treatments of various traumas. Although it is based on real medicine it has been modified, simplified and interpreted to make it easier to understand and more user friendly for gamers and writers. It is not intended in any way for real world use. Do not use this book to diagnose or treat any condition and no responsibility can be taken by the author for the consequences of using the knowledge in this book on anything but fictional characters. Children heal faster and a week of healing takes only five days. Race, path abilities, treatment, herbs, potions and magic may also affect the recovery time. Some traumas may specify an increase in the basic healing time. This can be a multiplier, such as x2, that increases the number of weeks it takes to heal to a lesser wound severity. It only applies to the first stage of healing. Thus a grim wound which takes five weeks might take ten weeks if a trauma doubles the healing times. However, after those ten weeks it would only take four weeks to go from grievous to nasty.

0 Healing Times
The time it takes for a wound to heal depends on the trauma inflicted. This forms the basis for the healing time. Medical treatment, healing and basic care can reduce healing times. Infection, illness, exertion and poor conditions can increase healing times. Some wounds require medical treatment in order to heal at all. The required treatment will be specified and if not supplied the wound will either not heal or heal badly causing deformity and often permanent impairment.
Basic Healing Time

1 Fracture
Broken Bone There are 206 bones in the body. Some are dealt with in their body location but most fractures can be handled as explained here.

1A Closed Fracture
A simple fracture where a bone is cleanly broken.
Symptoms

The basic healing depends on the wound severity. This starts at two weeks for a superficial wound and increases by one week for each additional severity. Each stage heals to a lower severity which in turn must heal until all stages are healed and the character fully recovered. Thus a nasty wound would first take three weeks to heal to a superficial wound and then another two weeks to heal fully. Different wounds heal independently of each other and at the same time. So two superficial wounds would both heal in two weeks.
Healing Time Adjustments

Pain, sometimes only felt when the bone is stressed by use. Swelling, discolouration and inability to move the affected body part are also common. Sometimes deformity can be seen.
Risks

The greatest risk is from the fracture not healing properly. A stable fracture always heals properly with treatment, but may result in a Mal-Union or Non-Union if not treated. An unstable fracture will never heal properly without treatment. Roll 1D10 to determine if the fracture is unstable: 1 - 8: No complication 9 -10: Unstable Fracture
Diagnosis

Healing times assume normal conditions, rest and adequate food. If infection occurs the wound will not start healing until the infection is cured. Poor nutrition, illness, lack of sanitation or exertion may also increase healing times up to twice the normal. A week of healing is normally seven days, but may be more or less depending on conditions and treatment. Poor nutrition, illness, lack of sanitation, exertion and even old age may increase a week of healing to eight to ten days.

Modern: Medieval: Futuristic: Spell:

X-Ray Scan (easy) Physical Exam (tricky) Scan (easy) Healing Vision

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Diagnosis is used both to detect a fracture and to decide if a fracture is unstable and needs treatment beyond immobilisation.
Treatment

Nanosurgery (easy) although bone needs to be manipulated into place for it to work. Spell: Regrow II

Modern: Medieval: Futuristic: Spell:

Immobilise (tricky) Set Bone (tricky) Immobilise (tricky) Set Bone (tricky) Drugs or nanobots might accelerate healing times. Regrow I

An Unstable Fracture can be treated with internal fixation surgery. Internal fixation holds the fracture together using screws, plates, rods and other devices of a biocompatible metal while it heals. The devices are not removed after healing is completed. If an Unstable Fracture is not treated it always results in a Mal-Union. In a Mal-Union the bones overlap or do not align properly. A Mal-Union is usually hard or worse to treat as the bones have fused and must be cut apart and then reset. A Non-Union means the healing process did not finish and the tissue connecting the broken ends fail to harden into bone. Usually the result of a poor blood supply to the bone or lack of rest. Bone grafting surgery where a section of bone is taken from another area of the body and used to bridge the open gap of the fracture can fix a Non-Union. This requires two operations. The extraction of the bone to graft and then the grafting itself. Both are of tricky difficulty. Alternatively a metal rod or plate may be implanted to hold the Non-Unioned fracture together. This saves an operation to extract bone for grafting but it is a bit more tricky to achieve a stable and solid joining. Some Non-Unions may heal with the use of an external coil which delivers an electric current to the fracture site.

A broken bone with no complication simply needs to be immobilised with a splint or sling. The pull of muscles and tendons will ensure the ends are kept together and the bone will heal. Strips of wood and bone are excellent as splints. Difficulty depends on the splint and injury. Doing an improvised splint in the woods is typically tricky for a simple leg fracture. A good leg splint (normal or better success) will allow the character to move at half normal movement speed. An unstable fracture needs the bone to be set, by bringing the broken ends together and only then immobilising with a splint, sling or sometimes a screw. The normal difficulty of setting and immobilising an unstable fracture is hard. It is easier done with internal fixation surgery as explained under surgery. An untreated unstable fracture always results in a MalUnion. An untreated stable fracture often heals properly on its own. Roll 1D10 and only on a 9 does it result in a Mal-Union and on 10 in a Non-Union. The risk of either may be increased if the bone was put under heavy strain or badly treated. Both a Mal-Union and a Non-Union will impose a permanent -1D penalty on all physical actions involving the limb. If in a leg it halves movement rates as the character limps along. Both can be surgically corrected but with different procedures of surgery.
Surgery

1B Open Fracture
Compound Fracture The fracture is exposed through an open wound.
Symptoms

The fracture itself is often quite obvious as the bone is exposed and may be sticking out through the open wound. Otherwise the symptoms are the same as for a closed fracture [1A].
Risks

Modern:

Internal Fixation (tricky) Mal-Union Resetting (hard) Non-Union Grafting (tricky) Non-Union Fixation (tricky) Mal-Union Resetting (severe) Internal Fixation may be possible in sophisticated societies (tricky) Hightech tools likely reduces all modern difficulties to (easy)

Medieval:

An open fracture is the same as a closed fracture [1A] with one major difference. The bone is exposed to bacteria through an open wound with a high risk of becoming infected. An outcome which is easily fatal and certainly unwelcome. Handle the direct infection [4] risk as normal, but if there is an infection there is a high chance of a bone infection [4G].

Futuristic:

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Treatment

Medieval: Immobilise and Set Bone (see 1A) Immobilise and Set Bone (see 1A) The cause of bone infection is obviously not understood, but some intelligent healers may understand the value of keeping a wound clean. Likely powders, ointments or beams exist to sterilise the wound completely. Purify I Futuristic:

Modern: Medieval:

Immobilise and Set Bone (see 1A) Permanent external plates screwed into the bone may eliminate the impairment Hightech tools (easy) Nanosurgery (easy), the difficulty is because the fragmented pieces may not be aligned properly and require a surgeons assistance to align them. Regrow III

Futuristic:

Spell:

Spell:

Like for a closed fracture [1A] the bone should be immobilised or the bone set if unstable, but not until the danger of infection is over. This can take up to a week. This is correctly judged on a healing roll which is a normal success. If there is no infection then there is no bone infection either. If there is an infection and the healing roll is not a success or the healer is unaware of the infection risk, such as in a medieval society, roll 1D10 and the infection becomes a bone infection on 6-10.
Surgery

Immobilising the fracture will not help healing, but may prevent further injury and allow some movement or reduce the impairment. Only surgery can repair a fragmented bone. Depending on the severity it may need to be pieced back together and plates, screws, nails, rods or some other mechanism installed to hold them in position. Difficulties will vary greatly but start at tricky and surgery brings with it the risk of bone infection as explained for open fractures [1B].

1D Open Fragmented Bone

Compound Comminuted Fracture The combination of a fragmented bone [1C] and an open fracture [1B]. Especially nasty because treatment to prevent infection is so difficult. Increase any treatment to reduce the risk of infection [4] by two difficulties.

Debridement, surgical removal of contaminated or dead bone, muscle and skin tissue, may reduce the risk of the initial infection as explained under infections [4]. Amputation will obviously also eliminate the risk, but is usually too extreme. If bone infection occurs [4G] it must be treated as explained under bone infection treatment.

1E Shattered Bone
Modern: Repair (insane) Artificial Replacement (severe) Shattered bone cannot be treated. Instead some sort of permanent external splint or amputation, perhaps with a prosthetic limb if possible. With hightech tools repair may be (tricky) and replacement (easy). Nanosurgery (tricky), the high difficulty is because the shattered pieces may not be aligned properly and require a surgeons assistance to align them. Regrow IV

1C Fragmented Bone
Comminuted Fracture Called a comminuted fracture, the bone is splintered into fragments.
Risks

Medieval:

Futuristic:

Without surgery it will never heal properly and so result in a permanent impairment, deformity or disability. The exact effect depends on the location and the severity of the trauma, but will usually be -1D.
Treatment and Surgery

Spell:

Modern:

Immobilise and Set Bone (see 1A) Repair (tricky)

This is reserved for when the bone is destroyed beyond any normal hope of repair or healing. Unless the bone 33

can be replaced surgically with some artificial replacement the impairment from the injury is permanent.

Risks

1F Open Shattered Bone

Compound Shattered Bone The shattered bone [1E] is exposed to an open wound and has the same risks of bone infection as an open fracture [1B]. Especially nasty because treatment to prevent infection is so difficult. Increase any treatment to reduce the risk of infection [4] by two difficulties.

Loss of blood kills through shock, but less severe blood loss can still lead to chronic fatigue or anaemia. Moderate bleeding causes +1 chronic fatigue if not treated in the same scene. Heavy bleeding results in +1 chronic fatigue if not treated with exceptional success, herbs or magic in the same scene. Massive bleeding always results in +1 chronic fatigue. Chronic fatigue stacks with chronic fatigue from other wounds. Heavy and massive bleeding lead to shock [3] if not stopped in time. This takes around ten minutes for heavy bleeding and two minutes for massive bleeding. These times are only rough estimates, but accurate enough as bleeding and shock is usually only considered in the aftermath of combat when exact time measures are not important.
Treatment

2 Bleeding
Haemorrhage Blood is essential for transporting oxygen around the body. Bleeding reduces the total volume of blood in the vessels. The body can compensate for the loss by contracting the vessels to maintain the blood pressure and in so doing causes the skin to turn pale. In a few hours normal blood volume is restored by diluting the blood with water from the body and the lost blood plasma is restored over a period of a few days. However, the vessels can only contract so much. If enough blood is lost the pressure drops and the organs do not get enough blood. Most importantly the brain is starved of oxygen and shock [3] is the result. Although blood loss rarely causes immediate death it is one of the primary causes of death from trauma.
Severity

Modern/Medieval:Moderate Bleeding (tricky) Heavy Bleeding (hard) Massive Bleeding (severe) Futuristic: Drugs, nanobots or other hightech solutions are likely able to stop any bleeding in seconds. Bloodmagic I (moderate) Bloodmagic II (heavy) Bloodmagic III (massive)

Spell:

Even if no bleeding is indicated there may still be some bleeding, like a nosebleed or from a cut, but it is insignificant. It can still be described for dramatic effect. When blood loss is indicated it is because it is serious enough to cause chronic fatigue and potentially life threatening shock and anaemia. The severities of bleeding are moderate, heavy and massive.
Blocked Bleeding

The above is the difficulty on average to stop the bleeding, but this may be adjusted up or down depending on the wound. The difficulties may also be lowered if helpful medical equipment is used, such as tourniquets. In a well equipped hospital only massive bleeding poses any danger and is typically tricky to stop. The degree of success determines how well the wound is bandaged and therefore how easily the bleeding will start again in the same day. After a nights sleep the wound can be assumed to have healed sufficiently that further major bleeding is unlikely.

This is an optional rule which adds a bit of realism and may give bleeding characters a second chance. Use or ignore at will. If the weapon or object which caused the bleeding is left in the wound the severity is temporarily reduced by one severity. This is possible for any large object or weapon, such as an arrow or spear, but not for bullets. As soon as the object is removed bleeding increases to full severity.

Marginal: Bleeding will resume on any significant movement. Normal: Care must be taken when moving as any strain can cause bleeding to resume. Exceptional: Bleeding will not resume unless put under extreme strain. Needed to prevent chronic fatigue from heavy bleeding.

34

Cumulative Blood Loss

2B Anaemia
Anaemia is a shortage of haemoglobin, oxygen-carrying red blood cells, causing a shortage of oxygen. The heart beat is accelerated to compensate for the loss. An anaemic person becomes pale, weary, weak and may develop a slight fever. If the character suffers from chronic fatigue from bleeding continuously for a week, or suffers more bleeding wounds in a week than there are days, anaemia develops. Continuous minor bleeding and an iron deficient diet may also result in anaemia. Anaemia triples the recovery time for all fatigue, both chronic and normal. As long as the character suffers any further blood loss the anaemia will not get better. Dizziness, breathlessness and eventually headache, chest pain (angina) and possibly leg pains develop. If the anaemia continues for more than two months chronic fatigue develops that does not get better, but instead increases one stage, from winded to drained, each week. After three weeks the overworked heart gives up and the character dies. This process can only be stopped by avoiding any blood loss or a blood transfusion [2C]. To recover can take up to two weeks of no further blood loss and a diet with plenty of iron, although a blood transfusion [2C] can speed up recovery.

All lethal blood loss is cumulative so a character bleeding badly from several wounds will die faster. However, in most cases it is not necessary to keep an exact track. Simply use the bleeding wound with the highest blood loss. If several then divide the time until shock sets in by the number of wounds of that severity, ignoring all blood loss of lesser severities. Each wound must of course still be treated separately.
Recovery

Blood volume is regenerated over hours. So if a new bleeding wound is inflicted soon after a previous one is stopped shock will set in much faster. The same is true if a wound that stopped bleeding only a short time before is re-opened. The blood plasma is not replaced until 2-3 (or 5-7) days and it can take 2-6 weeks for all the bloods constituents to return to normal. If significant, or continuous, blood loss happens repeatedly in such a period, even though it does not lead to shock, it can lead to anaemia [2B].

2A Internal Bleeding
Bleeding is blood lost from the vessels. It does not matter if it escapes the body. If the bleeding is internal there may be no immediate outward signs of the bleeding as the blood fills up internal cavities and seeps in between muscles. Diagnosing internal bleeding is usually impossible until the loss of blood reveals itself by such symptoms as paleness, cold and clammy skin, thirst, confusion or a weak and rapid pulse. There may also be blood from the mouth, nose, ears or in the urine if the bleeding is severe enough or close to the lungs, stomach, bladder or anywhere where the blood might find its way outside. Even when internal bleeding is in evidence it can still be hard to determine the location without exploratory surgery or some sort of sophisticated scanner. Because of this, internal bleeding is always more dangerous as it is usually discovered only when the patient goes into shock. If the location can be determined first aid, such as applying pressure, may be attempted, but with the an increase in difficulty of one or two as appropriate. If this fails and the bleeding does not stop on its own, only surgery or drugs can stop the bleeding. Bleeding inside the skull is especially fatal. If internal bleeding is indicated in the head it can be assumed to be intracranial bleeding [100A].

2C Blood Transfusion
Modern: Medieval: Futuristic: Spell: Transfusion (easy) Transfusion (hard) Transfusion (easy) Healing Vision Bloodmagic IV (transfers blood)

A blood transfusion is the transfer of blood from one person to another. Blood transfusion can be a real life saver in many situations. Shock from blood loss is always best treated with a blood transfusion, severe anaemia is fatal without it and it is often needed for nasty burns. In a medieval setting blood transfusions might be available in a very advanced society but would not be commonly used.
Blood Type

The four blood types are O, A, B and AB. The letter specifies the blood types protein which is an antigen which stimulates the production of antibodies in the recipient if his blood type does not match. The table below shows which blood types are compatible 35

Blood Type Compatibility Recipient Matching Donors O O A O and A B O and B AB All Furthermore each type is either rhesus-positive or rhesusnegative. This is usually denoted by a plus or minus after the blood type. Rhesus positive characters can receive blood from both positive and negative donors. Rhesus negative donors can only receive blood from other rhesus negative donors.
Mismatched Transfusions

3 - Shock
Shock is a life-threatening condition that occurs when the blood pressure is too low to maintain an adequate flow and often the cause of death from injury or acute illness. While the organs can manage for a while with a reduced supply the brain cannot. The main cause of shock is blood loss, but it may also result from internal trauma or acute illness. A character at any stage of shock is unable to walk or act normally. Going into shock is extremely dangerous and usually fatal if the right treatment is not initiated quickly.
Stages of shock

If the donated blood is incompatible in type or rhesus the recipient will have a negative reaction which is easily fatal. Blood type and rhesus can be determined with a blood test. This might not be possible in a medieval setting, unless magic can determine it, so blood transfusions might be a risky matter of trial-and-error. The reaction usually starts soon after the transfusion. If unconscious there may be no immediate outward signs that something is wrong, otherwise the character will feel unwell and agitated. Back pain and pain at the site of the infusion are common. If the transfusion is not stopped the character will die from shock. Every five minutes roll for shock [3] starting at easy but increasing one level in difficulty each time. If the transfusion is stopped once the character goes into shock he will usually start to recover from the shock with care.
Disease

Stage I: Cold, clammy skin, pale, shallow rapid breathing and often anxious or giddy. This is accompanied by weakness and often blurred vision. Stage II: Same as above but feels faint and dizzy and slips in and out of consciousness. Behaviour is confused and can be inappropriate. May also have chest pains, nausea and vomit. Stage III: Same as stage II, but unconscious and a rapid but very weak pulse. Brain damage may occur. Stage IV: Usually lasts less than a minute and invariably leads to death as the brain is starved of oxygen. In the unlikely event of recovery, massive brain damage will usually have occurred.
Going into shock

Any disease carried by the donor may be transferred during the transfusion. The risk depends on the amount of blood and disease but is generally very high.
Determining Blood Type

The two primary causes of shock in combat are from bleeding and severe trauma. In the first case shock always starts at stage I and the time before it progresses to the next stages depend on the severity of the bleeding. So ten minutes for heavy bleeding and two minutes for massive bleeding. In the case of severe trauma a shock roll is usually specified by the injury along with a difficulty in brackets. An attribute roll, same as would be used for resisting stun or poison, must then succeed against the difficulty to avoid going into shock.
Dying from shock

If blood type is not specified roll 1D100. Blood Type 1D100 1 37 38 72 73 81 82 84 85 91 92 97 98 99 100 Blood Type O+ A+ B+ AB+ OABAB-

Someone who has gone into shock will rarely recover without medical treatment or at the very least some first aid. The time it takes for a trauma induced shock to progress to the next stage depends on the trauma. If the trauma required periodic shock rolls then the time to progress to each stage is equal to the time specified between each 36

shock roll. Otherwise it depends on how badly the shock roll was failed as shown in the table below.

Shock Stage Progression Failure Interval Marginal 1D10 hours Normal 1D12 minutes Exceptional 1D6 minutes An exceptional shock roll failure takes the casualty straight to stage III, a normal failure to stage II while marginal failure starts from stage I. Fear, stress and any increase in pain will reduce the time until the casualty progresses to the next stage. Breathing problems, further bleeding or additional wounds may also reduce the time. If a casualty in shock is sufficiently injured or frightened he may immediately progress to the next stage and then progress quickly through any remaining stages until dead. When stage III is reached the casualty eventually suffers brain damage. When half way to stage IV the casualty suffers minor brain damage, two thirds to stage IV major brain damage and upon reaching stage IV massive brain damage due to oxygen starvation to the brain. A barbarian tries to get up after having an arrow pierce his right lung. He must roll shock (tricky). If the roll fails he will go into shock and his condition will deteriorate without treatment. Sure enough the barbarian gets a normal failure and collapses back down with dizziness. Because of the degree of failure he is already at stage II shock. 1D12 is rolled and results in a 8, meaning that after 8 minutes the barbarian will progress to stage III unless a surgeon or doctor comes to the rescue. After 4 minutes at stage III he suffers minor brain damage, then major brain damage at 6 minutes and finally after 8 minutes he reaches stage IV and dies from massive brain damage.
Types of shock

heart injury or any organ injury may induce shock. Spinal injury: The reaction of the nervous system to the injury may lead to shock. Loss of body fluids: Due to extensive burns, dehydration, severe vomiting or diarrhoea. Septic shock: Shock from severe sepsis [4E] or blood poisoning [4F] resulting from an infection.

Treatment

Modern: Medieval:

Care and shock treatment (tricky) Care and shock treatment (hard*) *the increased difficulty reflects a lack of understand for the condition. Care and shock treatment (tricky) Drugs and other treatment may exist to take the patient out of shock. Soothe I (stage I), Soothe II (stage II),
Soothe III (stage III), Soothe IV (stage IV)

Futuristic:

Spell:

Shock is a deteriorating condition that usually does not allow a casualty to recover without active medical intervention. A delay of even a few minutes may mean death. Even only basic shock treatment such as elevating the legs, keeping the casualty warm, comfortable and comforted may delay the progression of shock and in some cases this may allow the body to recover. How much it is delayed depends on what care is available and the skill of the carer. A normal success may double the time it takes for the shock to progress to the next stage and an exceptional one may even triple it. Treating the wound and stopping any bleeding will halt shock at a particular stage and if the patient is treated with care the stages may retreat one by one over the following hours, or days, depending on severity and treatment. Some injuries may require surgery to stabilise the casualty. Ideally some sort of infusion [2C] should be done to replace the lost blood and thus immediately take the patient out of shock.
Self Treatment

While bleeding and trauma are the most common causes of shock, burns, infections, toxins, suffocation, severe temperatures and even extreme fear may induce shock if severe enough.

Loss of blood: The most common cause. The greater the loss of blood the greater the chance of going into shock. Trauma: Burst appendix, perforated intestine or stomach, intestinal obstruction, pancreatitis,

At stage I it may be possible for the character to stop his own bleeding and rest to recover. This depends on the severity of the wound(s) and if the character has the means to heal them. All difficulties should be increased by one in addition to any penalty for self treatment. The strain of doing this may however worsen the shock to stage II at the GMs discretion (normal or exceptional failures for example). 37

The GM might in some circumstances allow someone in stage II of shock to treat themselves but this should increase difficulties by two or three. So a casualty at stage II or III shock left to himself will most likely die as he cannot heal his own wounds.

Risks

4 - Infection
Infections are caused by invading bacteria, or other micro organisms, usually following surgery or trauma. The risk of infection from surgery is discussed under surgery.
Internal Infection Risk

An infected wound does not start to heal until the infection is cured and the fever fatigue means that any physical effort will quickly exhaust the character. How it develops depends on if the result of the roll to resists the infection was a marginal or normal failure. If no such roll was made then generate one randomly by rolling 1D6; where 1-2 is marginal failure and 3-6 is normal failure. On a marginal failure the fever stays light [12A] and abates in two to three days. The only risk is from tetanus [4D], which develops on a random 1D10 roll of 10. On a normal failure the infection grows worse and a severe fever [12B] develops 1D12 hours after the onset of the light fever. Without treatment it will fester for 1D12 + 10 days and there is a high risk of a complication. Roll once for a complication around half way through the infection.

Infection from internal damage, such as ruptured intestines, stomach or esophagus, allow bacteria or fungus from one part of the body into places where they are not supposed to be. Internal infection is specified as a complication in the risk section of any trauma that carries the risk. If not specified treat as a festering infection.
Direct Infection Risk

1D12
1-4 5-7 8-9 10 11 12
Treatment

Any trauma that penetrates or breaks the skin carries a risk of direct infection from bacteria invading the open wound. Bacteria, skin and dirt are often forced into a wound along with the blade or projectile. If the wound is treated successfully there is normally no infection. This may include using antibiotics, if available, and the doctor believes the risk of infection to be high. However, if the wound is not treated successfully an attribute roll determines if the wound becomes infected. The difficulty starts at easy for a superficial wound and increases by one for each severity, so tricky for nasty wounds, hard for grievous wounds, severe for grim wounds and extreme for mortal wounds. If the wound was caused by a natural attack (claws, bite) the difficulty should be increased by one. Only roll once for the most severe wound. On a marginal or normal failure a nasty festering infection [4A] develops. On an exceptional failure gangrene [4B] or necrotizing fasciitis [4C] develops as determined by the situation or randomly.

Complication Risk Complication None Limb: No complication Abdomen: Peritonitis [300A] Chest: Chest Infection [200A] Head: Brain Infection [100D] Tetanus [4D] Sepsis [4E] Blood Poisoning [4F] Bone Infection [4G]

Modern:

Antibiotics Debridement (tricky) Amputation (easy) No treatment apart from caring for the patient or amputation is likely to be available. Any attempted debridement surgery if allowed will likely be severe or worse from the lack of scanners and technology. Powerful antibiotics, ointments, and nanobots or friendly bacteria may exist to cleanse the infection. Purify I (light fever) Purify II (severe fever)

Medieval:

4A Festering Infection
An infection is caused by opportunistic bacteria that infect a wound or damaged tissue.
Symptoms

Futuristic:

Spell:

A light fever [12A] develops in the first 24 hours. This will either abate in two or three days or turn into a severe fever [12B] if the infection grows worse.

Usually treatment consists of antibiotics and rest, although poor or good care may affect the recovery time and increase, or reduce, the risk for complications. Antibiotics will reduce the duration of the infection and in most cases eliminates the risk for complications. Weak 38

antibiotics might halve the infection time and leave a small risk of complication, while powerful antibiotics can cure it in 24 hours. To decrease the risk of complications add a negative modifier to the roll. When the source of infection is known, surgery can be effective. This usually requires a successful CT or MRI diagnostic scan of tricky difficulty or equivalent. Such surgery removes contaminated and dead tissue and is known as debridement surgery. Successful surgery halves the duration of the infection and reduces the risk of complications. Aggressive debridement cuts the infection time down to one tenth and practically eliminates the risk of complications, but will leave the character badly scarred and possibly with permanent impairment of -1D. Amputation will also work if the infection is in a limb, but is a very extreme cure.

Symptoms

Incubation: There are no symptoms. Early: As tissues die, carbon monoxide and hydrogen gases are released, causing bubbling around the tissue. Intermediate: Blue, black and red skin discolouration, loss of sensation and foul smelling discharge. Light fever [12A]. Late: Necrotic tissue visible in a large area and reaches down to bone. May crack open discharging foul smelling fluids. Deadly fever [12C].

Risks

4B Gangrene
Mortification, Tissue Necrosis Gangrene is very similar to necrotizing fasciitis [4C]. However, in necrotizing fasciitis truly nasty bacteria infect a wound and cause tissue necrosis as a by product of the toxins they produce. Gangrene on the other hand starts when body tissue dies from lack of oxygen and is then contaminated with bacteria that spread to healthy neighbouring tissue as well.
Stages

During the incubation and early stage there is no immediate risk of death. As soon as the intermediate stage is reached fatal complications do pose a danger. Shock [3], sepsis [4E], blood poisoning [4F] and kidney failure [305A]. Every time the intermediate or late stage is reached (whether getting worse or better) check for shock and then for any complications by rolling 1D12. The shock difficulty and result of the roll is listed for each stage below.

The development of gangrene is divided into four stages. The first is the incubation period. The incubation period is the time from the damage occurs through surgery or trauma, until the tissue dies from insufficient blood supply and bacteria infect the dead tissue and multiply in sufficient numbers to start spreading. Use the table below to determine the incubation period. Gangrene Incubation Stage 1D10 Time Period 1-2 1D10 hours 3-8 1D10 days 9-10 4 x D10 days The next is the early stage, and at this stage the gangrene is clearly visible. The early stage lasts 1D100 hours. When the intermediate stage is reached a fever will develop as the body is slowly losing to the spreading gangrene and health starts to decline. This stage lasts roughly twice as long as the early stage did. By the late stage the battle is lost and it is just a question of time until death, usually from sepsis, blood poisoning, kidney failure or the strain of the fever.

Incubation: no risks Early: no risks Intermediate: Shock (easy). 1-8 No Complication, 9-10 Sepsis, 11 Blood Poisoning, 12 Kidney Failure. Late: Shock (tricky). 1-5 No Complication, 6-8 Sepsis, 9-10 Blood Poisoning, 11-12 Kidney Failure.

If the late stage is reached the body will have lost to the gangrene infection and blood pressure will drop, resulting in unconsciousness and a much greater risk of shock. When the late stage is reached keep checking for complications every two hours until successful treatment takes the gangrene back down to an earlier stage or death. If the gangrene is in the abdomen it is known as a bowel gangrene. Increase the difficulty levels for shock by two. For gangrene in both the bowels and the chest also double the chances for sepsis to 7-10 for the intermediate stage and 3-8 for the late stage.
Recovering

Without treatment gangrene will be fatal in nearly all cases. Healthy characters may be allowed an attribute roll against extreme difficulty once at the intermediate stage and against insane difficulty once at the late stage. If successful the bodys defences will be winning and the character will slowly start to recover. The recovery will take 39

at least twice the time the gangrene lasted and a gradually improving fever will persist until fully cured.
Diagnosis

Modern: Medieval: Futuristic:

Physical Examination (see table) Scan (tricky) Physical Examination (see table). Physical Examination (see table) Scan, reduce the difficulty at each stage by three levels. Healing Vision

Stage Incubation Early Intermediate Late

Gangrene Treatment Diagnosis Surgery* Insane Tricky Tricky Hard Easy Severe Easy Extreme

* The difficulty is for a successful cure. If antibiotics are used

effectively, lower the difficulty by one degree. With no antibiotics increase difficulty by one. Amputations are easier.

Spell:

As always if surgery is not aseptic (sterile) secondary infection is a risk. Surgical intervention is needed several times to defeat the gangrene. Antibiotics alone cannot cure it, although highly effective treatment may halt it at a particular stage. If surgery succeeds treat the infection as having retreated one stage. For example if it was in an early stage it will have been reduced to the incubation stage. Another operation, usually around 12 hours later, will then take the infection from its incubation stage to cured. Failing to perform further surgery within 24 hours means that the infection will again start to spread and again progress to the next stage after the rolled number of hours. If a surgical attempt fails another attempt can usually not be attempted until the infection has progressed to the next stage. Both because there is a limit on how much surgery a patient can tolerate and more importantly because it is not known if the surgery was a success before the gangrene gets better or worse. A high degree of success with the surgery can speed the process of recovery. A normal success will reduce gangrene by two stages. An exceptional success reduces it by three. As long as the gangrene is in a limb an amputation (easy) immediately cures the gangrene. If and when the gangrene is cured a festering infection [4A] still remains in the body unless the gangrene never got past the incubation stage. Treat as a normal infection which has reached the stage of a severe fever. Serious disfigurement and some disability from the debridement surgery is probable if not caught in the incubation stage. If the gangrene was halted at the early stage this will be mainly in the form of serious scarring and long healing times. If it was halted at the intermediate stage there will terrible scarring and the character may end up with a limp or other disability depending on the location. If the gangrene reached the late stage before it was cured parts of lungs or intestines might have been removed or part of a leg or arm amputated. Also take into account how many times surgery was needed before the condition was finally cured and the sophistication of the surgery. 40

Diagnosis to detect the gangrene becomes easier for each stage the gangrene reaches and symptoms become more obvious. The difficulties listed in the gangrene treatment table below are for detecting gangrene with a physical examination. At any stage a MRI or CT scan can be used to determine the spread of the gangrene and if bones or organs are affected. Such a scan is usually of tricky difficulty and if successful the surgery difficulty can be reduced as normal.
Surgery

Modern: Medieval:

Debdridement Surgery (see table) Amputation (easy) Amputation (easy) If known debridement surgery may be possible in the limbs and up to the early stage in the chest and abdomen. Difficulties depending on the tools available. Nanobots or engineered biological healers may be able to consume the dead tissue and destroy the bacteria.
Purify I (incubation), Purify II (early), Purify III (intermediate), Purify IV (late)

Futuristic:

Spell:

The only effective cure is surgery to remove all necrotic tissue and to drain the infection. This type of surgery is called debridement. The difficulty for the diagnosis of the condition and for surgery to be successful in curing the infection depends directly on how early it is performed. The surgeon can decide upon a more aggressive debridement surgery which decreases the difficulty by one but which drastically increases the risk of disfigurement and disability.

4C Necrotizing fasciitis
Flesh-Eating Bacteria, Gas Gangrene, Necrotizing Soft Tissue, Soft Tissue Gangrene Although similar in many ways to gangrene, necrotizing fasciitis is the most severe form of infection possible. The term necrotizing fasciitis covers several types of infections, that have in common their rapid spread, resistance to treatment and high rate of fatality. As the infections spreads, muscles, tendons and other tissue is irrevocably destroyed. Although not differentiated it should be noted that there are three major types of necrotizing fasciitis. 1. 2. 3. Polymicrobial (several types of microbes) Flesh-eating bacteria Gas Gangrene

bad at this stage as nerves have usually been destroyed, but the fever turns deadly [12C] and delirium and unconsciousness is common.
Risks

The risks are essentially the same as for gangrene [4B], but the risk of shock is increased by one level to tricky for the intermediate stage and hard for the late stage.
Recovering, Diagnosis and Surgery

Recovery, diagnosis and surgery are the same as for gangrene [4B].

4D Tetanus
Lockjaw Tetanus is contracted through a wound, like a cut or bite and is a bacterial disease that attacks the nervous system. It is known as lockjaw because the jaw becomes locked making it impossible to open the mouth. Any wound no matter how small can cause tetanus, but deep cuts like those made by nails, knives and other puncture weapons are especially likely to lead to a tetanus infection. Tetanus bacteria exist everywhere in the soil, dust and especially in manure.
Symptoms

The infection goes deep, producing toxins and blocking blood which causes gangrene to develop. As the muscles and other tissues are destroyed the necrotic flesh becomes a perfect breeding ground for more bacteria which cannot be reached by the bodys defences or with antibiotics. Any cut or puncture in the skin can potentially cause necrotizing fasciitis.
Stages

Like gangrene, the development of necrotizing fasciitis is divided into four stages.

Incubation: 3x1D10 hours Early: 3x1D10 hours Intermediate: 2x1D10 hours Late: Last stage before death.

Symptoms only start 1D12 days after the infection. First with a headache, then severe muscle spasms and a locked jaw making it impossible to open the mouth or swallow. There is a light fever [12A] the first day which quickly progresses to a more severe fever [12B] which turns into a deadly fever [12C] after another day or so.
Risks

Symptoms

Incubation: Towards later half of incubation period symptoms appear to indicate a normal skin infection with a light fever [12A]. Early: Pain gets rapidly worse out of all proportion to visual symptoms. Swelling and painful dark bumps that quickly expand, first turning purple, then gradually black with a necrotic appearance. Light fever [12A]. The progress of the infection can be alarmingly fast, expanding visibly in a few minutes, spreading throughout a body location in only hours. Intermediate: Skin is likely to start breaking open and discharge purulent fluids. Fever becomes severe [12B]. Nausea and diarrhoea.. Late: Symptoms may start appearing in places away from the initial location. The pain is not as

The deadly fever, lockjaw and muscle spasms last for 1D10 + 10 days. The prolonged deadly fever, difficulty eating and breathing problems means that death is a risk even with care. It is certain without care. After the 1D10 + 10 days have passed the spasms will diminish over the next few days and the fever will gradually be reduced to a severe and then light fever. The light fever persists for 1D10 days before a more or less complete recovery is made, although fatigue from the infection may last for several more weeks.

41

Treatment

Modern: Medieval: Futuristic: Spell:

Vaccination No Possible Treatment Nanobots can likely cure tetanus. Purify III

fection is in the chest there is a 5% chance of respiratory failure [100B] every five hours. Life support may allow the character to survive. If put on life support treat as ARDS [212] as well as sepsis. If in the abdomen there is a 5% chance of kidney failure [305A]. If anywhere else there is a 2% chance of either every two hours. Eventually, and likely less than two days, multiple organ failure and death will occur.
Diagnosis

4E - Sepsis
Sepsis is the body's immune response to an infection gone berserk and the bodys defence mechanisms of inflammation and coagulation run amok throughout the body. The abdomen, urinary tract and pelvis are the three most likely sites where an infection may lead to sepsis. However, it is often not possible to determine the source of the infection. In fact sepsis can result from any infection, including the various forms of gangrene. In general the more severe the infection the greater the chance of sepsis.
Symptoms

Modern: Medieval: Futuristic:

Diagnosing Sepsis (special) Locating Infection Source (special) Diagnosing Sepsis (special) Diagnosing Sepsis (special), likely tests are available making it (tricky) Locating Infection Source (special), likely not harder than tricky with hightech tools. Healing Vision

Spell:

Severe fever [12B], shaking chills, nausea, vomiting, diarrhoea, confusion and reduced mental alertness
Risks

Diagnosing sepsis can be very hard as the symptoms are easily confused with other disorders. Drop the difficulty by one for every five hours observed and allow a new attempt. Treatment consists of finding the infection and eliminating it with antibiotics or surgery to drain the site of infection. The source of the infection may be obvious if there is an infected wound. Otherwise it can only be found with exploratory surgery at suspected sites, blood tests and scans. The difficulty can be anything from easy to insane.
Treatment

Inflammation and other reactions are normal defence mechanisms of the body against infection. It is when these processes are out of control that it becomes sepsis. Sepsis leads to tissue damage which causes organ failure and gangrene. In the first 10 + 1D10 hours of sepsis, symptoms start appearing and the character starts feeling ill. This is the initial stage of sepsis when treatment has the highest chance of success. After this the condition deteriorates rapidly, until septic shock [3] sets in and eventually organ failure and death. After the first 10 + 1D10 hours sepsis puts tremendous strain on the system which will cause septic shock sooner or later. Start at easy difficulty and roll shock every five hours, increasing the difficulty each time. If already rolling for shock due to some other condition, things get even worse. In such a case start the difficulty at whatever it is for the other condition. Make only one shock roll for both conditions, but take the most severe of the two and halve the time between each roll and difficulty increase. There is also a risk of organ or respiratory failure due to the stress sepsis puts on the system. If the originating in-

Spell:

Purify I (early sepsis), Purify IV (late sepsis)

Even if the source of the infection cannot be found, sepsis may be cured with antibiotics. If sepsis is caught in the initial stage, treatment should be much easier, doubling the effectiveness of antibiotics. With only care, every five hours the character is allowed an attribute roll against a difficulty of severe. This is reduced to tricky with weak antibiotics and easy with powerful antibiotics. Success means the character starts to recover with no further risk of shock or organ failures. Recovery from the symptoms takes 3x1D10 hours, although weakness may persist for days or even weeks. If sepsis causes septic shock (failed shock roll) the shock can be slowed by administering fluids, pain killers and 42

tube feeding. The kidney and lungs are both in danger of failing, and if they do only a dialysis or mechanical ventilator can keep the patient alive.
Surgery

the difficulty each time. As for sepsis, if already rolling for shock start the rolls at that difficulty. Make only one shock roll for both conditions but take the most severe of the two and halve the time between each roll and difficulty increase. That means a shock roll every hour in the best case.
Diagnosing

Modern: Medieval:

Draining (tricky) Usually not available but if known drainage surgery may be possible in the limbs and up to the early stage in the chest and abdomen. Difficulties depending on the tools available. Nanobots or engineered biological healers may be able to locate and destroy the infection. Drugs are probably available to control the sepsis and highly effective antibiotics.

Modern: Medieval: Futuristic:

Diagnosing (special) Locating Infection Source (special) Diagnosing (special) Diagnosing (special), although likely tests are available making it (tricky) Locating Infection Source (special), likely not harder than tricky with hightech tools. Healing Vision

Futuristic:

Spell:

The surgery difficulty will vary by location, but can be assumed tricky most of the time. Drainage, even without use of antibiotics, gives the character a fighting chance. Every five hours a constitution roll against a difficulty of tricky may be attempted. With weak antibiotics this is reduced to easy and with powerful antibiotics easy. Recovery is as detailed under treatment.

Diagnosing blood poisoning during the incubation period is insane. Once symptoms appear this drops to severe and for every two hours observed reduce the difficulty by one and allow a new attempt. Finding the source of the infection may require another diagnosis attempt with scans, blood tests or exploratory surgery. The difficulty would depend on the infection.
Treatment

4F Blood Poisoning
Septicemia This extremely deadly condition occurs when bacteria have managed to get into the blood stream. It can originate anywhere in the body but often starts with infection in the lungs, abdomen, bones or urinary tract.
Symptoms

Futuristic:

Powerful antibiotics and nanobots or friendly bacteria will exist to cleanse the infection. Purify IV

Spell:

Sudden fever, spiking fevers and chills, high heart rate, reduced mental alertness and feeling irritable, lethargic and anxious. Looks very ill and develops large, purple lesions. Eventually shock.
Risks

Although discovery and surgical removal of the infection may improve survival odds, the best treatment is with a broad spectrum of antibiotics. With only care the character can only deteriorate. With weak antibiotics the character is allowed one constitution roll every five hours against a difficulty of hard. With powerful antibiotics the roll is tricky. Success means the character starts to recover with no further risk of shock or organ failures. Recovery from the symptoms takes 3x1D10 hours, although weakness may persist for days or even weeks. Only early detection and treatment of the infection with antibiotics will have any effect. The mortality rate is very high. As the blood poisoning progresses to its later stages 43

Septicemia progresses rapidly to septic shock and death. Like sepsis it takes 10 + 1D10 hours from the onset of the blood poisoning to symptoms start appearing. After this incubation period symptoms suddenly manifest and the condition rapidly deteriorates. For blood poisoning start septic shock rolls at easy difficulty as well, but roll shock every two hours, increasing

the character will likely be in shock and only fluid transfusion can slow it and keep him alive.

4G Bone Infection
Osteomylitis Bone infection can happen after trauma or surgery which exposes bone, especially after open fractures. It may also occur from another infection that spreads to the bone through the blood. The vertebrae (spine) and pelvis are most commonly infected but any bone is potentially at risk.
Symptoms

termined by rolling randomly for location. To determine the exact bone the GM is advised to roll 1D10 for severity, higher being worse. So a low result in the chest indicates a rib, while a high result the spine. After roughly five weeks the bone dies and becomes necrotic. At this points antibiotics, although they may halt the spread and alleviate symptoms, can no longer cure the infection. The infection has become chronic. Also, every month the infection is not treated make one 1D100 roll. If the result is less or equal to the number of months since the infection the bone or joint has been permanently deformed or damaged. This will affect movement involving that bone and so cause a permanent impairment to be determined by the GM depending on the location and severity. If the infection is in the spine it may damage the spinal nerve or even prove fatal. Make the same roll as above but instead of deformity the risk is sudden shock and death if below the number of months or paralysis if below twice the number of months. Lastly the infection may spread outside the bone. Every month make an additional 1D10 roll where a result of 10 results in a festering infection [4A]. It develops as a normal infection with all its associated risks and can be treated as a normal infection. The bone infection, however, will persist unless specifically treated and next month it may again lead to the spread of a new infection.
Diagnosis

The symptoms can either come on rapidly with sudden pain, swelling and fever or they can be very subtle with fever the most noticeable symptom. In both cases there will be better and worse periods, during the worse periods the casualty will also suffer from chills, vomiting and weakness. If the infection becomes chronic (see risks) there may be periods without any symptoms and periods with severe symptoms. Regular intake of antibiotics will help a lot to alleviate symptoms. One period is defined as roughly one month. At the end of each period roll on the table below. Chronic Bone Infection 1D10 Symptoms No Antibiotics Antibiotics 1 13 None 25 48 Mild 6 10 9 10 Severe Mild symptoms consist of swelling and pain that usually get worse with use of limb or afflicted bone. When rested there may be no impairment but with use the swelling will get worse and impairment can increase to as much as -2D unless pain killers are used. Severe symptoms consist not only of swelling and pain but also fatigue, weakness and sometimes even open wounds leaking pus (yellow fluid). Impairment is a minimum of -1D, often getting worse with any exertion, and can only be temporarily reduced with pain killers.
Risks

Modern:

Examination (severe) Radiography (tricky) CT or MRI Scan (tricky) Blood Test (tricky) Biopsy (easy) Bone infection is not normally known, but if allowed an examination would be at least severe. Hightech Scanner (easy) Blood Test (easy) Biopsy (easy) Healing Vision

Medieval:

Futuristic:

Spell:

If untreated or not successfully treated there are several complications that may occur as the infection spreads. In most cases the location of the bone infection will be the same as where an open fracture occurred. If the infection was not caused by such a fracture it will either be near the original infection that caused it or can be de-

Difficulty of diagnosis depends on method, symptoms and circumstances. Blood tests and x-rays can help but a biopsy sample of the bone (surgery) is the best way to determine the presence of infection in the bone.

44

Treatment

Spell:

Purify IV

Untreated bone infection only gets worse. If antibiotics are administered in the first five weeks they may cure the infection completely. The difficulty to successfully administer and so cure the bone infection depends on the antibiotics. Usually hard for weak antibiotics and tricky for powerful antibiotics.
Surgery

Bone Infection Surgical Results Weeks Disfigurement Impairment 0-2 Scarring - (-1D) 3-5 Some - (-2D) 6 10 Severe -1D (-3D) 11+ Nasty Crippling*
* If in a limb means amputation. If location was chest or abdomen a patient will only survive with skin grafts and sophisticated medical treatment. Large chunks of flesh will have been removed and recovery will take years and even so end up with severe disability.

Amputation of an infected limb is the only way to guarantee success.

Debdridement Surgery (see table) Amputation (easy) Amputation (easy) Nanobots or engineered biological healers may be able to consume the dead tissue and destroy the bacteria.

Modern: Medieval: Futuristic:

5 Osteonecrosis
Bone Death, Avascular Necrosis (AVN), Aseptic Necrosis, Ischemic Bone Necrosis Osteonecrosis literally means dead bone and occurs when the bone dies and cannot regenerate itself due to an insufficient blood supply. The dead bone is worn down and weakened and eventually collapses. Most bones have many blood vessels supplying them and so damage to one usually does not cause a problem. Certain joints, like the hip and wrist, have only a few blood vessels and so are vulnerable to osteonecrosis after an injury.
Risks

Surgery can be used to remove (debride) infected bone and tissue. The difficulty of curing the infection with such a procedure depends on how far progressed the infection is, how much is removed and if antibiotics are also used. Aggressive debridement surgery is easier but causes greater permanent impairment. Weeks* 0-2 3-5 6 10 11+ Debridement Surgery Surgery Careful Aggressive Careful Aggressive Careful Aggressive Careful Aggressive Difficulty Tricky Easy Tricky Tricky Hard Tricky Severe Tricky

It takes 1D12 months before the bone is worn down enough for the first symptoms to appear. Osteonecrosis can therefore appear long after the initial trauma that caused it. At this point the bone has been so worn out that osteoarthritis develops in the joint. It begins as a 1D impairment to actions involving the limb from a painful and stiff joint. After that the pain and stiffness only gets worse increasing the impairment penalty by one every three months. Once the penalty reaches -3D there is a risk the bone will collapse completely. Every month roll 1D6 and on a 1 the bone collapses and the joint becomes useless. This will make an arm useless and if in the hip the character will be unable to stand on the leg.

* since infection ** more removed bone means greater impairment but also greater chance of success

The table can be used as a difficulty guideline. If antibiotics are not available increase the difficulty by one, while if powerful antibiotics are administered effectively reduce the difficulty by one. Impairment can be severe because bone tissue is removed. For aggressive surgery use the impairment in brackets. Whether the removed bone may be replaced or regenerated to eliminate the impairment depends of course on the medical equipment available such as bone grafts or bone prosthesis.

45

Treatment

crutches must be used for six months or the blood supply will not be restored.
X-Ray Early Scan (hard) X-Ray Scan (tricky) MRI Scan (tricky) Osteonecrosis can likely only be diagnosed from the impairment caused. Most medieval societies will not understand the cause. Hightech Scanner (easy) Healing Vision

Modern:

Medieval:

If the operation fails, or the blood supply is not restored, the only option is to artificially replace the joint. This is not possible for the wrist. For the hip this involves a total hip replacement. See total hip replacement under treatment for hip fracture [505B].

6 Burns
Any tissue damage caused by heat, flame, radiation, boiling water, electricity, friction or corrosive chemicals like acids and alkalis. As burns get more severe they destroy deeper layers of skin and tissue. The greater the temperature, voltage or corrosiveness the deeper it goes. The depth of the burn is grouped into four categories and determined by the severity of the burn wound. Each burn wound is treated separately as usual, but in addition some complications may occur if large areas of the body are burned. A single burn wound is usually considered to cover a large part of the affected location. If the exact dimensions of the burn are important this must be decided by the GM according to the type of burn and how it occurred.
Continuous Burns

Futuristic: Spell:

A x-ray scan can usually only detect osteonecrosis once the bone has been worn down significantly. Discovering the problem before then is much harder, the exact difficulty depending on how long the condition has been present. It becomes tricky in difficulty once the character starts to feel the first symptoms of pain and impairment. A MRI (magnetic resonance imaging) scan is much better and can detect osteonecrosis at any stage. It can even see the damage to the blood supply right after injury. The difficulty comes primarily from interpreting the results rather than any limitations of the scan.
Surgery

Modern: Medieval: Futuristic: Spell:

Restoration Surgery, Drill (tricky) Restoration Surgery, Graft (hard) Probably no treatment available. Hightech Surgery (easy) Regrow IV

Most burns, but especially flames and acids, continue to cause damage over time. The rate varies, but the end result is that the burn trauma grows worse and worse. This can make superficial burn trauma worsen into a nasty, grievous, grim and even mortal burn as it goes deeper. This of course increases the impairment and associated blood loss and other risks.
1st Degree - Superficial Burn Wound

If detected early, before symptoms, then surgery to restore the blood supply and relieve pressure on the bone may be possible. This is done either by drilling or by grafting bone from the lower leg along with blood supply. The first method drills a hole in the bone to relieve pressure and in the hope of restoring blood supply. It the surgery is successful it has a 1-4 chance on a 1D10 roll of healing osteonecrosis. If in the hip, crutches must be used to limit the weight on the hip for 6 weeks. Failure to do so could result in a hip fracture [505B]. The second method is much harder and involves two operations to graft healthy bone from another location, but it will usually heal the osteonecrosis. If in the hip

The skin is red and painful like a bad sunburn and pales when squeezed. The dead skin starts to peel and flake away after a few days. Risks: none, except small risk to eyes and hypothermia.
2nd Degree - Nasty Burn Wound

Extremely painful, deep skin damage covered with blisters. Swelling is likely and there may be some scarring. Risks: moderate blood risk, infection, risk to eyes and hypothermia.
3rd Degree Grievous & Grim Burn Wound

The skin is completely burned away and muscle tissue may be damaged. The surface of the burn is dry, leathery and inelastic. What skin is left is white and translucent 46

and blood vessels are visible. The leathery scab which forms over the burn is unable to stop water loss and does not prevent bacterial invasion and thus infection. Pain is minimal due to the destruction of most of the nerve fibres, but severe scarring may cause permanent impairment. Grim 3rd degree burns cause immediate nervous shock. The character grows pale and acts confused, anxious or frightened and may even faint. Risks: heavy blood loss, infection, risk to eyes and hypothermia.
4th Degree Mortal Burn Wound

exposure. May therefore appear harmless only to get worse.

Blood Loss

The most immediate threat is shock as blood and fluids leak into the burned tissue. Although there may be no or little visible bleeding the blood loss can be considerable. Blood Loss From Burns Burn Blood Loss 1st degree none 2nd degree moderate 3rd degree heavy 4th degree massive As per usual bleeding [2] rules the time to shock is divided by the number of burn wounds with the same severity of blood loss. This reflects the dramatic increase in fluid loss as a greater percentage of the body is burned. However, unlike bleeding from slash and pierce wounds, burn blood loss only counts as separate if it is in a different location. Two 3rd degree burns on the arm does not halve the time to shock, but one on the chest and another on the abdomen does. As usual only the most severe blood loss need be considered. Blood loss from burns cannot be stopped in any easy or obvious manner. Therefore the only reliable way to prevent shock if the blood loss becomes life threatening is to give a blood transfusion [2C] and administer fluids.
Hypothermia

The skin is burned away and the burn extends through muscles, tendons, nerves and blood vessels all the way to the bone. Similar to third degree burns, but with deeper destruction and more dysfunction. Causes serious scarring and impairment. 4th degree burns always cause immediate nervous shock. The character grows pale and acts confused, anxious or frightened and may even faint. Risks: massive blood loss, infection, disability, risk to eyes and hypothermia.
Types of Burns

Thermal Burns: Caused by the transfer of energy at a faster rate than the skin can dissipate it. The depth of the burn depends upon the temperature and duration of the heat applied. A branding iron heated to a thousand degrees Celsius causes a third degree burn in less than a second. However, because the area is so small this does not necessarily lead to complications. Thus the trauma inflicted by hot items must be determined by the size of the burn as well as temperature and duration. Scalding Burns: Thermal burn caused by liquids. Liquids luckily flow to the ground so exposure from splashes of hot liquids is usually brief. However, if immersed the duration is much longer and the burn more severe. Molten metals can cause 4th degree burns in less than 2 seconds and may even solidify on contact, prolonging the burn, and set fire to clothing. Flame Burns: Burns from a flame are similar to thermal burns. The temperature of the flame and the area and duration exposed will determine the severity of the burn. Electricity Burns: Usually causes deep 3rd or 4th degree burns that often appear less serious. Chemical Burns: Acids, alkalis and other corrosives may continue to burn for anything up to 48 hours after

Being burned on a large percentage of the body reduces the body's ability to retain heat. Water is rapidly lost and causes a drop in body temperature as it evaporates. This can result in hypothermia [15]. The body tries to compensate for the heat loss by increasing the metabolism, which in turn leads to a dramatic increase in calorie expenditure. Thus severe burn victims need to be kept warm and well fed. The exact effect should be determined according circumstance. If in a warm environment the risk of hypothermia is low, but in a cold or wet environment the risk might be very high. As a simple basis assume that for each location that has a burn the body temperature drops by half a degree per 1st and 2nd degree burn, and one degree per 3rd and 4th degree burn. Thus an arm with a 2 nd degree burn and leg with a 3rd degree burn will drop body temperature by 1.5 degrees Celsius. Adjust the heat loss down if covered with blankets or up if exposed to chilly weather, and so on.

47

Infection

Diagnosis

A 1st degree superficial burn trauma does not pose a significant risk of infection and no roll is needed. However, a more serious burn not only removes the barrier that skin provides against infection. The dead skin becomes an excellent growth medium for bacteria. The local blood supply is also reduced. Leaving inadequate defence mechanisms to fight a persistent infection. Treat the risk of infection for a burn as per normal infection [4] rules, but increase the difficulty of any treatment and the direct infection roll by one. Thus a nasty burn trauma requires a hard attribute roll to avoid infection, a grievous burn trauma requires a severe roll and so on. Mortal burn wounds are pretty much guaranteed to be infected as the difficulty to resist infection is insane. The normal modifiers for wound cleaning, antibiotics and debridement apply, but antibiotics are half as effective as usual, while debridement is twice as effective as usual. Antibiotics cannot reach the dead tissues but removing it with surgery removes the main source of potential infection. A 3rd and 4th degree burn trauma requires a second direct infection resistance roll after 1D10 days. If the burn has been kept very clean and cared for reduce the difficulty by one level. On the other hand, if the burn has been poorly kept, or exposed to wet or dirty environments, the difficulty should be increased by one level.
Risk to Eyes

Modern:

Flame Burn (tricky) Chemical Burn (tricky) Electricity Burn (tricky) Flame Burn (tricky) Chemical Burn (tricky) Electricity Burn (tricky) Hightech Scan (easy) Healing Vision

Medieval:

Futuristic: Spell:

The difficulty of diagnosing the seriousness of a burn depends on the type of burn. Electricity and corrosive chemical burns are tricky to diagnose right, while thermal burns and those from a naked flame are tricky.
Treatment

Modern:

Debdridement Surgery (tricky) Skin Grafting (tricky) Debridement surgery is possible, but skin grafting is usually not. Nanobots or engineered biological healers may be able to consume the burnt tissue and destroy any bacteria. Skin can easily be regrown, even for 4th degree burns. Regrow I (1st degree), Regrow II (2nd degree), Regrow III (3rd degree), Regrow IV (4th degree)

Medieval: Futuristic:

The eyes are especially vulnerable, especially to acid and naked flames. If the location is the head, then the type and extent of the burn should indicate if the eyes are likely to be at risk. If so, then the risk that the eye is burned and blinded is equal in percentage to twice the degree of the burn. So 2% risk for a 1st degree burn, 4% for 2nd degree, 6% for 3rd degree and 8% for a 4th degree burn. Roll once for each eye.
Disability

Spell:

The first step is always to stop any fire and wash away corrosive chemicals. Cold water can be applied, except when burn is so severe that hypothermia may be a risk. Burn care concerns itself with preventing shock, infection and hypothermia. It is also important to relieve pain and salvage as much viable burned tissue as possible. Blood transfusions [2C], fluid administration, antibiotics, surgical removal of dead tissue (debridement) and skin grafts may all be needed. Once the immediate risks are avoided cosmetic surgery with skin grafts may be needed to reduce scarring and avoid impairment from loss of functionality. See the various risks above for necessary treatments.

If the burn does not prove fatal it may still be disabling. For 2nd degree burns this is usually not an issue, although some scarring may occur. A 3rd degree burn will cause heavy scarring, and will reduce appearance if in the face. A 4th degree burn is the worst, with a permanent impairment of -1D unless treated with skin grafts. If this is a leg it will cause a limp and reduce movement speed.

48

7 Spine
Backbone The Spine runs from the brain down the entire length of the back. It provides support and contains the spinal cord which is a thick bundle of nerves providing communication between the brain and all parts of the body. The spine is made up of a series of interconnecting bony and cartilaginous segments called vertebra. It has 33 vertebrae, the first 24 forming a flexible column, the last 9 forming the sacrum and coccyx (tail). The spinal cord is well protected inside the spine but when the spine is damaged the spinal cord is also at risk.

There is an immediate risk that the spinal cord has already been damaged and another risk that it may be damaged or further damaged if the injured is moved. This second risk is always half that of the initial risk. The risk of cord damage will decrease as the wound heals but will only be completely gone once the wound is fully healed.
Spinal Injury Treatment

Characters with spinal injuries should not be moved because of the risk of further damage and paralysis. The risks of spinal cord injury when moving the patient is the same as half the initial risk. If the initial damage was partial then any further injury upon moving the patient will make the cord injury complete. If it is absolutely necessary to move the injured because of some life-threatening situation, at least three or four persons should move the injured on a stretcher or other solid object keeping the victim rigid and unmoving. This will reduce the risk of further cord damage at the GMs discretion, possibly requiring a patient care roll with difficulty dependant on equipment and manpower available. An x-ray or some other form of scan is usually the only way to determine whether the spine has been injured, the extent of any injury and necessary treatment. Difficulty of diagnosis depends on the scanner as well as extent and type of the spinal injury. Spinal operations are always difficult and in danger of damaging the spinal cord. Difficulties and risks are specified for each type of spinal damage.

7A Vertebrae Fracture
One of the 33 vertebrae segments of the spine is fractured and collapses bending the backbone and stretching the spinal cord.
Symptoms

Severe pain, swelling, reduced ability to move.

Risks

Risks

The immediate risk of spinal cord damage depends on the amount of trauma that was inflicted. Roll 1D10 on the table below and if the number matches with a complete [7D] or partial [7E] spinal cord damage for the wound severity the spinal cord is damaged. The risk when moving the patient is half of this initial risk, rounding down and so potentially eliminating the risk for less severe trauma. 49

The main risk with a spine injury is the danger of damaging the spinal cord. The specific risks are defined for each type of injury below.

Trauma Superficial Nasty Grievous Grim Mortal

Diagnosis

Spinal Cord Damage Complete [7D] Partial [7E] 1 1 2 1 2-3 1-3 4-6 1-6 7-9

7B Vertebrae Dislocation
A vertebrae dislocation is very serious because it has a high probability of damaging the spinal cord. It is also unstable which means further injury from movement is likely.
Symptoms

Severe pain, swelling, reduced ability to move.

Modern: Medieval: Futuristic: Spell: X-Ray (tricky) Physical Examination (severe) Hightech Scanner (easy) Healing Vision
Risks

The immediate risk of spinal cord damage depends on the amount of trauma that was inflicted. Roll 1D10 on the table below and if the number matches with a complete [7D] or partial [7E] spinal cord damage for the wound severity the spinal cord is damaged. The risk when moving the patient is half of this initial risk, rounding down and so potentially eliminating the risk for less severe trauma. Trauma Superficial Nasty Grievous Grim Mortal
Treatment

Treatment and Surgery

Modern: Medieval:

Non-Surgical Treatment (special) Surgical Correction (special) Non-Surgical Treatment (special) Surgical Correction may be available in very advanced societies. Non-Surgical Treatment (special) Hightech surgery likely has a difficulty two levels lower than the severity indicates. Regrow III

Futuristic:

Spinal Cord Damage Complete [7D] Partial [7E] 1 1 2 1-3 4 -5 1-4 4-7 1-8 9 - 10

Spell:

See vertebrae fracture (7A).

7C Ruptured Ligaments
The fracture itself may or may not heal correctly on its own depending on the type of fracture and amount of damage. To regain full function, and complete relief from the pain, surgery is often needed. On a 1D10 roll of 6-10 it will heal without surgery. Otherwise it will only heal partially. If the spine does not heal on its own it requires surgery, although there is a small chance that non-surgical treatment by a skilled doctor is possible instead of surgery. The difficulty of surgical treatment depends on the the severity of the wound that caused the injury. Tricky for any wound severity of grievous or less, hard for grim wounds and severe for mortal wounds. Note that surgical repair of spinal injuries from grim or mortal wounds will usually require some sort of internal support to be mounted to the spine for stability. Non-surgical treatment will be one difficulty higher. Each vertebrae is connected to the vertebrae above and below by several strong ligaments as well as by the discs. These ligaments have been torn or ruptured resulting in instability in the spinal column.
Symptoms

Pain in the neck, arms, legs or back along with reduced ability to move.
Risks

As well as being painful, if left untreated may damage the spinal cord when performing any strenuous physical action. Whenever the character pushes himself in sports, combat or feats of physical endurance, strength or agility make a single roll. The risk should depend on the duration and severity of the actions. The risk should be between 5-20 percent. The result is partial cord damage [7E]. Treat as 50

if it was caused by superficial trauma. Until healed cord damage can happen again and again.
Diagnosis

Risks

The immediate risk is from going into shock. Make this an easy shock roll for paraplegia and hard for quadriplegia. If the result is quadriplegia the injured will eventually die. However, with careful care and life support life may be extended more or less indefinitely. Injury to the spinal cord stops the bladder working. If the nerves are intact below the injury the bladder will empty itself on reflex whenever it is full. If this does not happen, however, the bladder will need to be emptied regularly with a catheter.
Treatment

Modern: Medieval: Futuristic: Spell:

Physical Examination (hard) Physical Examination (hard) Hightech Scanner (tricky) Healing Vision

Can be difficult to diagnose as does not show up on xrays.

Treatment and Surgery

Modern: Modern: Medieval: Surgical treatment (tricky) Immobilisation (special) Immobilisation (special) Surgical treatment may be available in very advanced societies. Immobilisation (special) Hightech surgery likely makes this easy. Nanosurgery (easy) Regrow II Medieval: Futuristic:

Care can extend life but not heal it. Abandon all hope. May be biological grafts or methods to trigger the cord to regrow. Nanosurgery (tricky) Regrow IV

Futuristic:

Spell:

Spell:

The spinal cord does not heal and cannot be treated. Future medicine may have a chance of healing cord damage.

7E Partial Cord Damage

Usually requires surgical treatment, although immobilisation of the spinal column for a few weeks or months has a 25% chance to be sufficient to allow spontaneous healing. Partial cord damage is very similar to complete cord damage. The major difference is that the cord is not completely severed or destroyed and so some function and sensation remains below the damage site. In time it is even possible to regain some or all of the lost function and sensation.
Symptoms

7D Complete Cord Damage

Quadriplegia, Paraplegia Complete damage to the spinal cord means permanent loss of sensation and motor control below the injury. Paralysis. If the wound was inflicted in the lower back (abdomen) this results in paralysis of the legs, paraplegia. If the wound was inflicted in the neck (head) the result is full body paralysis, quadriplegia. If in the upper back (chest) it also results in quadriplegia but some function may be retained in the arms depending on site of injury as determined by the GM.
Symptoms

Loss of some or all sensation and strength below injury and often severe pain. Occasionally loss of bowel and bladder control but this may be regained in the following weeks or months.
Risks

Paralysis, loss of feeling and function in affected regions. Loss of bowel and bladder control. Erectile dysfunction.

The risk is a permanent trauma impairment penalty of -1D resulting from the loss of function. The pain may also remain indefinitely and it is a short way from partial to complete cord damage. 51

Treatment

Spell: Modern: Medieval: Futuristic: No treatment aside from care. Luckily it may mostly heal. May be biological grafts or methods to trigger the cord to regrow. Nanosurgery (easy) Regrow III

Soothe I (relieve pain while concentrating), Soothe IV (remove all pain, even from surgery, while patient is calm and still)

Spell:

Rarely the spinal cord will heal itself over time and although some disability will usually remain the condition may improve enough that the impairment penalty no longer applies.

Pain can be reduced through the use of sedatives, drugs and narcotics. The pain can also be eliminated by severing the nerve in the pain pathway or otherwise stopping the signal travelling to the brain. The removal of pain is not done lightly however as its absence promotes carelessness and increases the risk of injury and further damage after the initial trauma. Even worse is long term or permanent loss of pain signals due to continuous use of drugs, cybernetics or extensive surgery. Pain is a critical part of the body's defence against damage. Instantly warning of any damage and triggering reflexes to move away from the source of pain. Characters who feel little or no pain do not have these reflexes, and so all inflicted trauma is increased by one. Such characters easily become careless in their actions and have difficulty judging the severity of any trauma. The GM may require a diagnosis roll each time the character has been wounded for the character to determine its seriousness. Carelessness could also be reflected in the character getting minor scrapes, cuts and bruises more often than usual.

8 Pain
Pain is an unpleasant and hurtful sensation triggered by the excessive stimulation of nerve endings due to inflicted trauma. The signal is transferred by the nerve fibres to the spinal cord and from there to the brain. Pain causes impairment because the character is suffering and distracted by the pain. All tasks are affected. From social skills to combat skills. Part of any impairment is usually from pain. Eliminating pain through treatment is a welcome relief for any character but not without some danger. Despite being unpleasant pain is there to force the character to take it easy and avoid further injury. If the character is resting there is no danger from treatment of pain, but if the character is physically active he may aggravate his injuries and make it worse. Pain is also a useful indicator during diagnosis and treatment. Therefore the GM may increase the difficulty of any diagnosis if the character feels no pain. Most of the time pain should be eliminated as soon as possible. If a character goes into shock pain can, at the GM's discretion, make it worse, and so reduce the time before each stage is reached and death occurs.
Treatment

9 Inflammation
Inflammation is a protective reaction of tissue to injury or infection. The symptoms are pain, redness and swelling. Sometimes inflammation itself can become the problem. Excessive inflammation can leave joints stiff and a runaway inflammation usually results in death. Sepsis [4E], peritonitis [300A] and dysentery [300C] are all examples of the bodys defences going amok and potentially killing the character.

10 Coma
An unconsciousness from which the subject cannot be aroused. Brain activity is low and reflexes such as coughing and reaction to pain and other sensations are absent. The most likely reason for a coma is brain damage.
Risks

Modern: Medieval:

Drugs is the most common way of relieving pain. Alcohol and potentially potions or herbs acting as drugs may lessen the pain. Pain can likely be turned on or off with hightech solutions or drugs.

Futuristic:

Because the normal reflexes are not working there is a significant risk of choking on vomit or even saliva. Because of this constant supervision is required to ensure 52

breathing continues. Feeding and general care is of course also vital to survival. If the cause of the coma gets worse, such as internal bleeding in the cranium, the coma will get worse. Eventually the brain will stop functioning completely and result in death.
Treatment

Risks

Unless taking anti epileptic drugs on a regular basis anyone prone to seizures may have an attack. Certain factors increase the likelihood of an attack. These are; tiredness, alcohol, high temperatures, dehydration, fever and physical or emotional stress. Whenever any of these factors affect the epileptic character the player should make a seizure check. The exact chance of having a seizure is up to the GM and player to determine based on the factors involved and situation. In a life and death combat for example a seizure might occur on a 1D10 roll of 6 or more. Unless taking medication there is also a routine chance of having a seizure every day. The GM should roll 1D10 secretly to determine how many days until the next seizure. On the day of the seizure the attack will usually take place whenever any of the risk factors are present or after 1D10 hours, whichever comes first. If well rested, and in good health and spirits, roll 1D100 instead for the next seizure. However, if conditions deteriorate for the character re-roll with 1D10 and the presence of trigger factors may of course bring on a seizure at any time.
Treatment

Modern: Medieval: Futuristic: Spell:

Care (tricky) Care (hard) Care (easy) Drugs to Arouse (easy hard) Arouse II (minor), Arouse III (major), Arouse IV (massive)

Careful supervision, feeding and care is usually the only treatment. Even the most dedicated team will struggle to keep a coma patient alive for any length of time without proper medical equipment to monitor patient health, feeding and emergencies such as clearing a blocked airway. It is usually very hard to determine when the patient might awaken. It may never happen. Healing any damage obviously increases the likelihood and shortens the duration. It is up to the GM to determine the duration based on the cause and treatment. As a very rough guide use 1D100 days for minor brain damage, 1D10 years + 1D100 days for major brain damage and 1D100 years for massive brain damage. Adjust the length based on any treatment of the brain damage. Even if awakening the patient might have lost all abilities. Even basic tasks like talking and dressing. This depends on the underlying reason for the coma and what treatment was possible for the brain damage.

Modern: Medieval: Futuristic:

Medication exists to significantly lower the risk and severity of seizures. No treatment available, but certain herbs may relieve or reduce seizures. Brain Surgery (tricky) Preventative Medication is probably easily available and can keep epilepsy under control in most situations and drastically reduce the risk even under stress. Curative Medication may also exist but possibly only for the well off. Purify II (stop a seizure) Purify IV (cure epilepsy)

11 Epilepsy
A disorder in which abnormal activity in the brain causes disturbances in sensation, emotion and behaviour as well as muscle spasms and loss of consciousness. Such epileptic attacks are called seizures. There are many different types of seizures and they last from a few seconds to several minutes and even hours. Only the three most common types of adult seizures are dealt with here but there are many others, such as vacant seizures which are often seen in children.

Spell:

Medication to prevent or reduce the risk of seizures is possible.

11A - Simple Partial Seizure

Does not affect consciousness. Only a part of the brain controlling motor function is affected causing involuntary jerks or spasms. Always in the same location. It may be a leg, an arm, the head or a hand. 53

A seizure may lead to tonic-clonic seizure [11C] if a roll of 1D10 results in 10. A seizure last for 1D10 / 2 minutes.

12B - Severe Fever

Spell: Soothe III

11B - Complex Partial Seizure

Awareness is altered. The seizure may cause an inability to act or bizarre and inappropriate behaviour. Chewing, jaw chomping, lip, smacking, mumbling and fumbling with the hands are also common effects of the seizure. A seizure may lead to tonic-clonic seizure [11C] if a roll of 1D10 results in 10. A seizure last for 1D10 / 2 minutes.

Sweating, or suffering from chills and shivering, sometimes alternating periodically between the two. Very high temperatures, extreme fatigue and often a feeling of impending doom. Chronic fatigue of exhausted lasts as long as the fever resulting in a minimum of a -1D fatigue penalty. And further exertion causing fatigue will leave the character drained. The fever dehydrates the body and without enough liquids this will lead to dehydration [14].

12C - Deadly Fever

Spell: Soothe IV

11C - Tonic-Clonic Seizure

Known as a grand mal attack, these dramatic seizures are sometimes preceded by a brief warning. A sinking feeling in the stomach, or a cry or groan, just before losing consciousness. As consciousness is lost the limbs go stiff and breathing stops. The eyes roll up into the head and the jaws are clenched shut possibly biting the tongue or lips. This tonic phase lasts up to sixty seconds after which the clonic phase starts shaking the body violently, arms and legs jerking wildly. This phase lasts a couple of minutes. Consciousness is immediately regained but confusion often follows and a desire to sleep for an hour or two. Headache and sore muscles are common after an attack.

Constantly drained and delirious with a very high temperature, and profound sweating. Suffering from at least a -2D fatigue penalty.

13 Carbon Monoxide Poisoning

Silent Killer, Smoke Damage Carbon monoxide (CO) is an invisible and odourless poisonous gas. It is present in smoke from fires, stoves, fireplaces, natural gas and anything burning fossil fuel, like combustion engines. It attaches to the haemoglobin in the blood much easier than oxygen. If enough carbon monoxide is inhaled not enough oxygen gets into the blood stream. Death results from prolonged or massive exposure.
Symptoms

12 Fever
Fever is usually associated with infections and other types of illness. The body temperature is regulated by a centre in the brain that adjusts it by regulating blood flow, sweating and even shivering. All of which may be triggered during a fever.

12A - Light Fever

Spell: Soothe I

Symptoms depend on the saturation of carbon monoxide in the bloodstream. The table in the risks section shows the symptoms according to percentage of carbon monoxide. If sleeping there may be no symptoms.
Risks

High temperature, fatigue and feeling of illness. Chronic fatigue of winded lasts as long as the fever and so any exertion will lead to rapid exhaustion.

The outcome depends on the carbon monoxide concentration in the air and duration of the exposure. The longer the expose the more carbon monoxide accumulates in the bloodstream. The effect from the various percentage levels of carbon monoxide in the bloodstream are listed in the table below.

54

Carbon Monoxide Poisoning

Concentration in Blood (%)

1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100

Effect
None. Tension in forehead and dilation of blood vessels. Headache and pulsating temples. Severe headache, weariness, dizziness, weakened sight, nausea and vomiting. As above plus increased breathing and pulse. Collapses, unconscious by time reaches 50%. Convulsions start, leading to coma and minor brain damage by the time 55% is reached. Deeper coma and major brain damage. Deeper coma and massive brain damage. Slowing of breathing and death within hours. Coma and death in less than one hour. Coma and irreversible death within a few minutes.

14 Dehydration
Dehydration means that the body does not have enough fluids. It can arise from not drinking enough water or from losing too much fluid.
Symptoms

Early signs are dry mouth, sunken eyes and skin that does not bounce back quickly when pinched. As it gets worse pulse increases, hands and feet turn cold, the lips blue and the dehydrated becomes confused and lethargic.
Risks

A man can only live a few days without water. This can be significantly shortened due to a fever or heat. Severe vomiting and diarrhoea can cause lethal dehydration in a day. Dehydration leads to confusion, unconsciousness, brain damage and eventually death.
Treatment

The cause of the dehydration, fever, vomiting, diarrhoea must first be treated while water, and possibly salts, to rehydrate the body.

Smoke from a badly ventilated fireplace will only increase the concentration by five percent every one or two hours. In contrast a smoke filled room in a burning house may increase the percentage level by five percent every ten seconds. If the smoke is seeping in from a fire behind a closed door, or up a stairway, it is more likely to increase the concentration in the bloodstream by something like five percent every five minutes. Obviously there are many other rates at which carbon monoxide may accumulate and each situation must be determined by the GM. Once out in fresh air again the percentage will slowly drop.
Treatment

15 Hypothermia
The table below shows the symptoms and treatment for abnormally low body temperatures in Celsius. If the warming is too rapid it may result in heart attack [202C]. Hypothermia

Body Temp
36 35 34 33

Symptoms
Feel cold Shivering Clumsy, Irrational, Confused Muscle stiffness Stops shivering and collapses Semi conscious Unconscious Slow pulse and breathing Heart Attack No vital signs and cold

Treatment
Dry shelter and clothes, warmth, light exercise, warm drinks and food. Avoid rapid warming, rest, warm food, drink and breathe warm air. As above, lie down with feet raised. As above, but nothing by mouth and keep airways open. Mouth-to-mouth breathing at slow pace.
Heart compression (CPR)

Spell:

Cleanse I (1-25), Cleanse II (26-50),

Cleanse III (51-75), Cleanse IV (76-100)

32 31 30

Fresh air or pure oxygen for more severe poisonings. A ventilator may be needed to save someone who has suffered prolonged exposure.

29 28 Below 28

CPR, mouth-to-mouth and slow warming may work. Should not be considered dead until warm and still without vital signs. 55

16 Hyperthermia
Heatstroke, Sunstroke Heatstroke occurs when the body temperature becomes too high. It can be fatal if not dealt with immediately. Hyperthermia

17A Diabetes I
Diabetes I is the most severe form of diabetes. It is fatal without insulin treatment. It can result from the removal, or destruction, of the pancreas but more commonly from an autoimmune disease in which the bodys immune system mistakenly launches an attack on the insulin-producing cells of the pancreas.
Symptoms

Body Temp
38 39 40 40.5 41 42 43 44 47 50
Treatment

Symptoms
Sweating Severe sweating, red, breathless and exhausted. Profuse sweating, weak, dehydration, headache and dizzy. Vomits, severe headache, dizzy, confused and may hallucinate. As above and delirious, drowsy. Turns Pale, abnormal blood pressure, fast heart rate, convulsions and faints. Minor brain damage and shock as if suffocating due to heart failure. Major brain damage and shock as if suffocating due to heart failure. Massive brain damage and shock as if suffocating due to heart failure. Muscle rigidity, immediate death.

Symptoms start mild but rapidly get worse. If the diabetes is the result of an autoimmune disease it will be 1D12 months before any symptoms start to appear. If it results from the loss of the pancreas, symptoms will start in 1D12 weeks. Once symptoms start they progress as described below. Mild symptoms for the first 1D10 months:

Treatment consists of lowering the body temperature. For sunstroke rest, shade, a damp cloth and hydration by drinking liquids is appropriate. For more serious cases the character may be lowered into cold water and fluids administered intravenously.

Poorly healing skin rashes which may affect appearance. Dry itchy or flaky skin Occasionally numb hands or feet. Poor healing. Add an additional week to any healing time before the wound actually starts to heal. Blurred vision. All perception related tasks have a 1D penalty and reading becomes more tiring. Drowsiness increasing the risk of the character falling asleep at the wrong time. Female characters may miss menstrual periods. Roll only once to check for weight loss or gain. On 1-25 the character will lose weight, on 26-50 gain weight, otherwise there will be no change.

17 Diabetes
Diabetes is a failure, or reduction, in the body's ability to handle sugar. It is a disorder of the metabolism. Food is broken down into glucose sugar and transported in the bloodstream as the main fuel for the body. For the body to use the energy stored in the glucose it needs insulin. Insulin is a hormone produced by the pancreas [308]. Diabetes occurs when there is not enough, or no, insulin or when the cells do not respond correctly to the insulin that is produced. The result is the inability to use the bodys primary source of fuel and too much glucose in the bloodstream. The high blood glucose damages nerves and blood vessels, leading to complications such as blindness, heart or kidney problems and infections.

The above list is by no means exhaustive as many other symptoms are possible. Severe symptoms for the next 1D10 weeks, while the mild symptoms either persist or grow worse.

Excessive thirst and urination causing mild dehydration [14]. Excessive hunger. Fatigue and tiredness makes the character sleep longer and makes it likely he will fall asleep on night shifts and even during the day. Wight loss or gain will usually get worse. The blurred vision will get much worse. All perception related tasks have a 2D penalty and reading is very slow and difficult. Muscle cramps and aches. Headaches. Irritability. Numb feet and an increased risk of infection due to decreased immune defence poses a seri56

ous risk. Each week roll 1D10 and on a 10 a festering infection [4A] develops. Careful foot care may eliminate this risk. After the period of severe symptoms the characters health will deteriorate quickly and the symptoms become life-threatening.
Risks

Futuristic:

Insulin producing device installed. Nanotechnology would allow nanobots to repair a damaged pancreas to restore insulin production. Purify IV (cure diabetes)

Spell:

All the minor risks and problems associated with the two first stages of diabetes are detailed under symptoms above. However, in the final stage the symptoms become life-threatening and the characters health deteriorates quickly. Frequent nausea and vomiting, fatigue, extreme thirst and need to urinate and all the symptoms of previous stages. After 1D10 days mental function will have deteriorated to where the character is constantly confused. Any task involving mental ability should have its difficulty increased two levels or a -3D penalty applied. When under pressure a roll is required to think straight and so come to the right conclusions and make the correct decisions. Every day after that the character must make an attribute roll starting at easy but increasing one difficulty each time. Failure means coma [10]. Even if the character is cared for failure to treat the underlying cause, by supplying insulin, will lead to death in another 1D10 days.
Diagnosis

Type I diabetes cannot normally be cured and must be treated with insulin injected into the bloodstream every day. Once it is treated with insulin on a regular basis the symptoms will grow less severe and their progression will slow. To completely remove all symptoms and risk the character must have his glucose levels monitored periodically and insulin levels adjusted. He must also eat a carefully planned diet. Only the best treatment and careful management can stop the progression of diabetes. In most cases the symptoms will keep getting gradually worse even with insulin treatment, but the progression can be measured in years rather than months, weeks and days.

17B Diabetes II
Adult Diabetes Far more common than diabetes I [17A]. It is similar in most ways to diabetes I but the pancreas retains some ability to produce insulin.
Symptoms

Modern: Medieval:

Blood Test (easy) Unlikely any knowledge of diabetes and more likely other reasons are blamed. Observing the character for a long period and seeing how the patient deteriorates may allow an educated guess if diabetes is known. Blood Test (easy) Healing Vision

The symptoms for diabetes II are the same as for diabetes I [17A] above, but progress at a much slower pace. A character can live with diabetes II for 1D10 / 2 years with no symptoms. Round down but treat zero as 1D12 months. Once symptoms start they progress as follows. Mild symptoms last for 1D12 months. Severe symptoms for 1D12 months after which the diabetes becomes lifethreatening just as for diabetes I.
Risks

Futuristic: Spell:

Diagnosing diabetes can be very difficult and depends entirely on how far it has progressed and what sort of tests are available. Blood tests are usually the only option to confirm diabetes.
Treatment

See diabetes I [17A] for the risks.

Treatment

Treatment and diagnosis is the same as for diabetes I [17] but insulin injections can prolong a characters life by decades, probably allowing him to live until old age.

Modern: Medieval:

Regular insulin injections, carefully planned diet and monitoring. Probably no treatment available.

57

19 Blood Clot
Thrombosis A potentially fatal obstruction of an artery or vein by a blood clot. Blood clots are most likely to form following surgery. A blood clot in an artery leading to the heart or lungs can result in a heart attack [202C], or if leading to the brain, in a stroke [20]. If the clot blocks a vessel leading to a limb it can result in gangrene [4B].
Symptoms

1D10 1-3 4-6 7-8 9 - 10

Stroke Damage Damage Minor Brain Damage [105A] Major Brain Damage [105B] Massive Brain Damage [105C] Death

There may be pain and swelling where the clot lodges.

Risks

If a blood clot forms roll 1D10. Blood Clot 1D10 1 2 3-4 5-6 7-8 9-10
Treatment

Result Gangrene in left arm Gangrene in right arm Gangrene in left leg Gangrene in right leg Heart Attack Stroke

The only treatment is preventive. By having the patient moving as soon as possible the risk is reduced. Anticoagulant medication like heparin and warfarin that prevents clots from forming can be given after surgery and dramatically reduce the risk.

20 - Stroke
Cerebrovascular Accident (CVA) A stroke is the sudden death of brain cells due to impaired blood supply. A stroke is usually caused by either a blocked artery or an artery which is ruptured in the neck or head. The results of a stroke may vary but are usually crippling and life changing. If the severity of the stroke is indicated by the trauma that caused it brain damage should be accordingly. In most cases however it will not have been defined and a roll on the stroke table below is required.

58

Head
While very grave head injuries are not always hopeless, none is so trivial that it can be ignored. Hippocrates (5th Century BC)

Vital Structures
The trachea (windpipe) connects the nose and mouth to the lungs. Also located in the throat is the vocal cord which is essential for speech.

Nerves
The brain is the supervisory centre of the nervous system. Different parts of the brain control different functions and so is usually divided into regions called lobes. Everything from basic reflexes and breathing to intelligence and higher thought takes place in the brain. Most communication with the body takes place through the thick bundle of nerves called the spinal cord. It runs from the brain down through the neck and back, well protected inside the spine. Twelve nerves, however, run outside the spine and are directly connected to the brain. Passing through holes in the skull. Some like the vagus nerve go down into the body to control a number of functions. Others go to the sensory organs, such as the optic nerve, that transmits information from the eye.

Skeleton
Protecting the delicate brain the skull is made up of more than twenty bones. It includes the cranium, face and jaw.

Anatomy
Here the head includes the throat and upper neck.

The nose is not made up of bone, but of cartilage which is a dense, fibrous connective tissue also found in the outer ears and larynx.

Vital Organs
The brain is the most important organ in the body. The supervisory centre of the nervous system and where thought, emotions and memory form self-awareness. It is practically speaking the essence of who a character is. Also located in the head are the very important sensory organs. Eyes, ears, nose and mouth.

100 - General
As the housing for the brain, sense organs and the inlet for air and food the head is the most vital and vulnerable part of the anatomy.

100A Intracranial Bleeding

Bleeding inside the skull is the most dangerous of all internal bleeding as it may cause additional damage to the brain.
Symptoms

Great Vessels
The carotid arteries running up on each side of the neck are vital to supply oxygen to the brain, as well as the face and scalp.

The accumulated blood presses against brain tissue causing all or some of the following symptoms; headache, nausea and vomiting, lethargy, slurred speech, loss of 59

ability to speak, physical weakness and loss of consciousness.

Risks

Surgery

Modern:

The greatest risk is that the bleeding is not stopped, or relieved. The pressure initially leads to unconsciousness. How quickly this happens depends on the severity of the blood loss and is generally half the time in which blood loss normally leads to shock. Five minutes for heavy bleeding and one minute for massive bleeding. Even moderate intracranial bleeding leads to unconsciousness in about thirty minutes. When unconscious an attribute roll must be made, typically Spirit. On a failed roll death follows after another interval of about twice the previous duration. The difficulty is tricky for moderate bleeding, severe for heavy bleeding and insane for massive bleeding. Even on a success a clot forms either between the skull and brain, or inside the brain. Roll 1D6. On a result of 12 the clot is not significant and the character regains consciousness in 1D12 hours. On a result of 3-4 the character regains consciousness in 1D12 hours too, but will experience some of the symptoms for the next 10 + 1D12 days as the clot gradually clears out. On a result of 5-6 the clot is so serious that the character remains unconscious for 1D12 days followed by most of the symptoms for the next 20 + 1D12 days. If more intracranial bleeding takes place before the clot clears out, that is while symptoms persist, minor brain damage [105B] occurs, and the new bleeding may of course also cause unconsciousness and death from pressure as normal.
Diagnosis

Drilling the skull (hard) Scan and drilling the skull (tricky) Clot Removal (varies) Drilling the skull (hard) Clot Removal (varies) Hightech Surgery (easy) Bloodmagic I (some), Bloodmagic II (moderate), Bloodmagic III (heavy), Bloodmagic IV (massive)

Medieval: Futuristic: Spell:

Making a hole, or opening, the skull can relieve pressure from an intracranial bleeding. However, if this causes an infection in the brain it can quickly be fatal. If done without a scan the surgery is hard because the surgeon does not know the position or size of the bleeding. If a successful scan is done first the difficulty is tricky. Due to the delicate nature of the brain a marginal failure does succeed in relieving the pressure but causes minor brain damage [105B]. Normal failure also relieves the pressure but causes major brain damage [105C] and an exceptional failure causes either massive brain damage [105D] or death. In all cases, success or failure, there is the danger of infection [100D]. A clot can also be surgically removed. If it is between the brain and the skull it is usually a tricky operation after a scan or hard otherwise. If the clot is inside the brain it is at least severe even with a scan and insane otherwise. All the same risks of brain damage as for surgery to relieve pressure described above apply.

Modern: Medieval: Futuristic: Spell:

CT or MRI Scan (tricky) May be guessed from observing symptoms (hard) Hightech Scan (easy) Healing Vision

100B Suffocation
Suffocation means that the brain is starved from oxygen (ischemia) which causes brain cells to die causing irreversible damage. How quickly the character suffocates depends on how completely the airway is blocked, or how much it is damaged. If completely blocked the table below can be used as a guideline. Note that the minutes for each level of brain damage represent the time since the airway was blocked, not since the previous brain damage. Suffocation Minutes 4 6 7 10 Effect Minor Brain Damage [105B] Major Brain Damage [105C] Massive Brain Damage [105D] Unlikely to be revived 60

Diagnosis is difficult and so a doctor should presume that progressive loss of consciousness after a head injury indicates an intracranial bleeding until proved otherwise. CT and MRI scans are best used and can determine the position and size of the bleeding.

If the suffocating character is conscious he will stay so until about thirty seconds before suffering minor brain damage. If unconscious, but no brain damage occurred, the character will wake from unconsciousness in roughly twice the time he was unconscious minus 1D10 seconds. If minor brain damage occurs the character will wake in 1D10 + 10 hours, but may be roused after some time and with some effort, although will be unable to function mentally or physically without support for the next 1D10 hours. More severe brain damage can see the character unconscious or in a coma for some time. If only partially blocked then the time to suffocate may be much longer. Determine the time depending on severity or multiply the minutes by the result of a 1D10 roll where 7+ means the character is not dying, only struggling to breathe. If already suffering from shock this will increase the difficulty of shock rolls and reduce any times between the stages of shock.
Treatment and Surgery

chest. After a couple of weeks the infection is encapsulated. Inside the capsule the abscess consists of necrotic and inflammatory debris. The capsule may persist for months, slowly expanding. Unless treated it usually either ruptures or increases the pressure on the brain until it herniates into an open space. Both are fatal. The infection is divided into two stages. The formation stage where the infection has not yet been encapsulated and the capsule stage where the abscess is contained.

Formation Stage: 8 + 1D10 days Capsule Stage: 50 + 1D100 days

Symptoms

Symptoms of a brain infection develop slowly and are often hard to recognise. The symptoms usually grow in severity from mild and hardly noticeable to disabling severity at the end of the capsule stage. Symptoms may even increase or decrease periodically. The type of symptoms depend on the location and size of the abscess in the brain. Roll 1D10 once for each symptom to determine if it will present itself. Brain Infection Symptoms 1D10 Symptoms 1-7 Headache 1-5 Fever, Nausea, Vomiting 1-4 Epileptic Seizures 1-5 Confusion, Loss of Awareness 1-2 Eye Tremor
Risks

Modern:

Scalpel Tracheostomy (easy) Knife Tracheostomy (tricky) Scalpel Tracheostomy (easy) Knife Tracheostomy (tricky)
Hightech Tracheostomy (easy) Cleanse (level would depend on the blocking object I-IV)

Medieval:

Futuristic: Spell:

Treatment depends on the damage, but if the air way is just blocked may only need to use instruments to dislodge whatever is blocking it. However, if it takes too long, or is impossible, to relieve the obstruction it should be resolved by a tracheostomy. A tracheostomy is a surgical opening of the windpipe to maintain a clear airway. The difficulty is easy with a scalpel and tricky with a sharp knife.

Without treatment it is fatal in the majority of cases, often quite suddenly from a ruptured abscess. There may be several abscesses throughout the brain and an abscess may damage vital parts of the brain as it turns brain matter into necrotic tissue. When the infection reaches the end of the capsule stage it is usually fatal, but otherwise the character has a miraculous recovery. After the formation stage roll 1D6 and on a five or six there is multiple abscesses. This increases the risk of brain damage, fatality and makes treatment much harder. At the capsule stage roll 1D6 about every thirty days and on a five or six it ruptures. If the abscess is treated, ruptures or at the end of the capsule stage roll for brain damage. This is in addition to any potential brain damage caused by the surgeon and is unavoidable as the abscess always destroys brain matter. Roll a dice as indicated below and consult the table.

100C Severed Neck

Instantly fatal. The neck is either partly or completely severed. Separating the head from the body. This usually makes continued living impossible.

100D Brain Infection

Brain Abscess An infection inside the brain. Caused by bacteria introduced through trauma or surgery, which penetrated the skull, or from a nearby infection in the head, throat or

61

Formation Stage: 1D6 Capsule Stage: 1D8 Capsule Stage with Multiple Abscesses: 1D12 End of Capsule Stage or Rupture: 1D12

not known a wide spectrum antibiotic must be used. If the bacteria is known the pharmacy difficulty is tricky, otherwise it is hard. Modified by what is available of antibiotics of course. Unless the antibiotic treatment is an exceptional success surgery is also needed.
Surgery

Brain Infection Brain Damage Roll Damage 1-3 No Brain Damage 4-6 Minor Brain Damage [105B] 7-9 Major Brain Damage [105C] 10 - 12 Massive Brain Damage [105D]
Diagnosis

Modern:

Drain Abscess (tricky-severe) Surgical Debridement (severe or worse) No treatment normally possible.
Hightech Surgery (easy-tricky)

Medieval: Modern:

MRI Scan (easy) X-Ray (tricky) Surgery (varies) From Symptoms (insane) Surgery (varies) From Symptoms (insane)
Hightech Scan (easy) Healing Vision

Futuristic:

If there are multiple abscesses increase all surgery difficulties by one. In addition to antibiotics surgery is nearly always necessary to drain the abscess. If scanners and surgical needles are available for the job this is of tricky difficulty. Otherwise it will be severe or worse, depending on the equipment available. Any failure might cause brain damage as described in the section on the brain [105] for treatment. Surgical removal of infected or dead tissue may also be needed. The difficulty will generally be severe or worse. See the section on the brain [105] for the risks of causing brain damage. The three techniques: antibiotics, surgical drainage and surgical removal work together to cure the infection. One may cure the infection alone only on an exceptional success. Alternatively if one has a normal success then only one other method needs to be employed at normal or better success. In all other cases the infection is only cured if all three methods are employed with at least marginal success. The outcome of each technique is of course not known at this stage. The decision to use or leave out each technique must be decided with no knowledge of the level of success of the other techniques. How many attempts can be made depends on the diagnostic capability available and the duration of the infection. With MRI or other sophisticated scanners an attempt can be made every ten days. Increase the length depending on the equipment available. Surgery can of course be used but it is severe to insane to diagnose this way. Also it introduces the risk of brain damage and another infection.

Medieval:

Futuristic: Spell:

For multiple abscesses reduce the difficulty of diagnosis by one. Diagnosing a brain infection is insane without advanced medical equipment. The best tools for the job are imaging devices and scanners. A MRI scanner makes it easy while it is tricky to diagnose with the use of a x-ray machine. Without such devices the doctor must either make a wild guess or have a surgeon open the skull. Diagnosis through surgery is somewhere between easy to severe depending on where the infection is located.
Treatment

Modern: Medieval: Futuristic:

Special Antibiotics (tricky-hard) No treatment likely exists Powerful antibiotics, and possibly nanobots or friendly bacteria will exist to cleanse the infection. Purify II

Spell:

Treatment consist primarily of antibiotics for six to eight weeks. The barrier that filters blood into the brain means that only some antibiotics will be effective and strong doses must be used. A surgical biopsy can be used to get a sample of the bacteria in the infection. If the bacteria is

62

101 - Ear
The ear is not only responsible for hearing but also balance. The outer ear gathers the sound. The middle ear amplifies and converts the sound vibrations to electrical impulses, and works out the heads position. The inner ear transmits the messages of sound and balance along two nerves, side by side, to the brain.

Risks

If the trauma that caused the severe ear trauma also caused internal bleeding, it can be assumed to be intracranial [100A] with some of it leaking out through the damaged ear. Temporary hearing loss on the ear is normal. Hearing is usually recovered in the next 1D10 hours. However, there is a 20% chance that hearing is permanently damaged. If this is the case roll 1D100. The result is the percentage of hearing remaining on the ear. Anything under 20% is effectively deaf.

101A - Severed Ear

The greatest impact of a severed ear is the deformity it causes. It also leads to some hearing loss but this is negligible in most cases, although may become an issue if both ears are severed.
Surgery

Modern:

Sew ear back on (hard) Microsurgery (easy) Prosthesis (varies) Sew ear back on (hard) Sew ear back on (hard) Hightech Microsurgery (easy) Nanosurgery (easy)
Regrow II (fuses ear back on)

Medieval: Futuristic:

Spell:

Re-attaching the ear surgically is possible but difficult. Failure usually means necrosis of the attached ear as it dies and withers away. Microsurgery, if available, has a greater chance of success. Creating a prosthesis is of course possible with cosmetic surgery with the right sophisticated equipment. The difficulty will vary depending on the equipment and material available and the success will determine how real it looks.

101B Moderate Ear Trauma

Damage to the middle or inner ear can cause both temporary and permanent debilitation.
Symptoms

The symptoms of damage to the inner ear can be bleeding from the ear canal, vertigo, tinnitus and reduced hearing depending on what has been damaged as outlined under risks below.

Unsteadiness, or vertigo, is also a risk with moderate ear trauma. The character has a constant feeling of spinning and moving even when he stands still. This may cause nausea, and will certainly impair any movement or actions requiring coordination. Even reading and keeping an object in focus becomes almost impossible. This happens in 50% of cases, in which case it lasts for 1D10 days. There is however a 20% chance that the character will be plagued with vertigo attacks for the rest of his life. If such is the case any action that requires sudden head movements has a 20% chance of causing vertigo. 63

Only one roll need be made for a series of connected actions, such as melee combat. An attack starts right after the offending head movement and lasts for roughly 30 seconds. In that period of time all actions requiring balance or sight have a 3D impairment penalty making most actions impossible. The GM may require an Agility attribute roll just to remain standing. There is also a 15% chance of the facial nerve [107E] being damaged. Severity moderate.
Surgery

Risks

The two most dangerous complications are massive bleeding and cerebronspinal fluid leakage. If the trauma that caused the severe ear trauma also caused internal bleeding, it can be assumed to be intracranial [100A] with some of it leaking out through the damaged ear. Cerebrospinal fluid may leak from the brain and out into the ear as a result of an opening into the brain cavity. There is a 30% chance of this. The leak will usually stop after 1D10 days but if the result was under 10% then the fluid will not stop on its own and the opening must be surgically closed to prevent future risks of infection through the opening. In either case it may resume at any time in the future with any further head trauma. The leakage is not usually itself a problem, but its presence means there is an opening straight to the brain. With severe ear trauma always treat the risk of brain infection [100D] as if the skull had been penetrated and if cerebrospinal fluid is present any infection in the ear turns into brain infection. Another rare complication is brain herniation. Brain matter leaks into the inner or even the middle ear. There is a 1% risk of this condition which will cause minor brain damage [105B] and reduce hearing on the ear to near deaf.

Modern: Medieval: Futuristic:

Surgical Repair (severe) No repair possible Hightech Surgery (tricky) Nanosurgery (easy)
Regrow III

Spell:

Except for emergency surgery to stop any severe intracranial bleeding [100A] ear traumas are usually best left alone. A damaged inner ear is often very hard to repair because of its elaborate and delicate structure. Even with proper medical equipment surgical repair is at least severe and impossible without. Any inner ear surgery may not only cause a brain infection [100D] but also runs the risk of causing brain herniation as explained for severe ear trauma [101C] below under risks.

101C Severe Ear Trauma

Severe ear trauma is usually a result of a heavy blow against the ear. This causes massive damage as the temporal bone, forming the side and base of the skull, is fractured. Inside which are housed the delicate workings of the inner ear. Penetrating trauma may also cause severe ear trauma but is less common. When it does occur, however, it is most likely accompanied with brain damage and serious internal bleeding.
Symptoms

The symptoms of damage to the inner ear can be bleeding from the ear canal, leaking fluid, vertigo, tinnitus and reduced hearing depending on what has been damaged as outlined under risks below.

Some hearing loss is a certainty with severe ear trauma. Initially the ear will go completely deaf. It will recover what hearing is left in the next 1D10 days. Roll 1D100 and the result is the percentage of hearing remaining on the ear. Anything under 20% is effectively deaf. Unsteadiness, or vertigo, is also a certainty with severe ear trauma. The character has a constant feeling of spinning and moving, even when standing still. This may cause nausea and will certainly impair any movement or 64

actions requiring coordination. Even reading and keeping an object in focus becomes almost impossible. The vertigo will get better over a period of 1D12 days as the damage heals or the brain adjusts to the new erroneous signals from the ear. There is, however, a 30% chance that the character will be plagued with vertigo attacks for the rest of his life. If such is the case any action that requires sudden head movements has a 20% chance of causing vertigo. Only one roll need be made for a series of connected actions, such as melee combat. An attack starts right after the offending head movement and lasts for roughly 30 seconds. In that period of time all actions requiring balance or sight have a 3D impairment, making most actions impossible. The GM may require an Agility attribute roll just to remain standing. Lastly there is a 50% chance of facial nerve damage [107E]. Severity very severe.
Treatment

socket itself is larger than the eye-ball, but filled with loose fat to allow the eye movement. The eye moves using six small muscles. The eye is also a relatively unprotected opening into the brain, as there are holes in the skull where the eyes are positioned. Even a blow that does not cause any serious damage can leave the eye painful, bruised and swollen. After which a black eye may show up a day or two later from blood collected under the skin.
Vision Impairment

Any damage to an eye that impairs vision is stated as a percentage reduction in vision. Each new percentage reduction is applied to the percentage of vision left from any previous damage. So if an eye is reduced by 50% and then another 50%, the total reduction is 75%. That is however only for that one eye. The total reduction for both eyes are added together and then divided by two to get the final percentage reduction of perception. Thus if one eye is unharmed any percentage reduction on an eye is halved.

Modern: Medieval: Futuristic:

Surgical Repair (severe) No repair possible Hightech Surgery (tricky) Nanosurgery (easy)
Regrow IV

Spell:

Except for emergency surgery to stop any severe intracranial bleeding [100A], ear traumas are usually best left alone. A damaged inner ear is often very hard to repair because of its elaborate and delicate structure. Even with proper medical equipment surgical repair is at least severe and impossible without. Any inner ear surgery may not only cause a brain infection [100D] but also runs the risk of causing brain herniation as explained under risks. The risk is 1% same as the initial risk when the ear trauma occurred. Diagnosing a brain herniation is tricky even with decent scanners and otherwise only really possible with exploratory surgery.

The percentage will usually be converted to an impairment penalty. For every 30% of vision reduction apply a 1D impairment. The impairment is applied to any roll that depends on vision such as perception rolls that rely primarily on sight. Other skills likely to be directly affected are any aiming and ranged skills such as using bows and handguns. Other skills may or may not be affected as logic dictates. Reading skills will for example not be affected by a slight reduction but more severe vision impairment may lead to reading becoming difficult and slow, or impossible without glasses or other vision aids. 65

102 - Eye
The eye is a sphere with a stalk trailing off behind it to the brain carrying the optical nerve. The front of the eye is made up of fine blood vessels, nerve fibres, iris, lens and a hole which is the pupil in the middle of the iris. The inside of the eyeball is made up of a clear jelly. The

The left eye is fine but the right eye has a 60% vision reduction. This gives a total vision reduction of 30% or 1D impairment. Then the left eye sustains trauma which reduces its sight by 75%. This gives a total vision reduction of 75% + 60% divided by two. Or 135 / 2% which is 67.5% or 2D impairment.

Futuristic:

Hightech Surgery (hard) Hightech Microsurgery (tricky) Hightech Microsurgery to restore nerve (tricky) Nanosurgery (easy) Cleanse II (remove fluids), Regrow III (repair damaged nerve)

Spell:

102A Pressure Blindness

The optic nerve [107B] is gradually damaged by pressure from a forming blood clot and build up of fluids. Vision deteriorates on the affected eye over the next 1D10 days after which the nerve is completely destroyed and vision is permanently lost.
Symptoms

Surgical removal of the blood and fluid causing damage to the nerve requires microsurgery, using a microscope, to avoid damaging the eye or nerve during the delicate operation. See the section on microsurgery for details. Attempting the operation without using microsurgery, but with the help of high quality surgical tools and scanner, the difficulty is increased to at least severe. Normal failure will sever the optic nerve causing permanent blindness on the eye. Exceptional failure will probably do even more damage and probably lead to death. Once vision is lost surgical intervention is useless, unless very advanced technology is available to restore the optic nerve.

There is often great pain which goes away along with vision when the nerve is destroyed.
Risks

Roll 1D10 to determine how many days until pressure blindness on the eye occurs. Gradually reduce eyesight by a percentage each day until the eye loses all vision. So if the roll was five, 20% of vision impairment is accumulated on the eye each day. After five days it reaches 100% and vision is permanently lost on the eye.
Diagnosis

102B Eye Laceration

The cornea is cut, punctured or ruptured permanently damaging vision.
Risks

Modern: Medieval: Futuristic: Spell:

MRI Scan (tricky)

Not possible
Hightech Scan (easy) Healing Vision

There is a 50% chance of complete and permanent blindness. Otherwise perception on the eye is reduced to 1D100 percent of what it was. Round down as usual. The secondary risk is an infection, which is determined as per normal for any trauma. An infected eye however, will lose all vision it has left and there is of course the small but deadly risk of a brain infection [100D].
Surgery

Surgical treatment before vision is lost may be possible if diagnosed quickly. Diagnosis is only possible with a sophisticated scanner, such as an MRI scanner which can detect the location of fluids and blood clots behind the eye.
Surgery

Modern: Medieval: Futuristic:

Microsurgery (hard)

No repair possible
Hightech Microsurgery (tricky)

Modern: Medieval:

Surgery (severe) Microsurgery (tricky)

Nanosurgery (easy)
Spell: Regrow III

No repair possible 66

Repairing a lacerated eye is usually not possible. However, with advanced medical equipment such as lasers, microsurgery might be able to restore some vision. The percentage of lost vision recovered depends on the success. Marginal success 30%, normal success 60%. Only an exceptional success will restore vision one hundred percent. Normal or worse failure will cause further damage to the eye and the loss of all vision if that is not already the case. Grievous

102C Blunt Eye Trauma

A heavy blow to the eye can seriously damage the eye and its surrounding structure of bone, ligaments, muscles, blood vessels and nerves.
Symptoms

Grim

Mortal

100% 70% 40% 20% 10% 5% 100% 80% 70% 50% 40% 30% 100%

Orbital Rim Fracture Retinal Detachment Severe Hyphema Dislocated Lens Blowout Fracture Nerve Damage Orbital Rim Fracture Retinal Detachment Severe Hyphema Dislocated Lens Blowout Fracture Nerve Damage Destroyed Eye

Symptoms will depend on the damage done but it is safe to say that the eye will be painful, bruised, swollen and discoloured. If there is a fracture the eye may also appear sunken into the skull and there may be deformity around the cheek or forehead in the case of an orbital rim fracture. Such deformity may be permanent and will reduce appearance.
Risks

As with eye laceration any infection will most likely leave the eye blind and pose a risk of brain infection [100D] as for any infection in the head.
Blowout

Modern: Medieval: Futuristic: Spell:

Surgical Trapped Muscle Repair (see treatment) Lowtech Surgical Repair (tricky) Hightech Surgical Repair (easy) Regrow II

The risk and extent of damage of a blunt eye trauma depends on the force, angle and shape of the impacting object. Thus the risks are divided in the table below depending on the severity of the trauma inflicted. Roll 1D100 only once. All types of damage to the eye that have a percentage chance higher or equal to the result apply. So that a low roll can result in several types of damage at once. If the result is greater than all the possible types of damage the result is only a severely black, swollen and painful eye that will have a somewhat blurred vision for a few days. Trauma Superficial Blunt Eye Trauma Risks 1D100 Damage to Eye 50% Blowout Fracture 15% Retinal Detachment 10% Hyphema 5% Dislocated Lens 70% Blowout Fracture 30% Retinal Detachment 20% Hyphema 10% Dislocated Lens 5% Orbital Rim Fracture

The eye is pushed back and the thin bone at the bottom of the eye socket is fractured, or in other words blown out by the pressure. In addition to great pain it causes double vision that lasts for 1D10 days. There is a 10% chance that the eye muscles become trapped by the bony fragments of the fracture. If that is the case surgery is necessary to cure the double vision. Double vision effectively reduces eyesight on the eye by 50%.
Retinal Detachment

Modern: Medieval: Futuristic: Spell:

Surgical Retinal Attachment (see treatment) No treatment Hightech Surgery (easy) Regrow II

Nasty

The retina is knocked away from the eyeball. It may not be immediately noticeable but the detachment is likely to get rapidly worse. The retina will separate completely with the eye after 1D10 days. At that point vision will be reduced by 50%. For every day after that vision will drop 67

another 10% until all vision is lost. If surgery is delayed too long it will become impossible to attach the retina again with any great success and the vision loss will have become permanent.
Hyphema and Severe Hyphema

et changes the position of the eye reducing its mobility and sight. Double vision also occurs but usually resolves naturally in 1D10 days. There is however a 10% chance that it will be permanently trapped requiring surgery to repair. Double vision effectively reduces eyesight on the eye by 50%. The reduced mobility and sight of the eye reduces vision by 20%. The head must be moved to see to the sides, up or down. As the eye socket fractures it may puncture the eye causing further damage. There is a 20% risk of such an eye laceration [102B]. The swelling and discolouration usually lasts about 10 days before it starts to go away. However, appearance may be reduced from bone deformities in the forehead or cheek.
Nerve Damage

Modern: Medieval: Futuristic: Spell:

Severe Hyphema Surgical Repair (see treatment) No treatment Hightech Surgery (tricky) Cleanse II

The blood vessels around the iris burst bleeding into the eye. The inside of the eye is a clear fluid but when hyphema occurs sight on the eye turns pinkish and foggy. For normal hyphema eyesight is temporarily reduced by about 50% percent. This lasts 1D10 days before it clears up. For severe hyphema all vision is lost on the eye, often permanently. Without surgery there is a 50% chance that 1D100 percent of vision will be recovered. With surgery it depends on the success of the operation.
Dislocated Lens

Modern: Medieval: Futuristic: Spell:

No treatment No treatment Hightech Microsurgery (tricky) Nanosurgery (easy) Regrow III

The optic nerve [107B] from the eye to the brain is damaged effectively blinding the eye.
Surgical Correction (see treatment) No treatment Hightech Surgery (easy) Regrow II
Treatment

Modern: Medieval: Futuristic: Spell:

The lens is detached from the eye and left floating free. This causes blurred vision with a 25% reduction in eyesight.
Eyesocket Fracture

Attaching a detached retina is only possible with specialised advanced medical equipment. The difficulty depends on how soon after detachment the operation is performed and the equipment and method used. For every day after the fourth since the retina detached completely, increase difficulty by one level. Assume tricky difficulty with good equipment. Only severe hyphema needs surgery but it is tricky even with the right equipment to improve on recovery. Any normal or worse failure damages the eyes as for surgical treatment of fractures detailed below. A dislocated lens is often best left untreated. Difficulty will be tricky even with the right equipment. Normal failure will cause a retinal detachment and significant or worse will damage the eye (vitreous loss) causing blindness. Surgical treatment to repair a blowout or orbital fracture is going to be tricky even with the right equipment. Even normal failure will mean puncturing of the eyeball 68

Modern: Medieval: Futuristic: Spell:

Surgical Repair (see treatment) No treatment Hightech Surgical Repair (easy) Regrow II

The bony cup called the eye socket that surrounds and protects the eye is fractured. The fracture of the eye sock-

[102B] and significant or worse failure means permanent loss of vision on the eye. The surgery must usually wait for a couple of weeks until the swelling is reduced or the difficulty is increased. Such surgery is usually performed to free a trapped eye and remove bone fragments, but may also be cosmetic if the fracture has affected appearance. Nerve damage is usually not treatable.

103A Mouth Injuries

The mouth is full of bacteria but serious infection is very uncommon since the mouth is very resistant to infection. This means however, that bite wounds are nearly always infectious, increasing the base risk threefold. The tongue and teeth can cause breathing problems and death by blocking the airway if loosened by damage

102D Destroyed Eye

The eye is completely destroyed beyond any hope of even surgical repair.
Risks

103B Broken Teeth

Teeth may be knocked out or loosened and can cause breathing problems and death by blocking the airway if loosened by damage.

In addition to the loss of vision and pain there is a high risk of serious infection from the remaining dead tissue of the eyeball in the socket.
Treatment and Surgery

Modern: Medieval: Futuristic: Spell:

Dead tissue Surgical Removal (easy) Dead tissue Surgical Removal (easy) Dead tissue Surgical Removal (easy) Install Cybernetic Eye Cleanse II (remove dead tissue), Regrow IV (new eye)

103C Severed Tongue

The tongue can cause breathing problems and death by blocking the airway if loosened by damage.

Removal of dead tissue and administrating antibiotics to prevent infection.

104 - Nose
Supported by the nasal bone, which is in fact cartilage, the nose is the normal organ for breathing. It is also responsible for smell.

103 Mouth
The mouth is surrounded by muscles essential in eating, swallowing and to articulate speech.

104A Broken Nose

Although swollen, discoloured and bleeding a fractured nose is usually not life threatening. Without the right treatment it may however result in a deformed nose.
Symptoms

Nosebleed, tenderness, swelling and deformity.

Risks

Any infection in a nose wound will have a greater chance of causing a brain infection [100D] than normal even though the skull is not penetrated. For minor infections the risk is 10%, while for major infections the risk is 40%. 69

After brain infection, the greatest risk is loss of the ability to smell. There is a 10% chance that the ethmoid plate is fractured severing the olfactory nerve [107A] which results in a loss of ability to smell and with it most of the ability to taste as well. There is also a small but serious risk that any bleeding from the arteries at the back of the nose may cause breathing difficulties. If this occurs the times before shock occurs from the bleeding are halved. The risk depends on the bleeding caused by the trauma that broke the nose. It is 5% for moderate bleeding, 15% for heavy bleeding and 25% for massive bleeding.
Treatment

though the skull is not penetrated. For minor infections the risk is 10%, while for major infections the risk is 40%. There is a 50% chance that the ethmoid plate is fractured severing the olfactory nerve [107A] which results in a loss of ability to smell and with it most of the ability to taste as well. There is also a small but serious risk that any bleeding from the arteries at the back of the nose may cause breathing difficulties. If this occurs the times before shock occurs from the bleeding are halved. The risk depends on the bleeding caused by the trauma that broke the nose. It is 5% for moderate bleeding, 15% for heavy bleeding and 25% for massive bleeding. Unless repaired the character will suffer from permanent breathing difficulties. Halving stamina during physical activity.
Surgery

Modern: Medieval: Futuristic: Spell:

Diagnosis, Examination (easy) Splintering (easy) Diagnosis, Examination (easy) Splintering (easy) Diagnosis, Examination (easy) Splintering (easy) Regrow I

Modern: Medieval: Futuristic:

Diagnosis, Examination (easy) Nose Reconstruction (hard) Diagnosis, Examination (easy) Nose Reconstruction (severe) Diagnosis, Examination (easy) Hightech Reconstruction (tricky) Nanosurgery (tricky), the high difficulty is because the shattered pieces may not be aligned properly and require a surgeons assistance to align them. Regrow II

The nose can remain swollen for several days, but once it goes down the bone can usually be set or splinted to ensure it heals correctly. Usually an easy set bone roll. If untreated, or the treatment fails, roll 1D10: 1-4 heals fine, 5-8 crooked or to one side, 9-10 depressed. If crooked or depressed appearance will suffer somewhat. Exceptional treatment failure guarantees a deformed nose and reduced appearance.

Spell:

104B Shattered Nose

Same as a broken nose [104A], but the fracture is very severe and the nose is busted open. The fracture impairs breathing and the nose is severely misshapen. It will not heal on its own.
Symptoms

Surgery is the only way to repair the nose and will involve several long operations requiring good access to surgical tools suited for the job. Anything less than a significant success will leave the nose somewhat scarred and deformed affecting the character's appearance.

The nose is split open and the bones can be shattered into more than twenty pieces.
Risks

104C Severed Nose

The nose is severed or severely mutilated.
Symptoms

The character will be less attractive, unless the nose is reconstructed. Any infection in a nose wound will have a greater chance of causing a brain infection [100D] than normal even

The nose is cut off from the face or otherwise destroyed.

70

Risks

A severed nose has a dramatic impact on appearance and the character is likely to be met with shock and even repulsion. Any infection in a nose wound will have a greater chance of causing a brain infection [100D] than normal even though the skull is not penetrated. For minor infections the risk is 10%, while for major infections the risk is 40%. The ability to smell is lost and breathing difficulties halves stamina during physical activity. There is also a small but serious risk that any bleeding from the arteries at the back of the nose may cause breathing difficulties. If this occurs the times before shock occurs from the bleeding are halved. The risk depends on the bleeding caused by the trauma that broke the nose. It is 5% for moderate bleeding, 15% for heavy bleeding and 25% for massive bleeding.
Treatment

entirely severed from its original position in order to keep it alive. The site of the nose is cut and the skin flap twisted around and attached. The patient must usually lie still for about a week and the skin may need to remain connected to its original position for as much as 20 days. After about ten days cloth or something similar needs to be inserted into the nostrils to make sure they remain open. Once the skin is severed from its original position some final cutting of the nose is usually performed to improve its shape. The operation is usually hard but the new nose can look almost natural. If only a marginal success the face will still be hideously disfigured. A normal success means the character will look more normal even if the nose does not look entirely natural. If the success is exceptional the nose is almost perfectly restored.

105 - Brain
The brain is without doubt the most important organ of the body. Reflexes, blood circulation, breathing and other similar functions are generally located in the lower part of the hindbrain near the spinal cord. While the forebrain, further out, is the primary centre for intelligence and higher thought. This is a simplified view, however, as the brain works as one integrated unit. Certain parts of the brain deals primarily with certain functions and so it is divided into regions called lobes. The brain needs a constant supply of oxygen and glucose at all times. If this is interrupted the brain immediately stops working and irreparable damage is done in minutes, see suffocation [100B]. Because the cerebral cortex controls most of the functions of the human body, apart from the very basics, such as breathing, damage to it can affect almost any part of the body.

Modern:

Diagnosis, Examination (easy) Reattachment (hard) Reconstruction (hard) Microsurgery Reattachment (tricky) Diagnosis, Examination (easy) Reattachment (hard) Reconstruction (severe) Diagnosis, Examination (easy) Reattachment (tricky) Reconstruction (tricky) Hightech Microsurgery Reat. (easy) Nanosurgery (easy) Regrow III (fuse nose), Regrow IV (grow new nose)

Medieval:

Futuristic:

Spell:

A severed or destroyed nose will not regenerate and can only be restored by surgery. If the severed nose is available it may be reattached if done within 12 hours. The difficulty depends on how clean the cut was and time since it was severed, as well as surgical tools available. It is usually around tricky with microsurgery and hard or worse with standard surgery. If the severed nose is lost, destroyed or has been severed for more than 12 hours a new nose must be constructed. This is done by forming a new nose with skin from another part of the body. This is usually done with skin from the forehead or cheek, but skin from the arm may also be used to avoid scarring in the face. The skin is not 71

Brain damage can affect the higher functions of the brain in random ways, disabling some functions and retaining others.
Fatal Brain Swelling

Brain Disorder Regions

1D10
1-2 3-4 5-6 7-8 9 10
Frontal Lobe (1

Region
Frontal Lobe Parietal Lobe Occipital Lobes Temporal Lobes Brain Stem Cerebellum - 2)

When the brain is injured it swells. Because it is encased within the skull the swelling causes parts of the brain to compress. This compression decreases the blood flow and oxygen to parts of the brain which, in turn, causes more swelling. As it gets worse it will eventually kill the character. Usually in a matter of hours from the initial injury but it may take up to a day. Roll 1D100 and consult the table below every time brain damage is suffered. The risk for each new brain damage is cumulative with any brain damage, or concussion, that has happened in the last 48 hours. So if suffering a minor brain damage the risk would be 5% but a following second bang on the head causing another minor brain damage would have a risk of 10%. Fatal Brain Swelling Brain Damage Concussion Minor Major Massive Risk 1% 5% 10% 20%

The frontal lobe is at the front of the cerebral cortex. It is the main part responsible for consciousness and ability to interact with the surroundings. It also controls emotions, expression of language, habits and motor activities. Frontal Lobe: Forehead

1D10
1

Effect
Paralysis. Left or right side of body is completely paralysed. Loss of spontaneity. Will follow leads, commands, plans and react in a predictable and previously learned manner. Will never say, think or do anything impulsive or unexpected. Inability to express language. Will understand others and can even learn new languages but is completely unable to pronounce words. Is still able to shriek, grunt and speak utter nonsense. Single mindedness. Becomes obsessed with a single thought and is unable to stop thinking about it. Will constantly talk about it, compare it with current activities and involve it in every imaginable way. The focus may shift gradually over the years but the persistence will remain. Attention disorder. Unable to focus on a task for any length of time. 2D impairment penalty to any task which requires concentration for more than a few seconds. Reduce this to -1D if someone is helping the character to keep focused or is in a minimal environment designed to eliminate distractions. Intense, rapid actions such as combat are usually not affected, while driving a car would be suicide. Experience point cost will be increased for learning any new skills, typically +1XP. Action skills, such as combat skills and athletics, may be exempt.

The only way to stop the swelling from killing the patient is by brain surgery or some drugs like corticosteroids.
Brain Disorders

The brain disorders are caused by the damage done to the various regions in the brain. Roll on the tables below twice for minor brain damage [105B] and four times for major brain damage [105C]. Identical results on the same table causes no further disorder meaning that a lucky character may escape with fewer than normal brain disorders for the type of brain damage. Each region of the brain has its own table. Depending on how the brain damage was inflicted the GM must decide if all the damage is in the same brain region and so rolled on the same table or if they may be in different regions. If the location of the damage is not determined the region can be determined randomly by rolling 1D10 and consulting the table below or comparing to the numbers in brackets for each region.

72

Emotionally unstable. Short tempered, prone to crying and anxious. May switch suddenly from anger to sadness or from happiness to depression and so on. Usually brought on by stress, physical exhaustion or other strong reactions or emotions but may happen spontaneously. A successful attribute roll, typically Cunning, might conceal the fluctuating emotions. This is tricky at the best of times and can be severe to maintain for any length of time. Personality change. The character is no longer who he used to be. The caring, patient healer may now be a rude, insensitive loudmouth. The outspoken leader may become an introverted recluse. The new personality will often be more prone to disruptive, inappropriate and offensive behaviour. May for example become anxious, clingy, emotional and prone to cry or turn into an extravagant, anti-social, liar with bad manners. Twitches. Suffers from sudden and uncontrollable twitches. May come at any time but more frequently during physical or emotional stress. Although causes no physical handicap will have a negative impact on social interactions. Roll 1D10 to make a check. When calm twitches only appear on a result of 8 or more. Mild and moderate stress reduces this to 6 and 4 and in time of extreme agitation twitches are guaranteed. The twitches result in a 1D penalty to all social tasks and may result in negative reactions. Impaired problem solving ability. Greater difficulty with abstract and complex thought. This is reflected with a permanent -1 reduction of the primary mental attribute, typically Cunning. Seriously impaired mental function. All mental attributes, such as Cunning and Wisdom, are permanently reduced by one.

Parietal Lobe (3

4)

Located near the back and top of the head, the parietal lobe controls visual attention, reading, writing, touch perception, use of objects and integrates the senses. Parietal Lobe: Near Back and Top

1D10

Effect
Attention inability. Unable to consider more than one object at a time. When talking to a person, engaged in a duel or reading a book is completely unable to notice anything or anyone else. The world can be falling down around him and he will not notice unless directly struck. Impaired word recall. Although objects are still known and recognised, it is difficult to remember their names. People, places and things can often be described but the word is out of reach. There is no problem repeating the word if it is provided but it may be forgotten again in the future. This should be roleplayed but when a roll is required the name of an object or person is only remembered on a 1D10 roll of 9 or 10 (20%). Writing impairment. Unable to find words when attempting to write. Does not affect reading but makes writing very slow, awkward and often impossible. Reading impairment. While still able to write cannot recognise written words and has difficulty recognising letters. Can recognise words spelled out loud by others and may in time be able to recognise most letters and so read words letter-by-letter. Obviously this is a slower form of reading. Great difficulty in drawing. Drawings will be crude and often unrecognisable. Unable to distinguish left from right. Mathematically impaired. Simple additions and subtractions that used to be easy become severe to solve. Easy becomes extreme and tricky becomes insane. Anything harder is impossible. Reduced eye and hand coordination. Any task that requires eye-hand coordination receives a 1D permanent penalty. This obviously affects all combat skills. No visual focus. While still able to listen and feel is unable to focus visually. Can see surrounding objects but not able to read, spot details or focus. -2D penalty to any task that requires visual focus, such as ranged attacks and most perception rolls.
Lack of awareness. Generally unaware of both self and surroundings. Will neglect selfcare and generally be unresponsive to surroundings unless directly targeted.

5 6 7

10

10

73

Occipital Lobes (5

-6)

Temporal Lobes (7

- 8)

At the back of the head, the occipital lobes are the centre of the visual perception system. Occipital Lobes: Back

Located above the ears on each side the temporal lobes. Temporal Lobes: Side Above Ears

1D10
1-2 3

Effect
Reduced field of vision. The vision field is cut. -1D to defensive actions and Perception. Colour blindness. Hallucinations. Colours, stars, spots, balls of fire and flashes of light may suddenly appear. Especially in times of stress, tiredness or physical strain. Even colourful, vivid, moving objects, animals and people may suddenly appear. While aware that they are not real they will distract and interfere with concentration. It is also unsettling and may be mistaken for superstitious visions. Visual illusions. Objects will appear closer or further away than they really are. They may appear smaller or larger or even to the left or to the right of where they are. Any task that relies on eye-hand coordination suffers an initial 3D penalty. Over time the character learns to compensate for the effect and so the penalty is gradually reduced, but without structured training it can take a long time to completely eliminate the penalty. Word blindness. Completely unable to recognise words, making reading impossible. Writing is still possible if already learned but will not be able to read what is being written and so errors will be more frequent. Unable to notice movements. Will always know where the object is and can from memory therefore recognise that an object must have moved. This makes reacting to other peoples' movements, such as attacks, much slower. 1D penalty to initiative and reflex rolls, close combat and any ranged attacks against a moving target. Read/Write impairment. While able to read and write, will make many errors, miss words and have a much harder time comprehending words and letters making the whole process very slow.

1D10

Effect
Face blindness. Unable to recognize faces as the part of the brain which usually does this no longer functions. People are not easily recognised and voice, clothing, hair and general features are more important than the face. Friends may not be recognised and it is easy to make mistakes when identifying a person. The character is easily fooled by someone wearing somebody else's outfit and will frequently fail to recognise people and confuse identities. Persistent talking. The damage to the brain removes natural inhibitions for talking. Will constantly talk out loud about anything and everything on his mind, and even if persuaded or threatened into stopping this behaviour will resume talking again soon after as is simply unable to help himself. Short term memory impairment. A serious disability that makes it impossible to remember anything for more than a second or two. Will need constant help or depend on routines to get through a day. It will not impair skill or ability and new ones can be learned, although the cost for both study and experience points are doubled. Thus a memory impaired fighter will have no problem defending himself when attacked, but will not remember why he killed the poor man afterwards and forget the whole thing soon after. Things can be remembered if they are repeated many times by friends or written down and studied. Severe memory impairment. Makes it difficult to remember even simple things and much harder to learn new things. Wisdom attribute is permanently reduced by one. Double experience point costs for learning any skill that relies on wisdom. Increased interest in sexual behaviour. Increased aggressive behaviour. Becomes aggressive and violent. Inability to understand spoken or written language. Although able to speak, it makes no sense. Can still understand a few individual words.

1-2

4-5

7-8

9-10

7 8 9-10

74

Brain Stem (9)

Deep in the brain and connected to the spinal cord. All information to and from the body passes through the brain stem and it is responsible for basic consciousness as well as attention and arousal. Being near bony protrusions it is vulnerable to damage from trauma. Brain Stem: Deep Within the Brain

4-5

1D10
1-2

Effect
Decreased vital capacity in breathing. Voice almost a whisper and unable to shout. Difficulties in swallowing food and water. Eating and drinking enough becomes a problem. Will easily get things in windpipe and is unable to cough such things clear. Will suffer from malnourishment and loss of weight over time. Perception impairment. Problems perceiving and organizing what is seen. Able to see things when pointed out and able to focus on an object or person. However, unable to keep track of everything in the field of vision. Any task that requires visual orientation or perception, including combat skills, will have a penalty of 1D. Problems with balance and walking. Will sway and stagger when walking. Running or any tasks involving balance receive a 1D impairment penalty. Vertigo. Dizziness because of a sensation of spinning or whirling. It is a balance problem which may vary in it severity but is always present. Running or any tasks involving balance receive a 1D impairment penalty and may cause nausea. Insomnia. Inability to sleep during night causes sleepiness during the day and so reduced concentration. Depression, irritability, memory problems and falling asleep during the day will occur frequently. Increase the difficulty for tasks needing concentration. 6 7-8

3-4

9-10

Unable to judge distance. Makes it difficult to reach out and grab, push or even attack. May also easily walk into objects or walls if not careful. A 1D penalty for most combat skills and other tasks that require a sense of distance to the target. Tremors. Does not affect normal tasks, but any task that requires fine control, such as surgery, and any aiming suffers -1D penalty. Vertigo. Dizziness because of a sensation of spinning or whirling a balance problem which may vary in severity but always present. Running or tasks involving balance receive 1D and may cause nausea. Slurred speech as if drunk. Inability to perform rapid alternating movements, such as moving an arm to the left and then quickly to the right. Will instead hesitate and require concentration to make the switch in direction. Needless to say this makes close combat and many other movement related tasks much harder. 1D penalty to close combat skills.

Treatment

6-7

Modern:

Diagnostic Scan (tricky) Minor Surgery (severe) Major Surgery (extreme) Massive Surgery (insane) Relieve Brain Swell (tricky) Relieve Brain Swell (tricky) No other treatment available Diagnostic Scan (easy) Minor Surgery (tricky) Major Surgery (tricky) Massive Surgery (severe) Relieve Brain Swell (easy) Nanosurgery may be able to completely repair minor and even major brain damage. Massive brain damage may also be fixable but would result in memory loss and personality changes. Healing Vision Soothe II (stop brain swelling), Regrow III (minor brain damage), Regrow IV (major brain damage)

Medieval: Futuristic:

9-10

Cerebellum (10)

Located at the base of the skull. The cerebellum is involved in the coordination of movement and balance. It is also one of the least likely parts of the brain to suffer damage from trauma. Cerebellum: Base of the Skull

Spell:

1D10
1 2

Effect
Clumsy. Will sway and stagger when walking. Constantly knocks things over and has great difficulty with fine movements. 1D penalty to delicate tasks. Unable to walk. Can only stagger a few steps without falling. Still able to stand.

Generally there is no treatment for brain damage. However a skilled brain surgeon may be able to remove damaged parts and perform simple repairs. Such an operation would be severe for minor brain damage, extreme for major brain damage and insane for 75

massive brain damage. Assuming of course that the surgeon has the right surgical tools for the job. Any failure, except marginal, would cause further brain damage. Normal failure minor brain damage and exceptional major brain damage or death. A marginal success might reduce or stop epileptic attacks, while a normal success could improve the condition. An exceptional success may almost restore the patient completely. Any brain surgery carries the risk of a brain infection [100D]. The exact risk of course depends on cleanliness and if it is antiseptic.

Treatment

Rest is usually the only needed treatment. A concussion will usually wear of in a day or so but a more severe concussion may have symptoms for over a week.

105B Minor Brain Damage

Although it is called minor brain damage the result is usually both crippling and life changing.
Symptoms

105A Concussion
Concussion shows itself in confusion and amnesia often after a loss of consciousness.
Symptoms

Epilepsy, memory problems, poor judgement, reduced abstract reasoning, emotional difficulties, depression, personality changes and a short temper are just some of the possible symptoms of brain damage.
Risks

The main risk is the brain disorders caused by the damage to the brain. Roll two different brain disorders as explained under brain [105] above. Another danger is intracranial pressure from brain swelling. See fatal brain swelling under brain [105] above. There is also a small risk of epilepsy. Roll 1D10 and check the table below. Epilepsy Risk

A mild concussion may cause some dizziness, headache and disorientation. A severe concussion may also cause nausea, vomiting, sleep disturbances, intolerance to light and noise and poor attention and ability to concentrate for 1D10 days.
Risks

1D10
1-7 8 9 10

Epilepsy
No epilepsy Simple Partial Epilepsy (15A) Complex Partial Epilepsy (15B) Tonic-Conic Epilepsy (15C)

The main risk of a concussion is amnesia. Roll 1D100 and consult the table below. Concussion Amnesia 1D100 Memories Lost 1-30 None Last few minutes before 31-50 the concussion. Last few hours before the 51-70 concussion. Everything since that 71-80 morning. Everything for the last 81-90 1D10 days. Loss of identity and all personal memories. Does not 91-100 affect skills, language or general knowledge. Memories will usually return gradually with time, but for a more severe amnesia it may take months or even years, and even then some things may not come back. They may never come back or they may return with some trigger that suddenly opens up access to the lost memories. Another danger is intracranial pressure from brain swelling. See fatal brain swelling under brain [105] above.

Finally roll 1D10 and on a 8 or greater the brain damage will have caused a coma [10]. Even if this is not the case brain damage always causes unconsciousness and this will generally last until the head injury has been treated or started to heal.
Treatment

See treatment under brain [105] above.

105C Major Brain Damage

Major brain damage is very serious and invariably leads to serious handicaps and disabilities.
Symptoms

Epilepsy, memory problems, poor judgement, reduced abstract reasoning, emotional difficulties, depression, personality changes and a short temper are just some of the possible symptoms of brain damage. 76

Risks

105E Breathing Stop

Apnea As a result of massive internal bleeding inside the skull or severe head injuries breathing stops. Since the heart still continues pumping the pressure increases in the skull until the brain tissue herniates down through the bony ring, tentorial opening, on which it rests. The brain stem is dislocated and pushed downwards and irreversible damage is caused by the squeezing of the brain on each side as it is pushed down. The end result is either massive brain damage [105D] or death.

The main risk is the brain disorders caused by the damage to the brain. Roll four different brain disorders as explained under brain [105] above. Another danger is intracranial pressure from brain swelling. See fatal brain swelling under brain [105] above. There is also a significant risk of epilepsy. Roll 1D10 and check the table below. Epilepsy Risk

1D10
1-4 5-7 8-9 10

Epilepsy
No epilepsy Simple Partial Epilepsy (15A) Complex Partial Epilepsy (15B) Tonic-Conic Epilepsy (15C)

Finally roll 1D10 and on a 7 or greater the brain damage will have caused a coma [10]. Even if this is not the case brain damage always causes unconsciousness and this will generally last until the head injury has been treated or started to heal.
Treatment

See treatment under brain [105] above.

105D Massive Brain Damage

A character suffering massive brain damage will no longer be able to function without constant care. Can be anything from a persistent vegetative state, where the body is alive but the conscious part of the brain is dead, to active but confused, inappropriate behaviour and a lack of awareness. Will be unable to perform most selfcare and neither will he be able to act purposefully in response to what is happening around him. At best he will be able to respond to simple commands although their purpose will not be understood. Roll 1D10 and on a 4 or greater the brain damage will have caused a coma [10]. Even if this is not the case brain damage always causes unconsciousness and this will generally last until the head injury has been treated or started to heal.
Treatment

Not much can be done but very slight improvements may be possible as described in treatment under brain [105] above.

77

106 Carotid Arteries

Two main arteries of the head. Running up on each side of the neck, covered by muscles. Just above the adam's apple they divide into arteries for the face, scalp and brain.

Surgery

Modern:

Diagnosing (easy) Severed Carotid (extreme) Partially Severed Carotid (severe) Diagnosing (easy) Severed Carotid (extreme) Partially Severed Carotid (severe) Diagnosing (easy) Hightech Severed Carotid (tricky) Hightech Partially Severed (easy) Bloodmagic III (heavy), Bloodmagic IV (massive)

Medieval:

Futuristic:

Spell:

Treatment consist of restoring blood circulation to the brain, this must be done very rapidly to avoid brain damage. Pressure may stop the bleeding but will not help restore the supply of oxygen to the brain. The surgical difficulty of restoring the blood supply in time when completely severed is extreme unless there are speciality tools or machines at hand. If partially severed it is still severe. The stated difficulties assume proper surgical tools are available of course.

106A Carotid Severed in Neck

Even if only partially severed can cause oxygen starvation to the brain and thereby brain damage or death.
Risks

106B Carotid Severed in Head

If the carotid artery is severed in the head blood leaks into the brain where there is no room to expand. This is just a specific case of intracranial bleeding [100A] and should be treated as any other such bleeding.

A severed carotid will probably mean heavy or possibly even massive blood loss but the immediate risk is death from oxygen starvation to the brain. This works a lot like suffocation [100B], but unconsciousness and brain damage occurs much faster. For one severed carotid treat as suffocation [100B], but if both are severed then unconscious occurs in ten seconds. Minor brain damage [105B] occurs in a minute, major brain damage [105C] ninety seconds, massive brain damage [105D] two minutes and death after two minutes and thirty seconds. Remember that the brain still gets some blood from the vertebral arteries, if this is also severed then death and brain damage will occur much faster. If only one carotid is partially severed then treat as suffocation, but times are doubled. Constitution has no effect. If the damage does not specify if the carotid is completely severed roll 1D100. It is completely severed if the result is less than; 25% for a superficial wound, 50% nasty wound, 75% grievous wound, 90% grim wound, and always for mortal wounds.

107 Cranial Nerves

Twelve nerves passing through holes in the skull and connected directly to the brain.

107A - Olfactory Nerve

The olfactory nerve is a collection of sensory nerves located in the upper part of the nasal cavity. The olfactory nerves are the only nerves that regenerate and some damage may therefore heal over time. Most injuries to the nose [104] holds some risk of damaging the olfactory nerve.

107B - Optic Nerve

The optic nerve transmits information from the retina to the brain. It connects to the back of the eye and can be seen there as a small disc. There are no sensory receptor cells on the optic nerve disc and this creates a blind spot. 78

The blind spot is not normally noticeable because the vision of both eyes overlap. See pressure blindness [102A] and blunt eye trauma [102C] for examples of damage to the optic nerve. Severe

107C - Oculomotor, Trachlear and Abducens Nerve

Nerves responsible for eye movement.

Very Severe

107D - Trigemenial Nerve

Sensations from face and scalp as well as controlling the movement of the jaw. It emerges from the root of the brain and follows the floor of the skull to the inner ear. From there it divides into the ophtalmic nerve carrying sensation from the upper part of the face, the maxillary nerve carrying sensation from the middle of the face and the mandibular nerve controlling the jaw. Damage to this nerve can cause severe stabbing pains in the face, jaw, tongue, ears and lips. Usually associated with movement of the jaw, making it very painful to talk, eat or even swallow.

Total

One side of face droops severely affecting appearance. Slurred speech and unable to close eye on the damaged side completely. One side of face droops severely and is partially paralysed causing slurred speech and affecting appearance. Inability to close eye. As above, but completely paralysed. Speech is very unclear and eye cannot be closed or kept shut without manual manipulation with hands.

Treatment and Surgery

Modern: Medieval: Futuristic:

Surgery (severe) Microsurgery (tricky) Lowtech Surgery (extreme) Hightech Surgery (hard) Hightech Microsurgery (tricky) Nanosurgery (easy) Regrow III

107E - Facial Nerve

Controls movements of the face as it branches out to all the muscles of facial expressions.
Symptoms

Spell:

Damage to the facial nerve can be seen from one side of the face drooping as the muscles on the side of the damaged nerve hang loosely.
Risks

The facial nerve is robust and has an excellent ability to recover from any but the most severe damage. Normally it will heal for superficial, nasty and grievous wounds, but not for grim and mortal. However, if infected the facial nerve will never heal for any wound severity unless treated immediately. Surgery may be attempted if the nerve does not heal, but is tricky using microsurgery and at least severe otherwise. Even with very good surgical tools.

The facial nerve is usually damaged when the temporal bone is fractured. The severity should be specified with the trauma. If it is not it should be determined by the severity of the trauma or a random roll. Severity Mild Facial Nerve Damage Effect Barely noticeable involuntary contractions of facial muscles and a slight sag of face and mouth on damaged side. One side of face and mouth sags somewhat and there are noticeable involuntary contractions of facial muscles. Appearance is affected.

107F - Auditory Nerve

Also known as the acoustic nerve. Made up of the cochlear nerve for hearing and the vestibular nerve for balance. See moderate ear trauma [101B] and severe ear trauma [101C] for some of the associated risks.

107G - Glossopharyngeal Nerve

Sensations in the back of the mouth.

107H - Vagus Nerve

Extends from the brain, down into the neck all the way to the chest and abdomen where it branches out to provide motor control and sensory information. It is responsible for a wide range of tasks from digestion to the heart and 79

Moderate

it controls many muscles and is important for speech, breathing and even plays a role in memory.
Symptoms

live with the condition. A -1D impairment is permanent unless the condition is treated or heals completely.
Treatment

Damage to the vagus nerve often shows itself as hoarseness and problems with swallowing.
Risks

Modern: Medieval: Futuristic:

Surgery (hard) Microsurgery (tricky) Lowtech Surgery (severe) Hightech Surgery (tricky) Hightech Microsurgery (easy) Nanosurgery (easy) Regrow III

Damage to the vagus nerve can have a wide range of effects depending on the location and severity of the damage. Chronic fatigue, inability to cough, problems swallowing, hoarse voice and much more.
Treatment

Spell:

Modern: Medieval: Futuristic:

Surgery (hard) Microsurgery (tricky) Lowtech Surgery (severe) Hightech Surgery (tricky) Hightech Microsurgery (easy) Nanosurgery (easy) Regrow III

The nerve will usually heal, but often surgery is required to repair the damage and remove clotted blood, bone fragments or otherwise relieve the nerve of unwanted pressure. If no surgery is attempted roll 1D10. On a 1-4 the nerve will not heal and the damage becomes permanent. Otherwise it heals as normal and the character makes a full recovery.

Spell:

107J - Hypoglossal Nerve

The nerve will usually heal, but often surgery is required to repair the damage and remove clotted blood, bone fragments or otherwise relieve the nerve of unwanted pressure. If no surgery is attempted roll 1D10. On a 1-4 the nerve will not heal and the damage becomes permanent. Otherwise it heals as normal and the character makes a full recovery. The twelfth cranial nerve, the hypoglossal nerve, is the motor nerve of the tongue.
Symptoms

107I - Accessory Nerve

Controls the sternomastoid and trapezius muscles. The first which flex the neck and turns the head and the second which is a large muscle of the back which rotates the shoulder blade.
Risks

Damage to the hypoglossal nerve impairs speech making it sound thick. It also causes the tongue to deviate to one side. Over the following months the tongue gradually diminishes in size as unused muscles waste away (atrophies).
Risks

The immediate problem of damage to the nerve is its impact on speech. It makes speaking difficult and makes the speaker sound stupid and retarded. It also makes chewing and swallowing harder and harder as the tongue wastes away. This increases the danger of choking on food and makes eating slower and more messy. Sadly, poking your tongue at someone is no longer an option.

Damage to the accessory nerve can lead to a crooked position of the head where it is twisted to one side. The awkward position is both a handicap and a social problem as might make the character seem weird and retarded. How badly the head is twisted should be determined from the amount of trauma inflicted. The penalty should initially be the impairment for the trauma, but this should gradually be reduced with time as the character learns to

80

Treatment

Modern: Medieval: Futuristic:

No treatment No treatment Hightech Surgery (hard) Hightech Microsurgery (tricky) Nanosurgery (easy) Regrow III

quired. Future dislocations are however more likely since ligaments will have been stretched and shouting or any other activity which causes the mouth to open wide is not recommended for the first couple of months.

108B Fractured Jaw

The jawbone is fractured. This requires great force and so there are usually other complications as well and teeth are usually lost.
Symptoms

Spell:

Surgical treatment is not normally possible. Only very advanced technology may be able to repair the damage.

In addition to pain and tenderness the character will usually be unable to bring his teeth together properly. Those he may have left that is.
Risks

The greatest risk comes from a blocked airway which is common with jaw fractures. Bleeding, loose teeth, tongue or displacement of a part of the jaw are just some of the things that may block the airway. There is a 60% chance that one of the above causes suffocation [100B].
Treatment

Clearing of a blocked airway should of course be the immediate concern as detailed under suffocation [100B].

108 Jaw
Mandible The lower jaw is a single bone loosely jointed with the skull.

A minor jaw fracture may heal with simple limitation of movement, usually achieved through the use of bandage. If however the trauma that caused the fracture was more severe than a nasty wound surgical repair is required to heal properly. Failure to do so may leave the characters face deformed and with an incorrect bite that may interfere with talking and eating.
Surgery

108A Dislocated Jaw

Although anchored by strong chewing muscles, the jaw is unstable in comparison with other bones and can thus be dislocated from the joints attaching it to the skull.
Symptoms

Modern: Medieval: Futuristic: Spell:

Surgery (tricky) Lowtech Surgery (hard) Hightech Surgery (tricky) Regrow III

The mouth cannot be closed and the jaw might be twisted to one side.
Risks

The character is unable to close his mouth and will be unable to talk or eat.
Treatment

The dislocated jaw will not heal on its own but manoeuvring it back into place is not difficult. An easy treatment roll pushes the jaw back into place and is all that is re-

Repairing a fractured jaw is a long and complicated process. The jaw must be surgically immobilised and properly aligned and secured, ideally with metal pins and wires. The difficulty of the surgery depends on what is available to immobilise the fracture as well as surgical tools. Even with good equipment though it is a tricky operation.

81

108C Shattered Jaw

The jaw is fractured into dozens or even hundreds of pieces making recovery unlikely.

109 Skull
The skull is made up of more than twenty bones, with the main features being the cranium (brain-box) and the face.

Symptoms

With the jaw shattered, talking becomes impossible and so does eating anything that requires chewing. Even drinking becomes very difficult and food will have to be basically dropped down the throat.
Risks

109A Cranial Fracture

A cranial fracture is a fracture of the skull. It can be depressed or non-depressed.
Symptoms

The force required to shatter the jaw means the character is very lucky to be alive at all. As for a fractured jaw a blocked airway is the most immediate danger. There is a 85% chance of suffocation [100B] usually due to fragments of the jaw, teeth or the tongue blocking the airway. Bleeding is also certain to be dramatic and the risk of infection is great.
Surgery

In a non-depressed fracture the fracture is invisible without the use of x-rays and there are no symptoms. In a depressed fracture the segment of the skull bone has been displaced in towards the brain. The symptoms are usually low level of awareness, nausea, vomiting and possibly signs of brain damage.
Risks

Modern: Medieval: Futuristic: Spell:

Repair (Extreme) Artificial Replacement (Severe) Lowtech Surgery (Insane) Hightech Surgery (tricky) Artificial Replacement (easy) Regrow IV

Superficial and nasty wounds cause non-depressed fractures, while more severe traumas cause depressed fractures. If non-depressed there are no further risks from the fracture, although the trauma itself may have caused further damage such as intracranial bleeding [100A]. A depressed fracture is much more serious. It has a 50% chance of being an open fracture [1B] where the skin is broken leaving an opening straight to the brain. Any wound infection in such a case is guaranteed to become a brain infection [100D]. A depressed fracture also carries the risk of brain damage. Roll 1D10 once with a 1 major brain damage [105C] and 2 or 3 minor brain damage [105B]. 82

A shattered jaw cannot heal and without it the patient is not only deformed but also unable to eat or talk. Breathing will usually also be difficult and constant pain is almost guaranteed. Surgical repair, even in a well equipped, modern hospital has a difficulty of extreme. In any other setting it is bound to be insane or impossible. The best bet is usually a prosthesis if such is available.

A depressed fracture will usually leave the character unconscious until the pressure from the displaced fragment is relieved.
Surgery

Also, facial fractures resulting from grievous or worse trauma have a 50% risk of being an open fracture [1B] with a much higher risk of infection.
Symptoms

Modern: Medieval: Futuristic: Spell:

Surgical Repair (tricky) Lowtech Surgery (hard) Hightech Surgery (tricky) Regrow III

Swelling, pain and possibly bleeding from the nose or mouth. There may be bruising around the eyes.
Treatment and Surgery

Modern: Medieval: Futuristic:

Major Fracture Surgery (hard) Lowtech Surgery (severe) Hightech Surgery (tricky) Regrow II

No treatment needed for a non-depressed fracture. For a depressed fracture the depressed segment must be elevated to relieve pressure on the brain and most likely there will be intracranial bleeding [100A] to deal with as well. The surgical repair of the depressed fracture is at least tricky even with the right equipment. Then there is of course the risk of brain infection [100D] associated with such surgery. Normal failure results in minor brain damage [105B], while exceptional failure results in major brain damage [105C].

Spell:

Treated as a normal fracture, but with a higher difficulty as it is difficult to properly splint a fracture in the face. If the fracture is more serious, grievous trauma or worse, then surgery is required to correctly set the fracture. The operation is difficult and should be considered hard even in a well equipped surgery. Failure to splint or operate will result in facial deformity, something which is always noticeable and detrimental to appearance. There is also the possibility of chronic pain.

109B Facial Fracture

A facial fracture will most typically be a fracture of the cheek bone (zygomatic fracture) or of the upper jaw (maxillary fracture).

110 Throat
Here throat is meant to mean the area below the jaw down to the collarbone in the chest. The throat houses the airways down to the lungs, the vocal cord and the food tract.

110A Damaged Windpipe

Tracheal Injury Casualty suffocates as for a blocked airway [100B], how quickly depends on how bad the damage to the windpipe. A collapsed trachea will quickly choke the victim.
Symptoms

Risks

A pierced trachea may give off a sucking or hissing sound and cause drooling or air bubbling from the wound site. The character will be unable to make sounds except for a high-pitched sound with inhalation and exhalation.
Risks

Those who suffer facial fractures are usually knocked unconscious due to the force of the blow to the head. If they are conscious they will usually have problems seeing clearly for 2D10 hours resulting in a temporary 2D penalty to all visual tasks.

If the trauma is superficial or nasty the trachea is pierced but still functional. The casualty has difficulty breathing 83

and so increases any risks of going into shock but is not directly lethal. If the trauma is grievous or worse the casualty will be choking as detailed under suffocation [100B].
Treatment

Surgery

Modern:

Laser Surgery (tricky)

Transplant (tricky)
Medieval: Futuristic: No treatment possible Hightech Surgery (tricky) Hightech Replacement (tricky) Regrow II (superficial or nasty), Regrow III (grievous or worse)

Modern:

Breathing Tube (tricky)

Scalpel Tracheostomy (easy)

Medieval: Futuristic: Tracheostomy (easy) Hightech Breathing Tube (easy)

Spell:

Hightech Tracheostomy (easy)

Spell: Regrow II

Treatment is only possible with sophisticated surgery tools. If partially damaged laser surgery might be able to restore most or all of the lost vocal range. Otherwise only a transplant can restore a lost voice. Both surgical procedures are probably going to be at least tricky.

If the trauma was superficial or nasty it will heal on its own, although a skilled surgeon might prefer to close the hole. If grievous or worse immediate surgical repair, primarily to establish an adequate airway, is required. Ideally this should be done by inserting a breathing tube but when this is not possible tracheostomy as described under suffocation treatment [100B] can be used to establish an airway.

110C Damaged Esophagus

Damage to the digestive tract that carries food from the mouth to the stomach, spilling gastrointestinal contents.
Symptoms

Breathing problems, rapid, shallow breathing and pain. Eventually symptoms of sepsis if infection sets in.
Risks

110B Vocal Cord Damage

The vocal cord is damaged causing hoarseness or complete loss of voice.
Symptoms

If the esophagus is injured then the windpipe [110A] and spine [7] are also likely to have been damaged. Damage to the esophagus is usually not immediately life threatening but food and water cannot be consumed until repaired. The risk of infection from the spilled contents of the esophagus are independent of any other infection and occurs in 95% of cases. Swift and skilful surgery may lower the risk, but rarely below 60%. Eating or drinking anything guarantees an infection. The infection is a chest infection [200A]. If the esophagus is not repaired then starvation and infection will eventually lead to death.
Diagnosis

Damage to the vocal cord is obvious as the ability to speak is lost or reduced.
Risks

If the trauma causing the damage is superficial, nasty or grievous the vocal cord is only partially damaged. If this is the case then the ability to speak and make sounds is not completely lost, only reduced. Speech suffers from severe hoarseness however and will be unable to shout loudly. For grim or mortal trauma all ability to speak and make vocal sounds is lost.

Modern: Medieval: Futuristic: Spell:

Physical Exam. (tricky or worse) Scan (tricky) Physical Exam. (tricky or worse) Physical Exam. (tricky or worse) Hightech Scan (easy) Healing Vision

84

Diagnosis can be tricky or even severe if the damage resulted from a blunt trauma. There may be no outwards signs, but unless the esophagus is repaired with surgery the casualty will die.
Surgery

Modern: Medieval: Futuristic: Spell:

Repair (tricky) Lowtech Surgery (tricky) Hightech Surgery (easy) Regrow II

Surgery is required to repair and close the esophagus, as is the right intravenous antibiotics or infection risk is very high. The prognosis can be grave, especially if diagnosis is delayed. Even with prompt diagnosis and treatment the mortality rate is high from the following infection. The surgical repair is of tricky difficulty.

110D Vagus Nerve Damage

The vagus nerve can be damaged as it runs down through the neck outside and independent of the spine. See the vagus nerve [107H].

85

Chest
"One night I awoke with a simple solution to the problem; cool the entire body, reduce oxygen requirements, interrupt the circulation and open the heart" - Bigelow (20th Century)

The aorta is a huge artery carrying blood from the heart into all parts of the body. In the chest it branches into the left and right carotid arteries to the head, the subclavian arteries into the arms and down into the abdomen to supply the lower part of the body with oxygen. All the bodies veins originate from either the superior or inferior vena cava. The superior vena cava receives blood from the head through the jugular vein and from the arms through the subclavian veins. The inferior vena cava goes down into the abdomen where it receives blood from the lower part of the body.

Vital Structures
The trachea (windpipe) connects the nose and mouth to the lungs. It extends from the larynx in the throat to the two bronchi branching out into the lungs. The thymus gland is located in the upper part of the chest cavity. It helps develop the immune system during puberty after which it shrinks in size until it is replaced with fat. The esophagus (gullet) is the food tube passing from the mouth to the stomach. The diaphragm is a muscle separating the thoracic cavity from the abdominal cavity. It is critical for respiration.

Nerves
In the chest the central nervous system in the form of the spinal cord is protected inside the spine. The peripheral nerves connect to the limbs, muscles and organs, most originate from the spinal cord but some like the vagus nerve travel directly from the brain.

Anatomy
The chest is defined as what is called the thoracic cavity as well as the upper part of the back. The thoracic cavity extends from the bottom of the neck to the diaphragm which separates the chest and abdomen.

Skeleton
The ribs, sternum (chest bone) and thoracic vertebrae (upper spine) are all located in the chest. The scapula (shoulder blades) are also considered part of the chest here.

Vital Organs
The heart lies between the lungs, in the middle of the chest, inside a fibrous bag called the pericardium. It is protected behind the sternum and by the third to seventh rib on the left side where it is slightly larger. The lungs fill a lot of the chest cavity and are completely protected by the ribs and enclosed inside thin membranes to maintain a negative pressure.

200 - Infection
The chest is very vulnerable to infection. Infections in the chest are treated like any other infection [4]. However, they do carry some additional dangers. Gangrenes and necrotizing fasciitis in the chest have an increased risk of sepsis, and minor and major infections have a 30% and 90% risk respectively of developing into the much more deadly chest infection [200A].

Great Vessels
The pulmonary arteries and veins carry blood between the lungs and the heart.

86

Finally there is the risk of pneumonia [200E]. Pneumonia is usually caught from an infected person or animal as it can be quite contagious, but may also result from infected drinking water or penetrating trauma.

In the unlikely event that the character does not recover or die after 80 hours the shock difficulty will stay at insane and the recovery at tricky until recovery or death from shock. Chest Infection Progression Hours Shock Recovery 10 Easy Insane 20 Easy Insane 30 Tricky Extreme 40 Tricky Extreme 50 Hard Severe 60 Severe Severe 70 Extreme Tricky 80 Insane Tricky Every +10 Insane Tricky The onset of sepsis will of course accelerate the risk of shock greatly which makes recovery very unlikely. See sepsis [4E].
Diagnosis

200A Chest Infection

Mediastinitis, pleurisy, sepsis Any trauma or surgery that penetrates the chest will have a high risk of causing infection and sepsis. Infection in the chest spreads easily and is often fatal.
Symptoms

Fever, chills, chest pain, shortness of breath and exhaustion.

Risks

Unlike infection in most other places in the body, the chest is an excellent and spacious breeding ground for bacteria. Hence symptoms may appear from the infection any time in the 1D10 days after infection. Once they do the condition will deteriorate quickly. Every ten hours after the onset of symptoms make a shock roll, starting at easy, but increasing by one level each time. As the symptoms get worse and the difficulty higher this reflects the infection spreading to surrounding structures like the heart, great vessels, lungs and even bones. In addition to shock also roll 1D100 for other complications each time shock is rolled. If the result is within one of the ranges below that complication occurs. For the first 40 hours.

Modern:

Scan (tricky) Exploratory Surgery (tricky) Diagnose Symptoms (special) Diagnose Symptoms (special) Hightech Scan (easy) Diagnose Symptoms (special) Healing Vision

Medieval: Futuristic: Spell:

1 : Bone Infection [4G] 2 - 3 : Blood Poisoning [4F] 4 - 7 : Sepsis [4E] 8 - 10 : Pneumonia [200E]

Early diagnosis before the symptoms appear is only possibly with exploratory surgery or some very advanced equipment. Once symptoms start appearing the difficulty starts at hard and drops by one level after every ten hours of observation.
Treatment and Surgery

After the first 40 hours the risks increase.

Modern: Medieval: Futuristic:

1 - 2 : Bone Infection [4G] 3 - 7 : Blood Poisoning [4F] 8 - 15 : Sepsis [4E] 16 - 20 : Pneumonia [200E]

Antibiotics Chest Surgery (tricky) Chest Surgery not possible in a lowtech society. Powerful antibiotics, ointments and possibly nanobots or friendly bacteria will exist to cleanse the infection. Purify II

As the danger of shock increases with time so does the chance that the body will be able to defeat the infection. After every shock roll also make a recovery roll. Make it the same way as a shock roll with the appropriate attribute, typically Spirit, but the difficulty starts at insane and only decreases one level every twenty hours. Also, it can never decrease below tricky.

Spell:

Antibiotics and sometimes surgical removal of infected areas is the only effective treatment. The latter usually requires a successful CT or MRI diagnostic scan of 87

tricky difficulty or equivalent to locate the infected tissues. The treatment will slow the progression of shock. Depending on the treatment the interval between each shock roll and increase in difficulty is increased by a number of hours. The recovery roll is unaffected which effectively improves the chance of recovery. The table below gives some examples. Treatment Effect Treatment Shock Progression Weak Antibiotics +5 hours Powerful Antibiotics +10 hours Marginally Successful Surgery +5 hours Normal Successful Surgery +10 hours Exceptional Successful Surgery +20 hours Any surgery in the chest is of course risky and carries the risk of a secondary infection. There is no way to halt the onset of shock except to cure the chest infection with antibiotics and surgery, and hope the character will recover before he dies from the effects of shock [3]. Keep rolling for recovery every ten hours even after a failed shock roll. With care there is some hope as the shock normally progresses one stage only every ten hours, depending on the treatment of the character of course.

200E - Pneumonia
Pneumonia can be caught from an infected person or animal. It can be the result of contaminated drinking water or as a result of surgery or penetrating trauma. In the last two cases pneumonia is usually the complication of a chest infection [200A]. Pneumonia is an inflammation of the lungs and can be caused by an infection of bacteria, viruses or fungi. Viral pneumonia is usually less severe than bacterial pneumonia. Viral pneumonia is usually caught of an ill person or animal, while bacterial pneumonia is usually the result of an infection after trauma or surgery.
Symptoms

The incubation period before the symptoms appear can be anything from a day to a week depending on the type of infection. If not specified the incubation period lasts 1D6 days. Symptoms can appear quite suddenly and may be very similar to a cold or influenza. Pneumonia caught from another person or animal usually starts with a sore throat. Then typically all pneumonias cause painful coughing and breathlessness which gets gradually worse. The coughs are initially dry but then progress to produce yellowish and smelly phlegm. As it progresses fever breaks out with loss of appetite and stabbing chest pains.
Risk

200B Tetanus in Chest

Tetanus that starts in the chest behaves like tetanus that starts in any other part of the body. See tetanus [4D].

200C Chest Gangrene

Gangrene in the chest is even more deadly than normal because of the increased risk of sepsis. Double the normal chances for sepsis to 7-10 for the intermediate stage and 3-8 for the late stage, but otherwise it progresses like any other gangrene [4B]. The heart will normally not develop gangrene from blunt or non penetrating damage as it is free from bacteria. It may however scar which may affect its ability to pump blood thus reducing constitution. Penetrating trauma or surgery may of course introduce bacteria into the heart. Such gangrene of the heart should be very rare but will almost certainly be very fatal too.

After the onset of symptoms pneumonia can last anywhere from a week to several months depending on the type of pneumonia and treatment. The duration is 10 + 1D12 weeks although general health and fitness may increase or reduce the duration. For each week of pneumonia the condition and general health of the character decreases. Then about half way through it slowly starts to improve again. In the first week there is a 1D impairment penalty to all physical tasks. Every two weeks the impairment increases by one until it reaches -3D. Once half way through the duration the impairment starts to decrease by one every two weeks until all impairment is gone and the character has recovered. Every week there is a risk of complications. The primary risk is respiratory failure and death as pus and fluids reduce the ability to breathe to the point of oxygen starvation. Roll 1D6 and on a 1 respiratory failure occurs. In the case of respiratory failure, breathing will get worse over a period of 1D12 hours ending in suffocation [100B]. Life support may allow the character to survive. 88

200D Chest Fasciitis

Like gangrene in the chest, necrotizing fasciitis in the chest is more serious. Double the normal chances for sepsis to 7-10 for the intermediate stage and 3-8 for the late stage, See necrotizing fasciitis [4C] for details.

If put on life support treat that condition as ARDS [212] as well as the pneumonia continuing to develop. The secondary risks of blood poisoning [4F] and sepsis [4E] are resolved by rolling 1D100 each week. If the result is a 1 blood poisoning occurs and on 2 or 3 sepsis.
Diagnosis

201 - Great Vessels

The aorta is the main artery from the heart accompanied by the vena cava and azygos veins. The aorta originates at the heart pointing upwards but immediately bends down in an arch into the abdomen (see Abdominal Aorta). It also branches out into several arteries supplying the head (carotid artery) and arms (subclavian artery) as well as to organs and muscles. The subclavian arteries are two very large arteries on each side under the collarbone providing blood to the arms and to the carotid arteries for the head.

Modern:

Physical Examination (see below) Blood Test (tricky) X-Ray (tricky) Physical Examination (see below) Physical Examination (see below) Hightech Blood Test (easy) Advanced Scan (easy) Healing Vision

Medieval: Futuristic:

201A Great Vessel Tear

An incomplete tear of the aorta or any great vessel is survivable with prompt surgical repair but untreated eventually leads to the same death as for a rupture [201B].
Symptoms and Risk

Spell:

Diagnosis is usually based on symptoms and physical examination. Diagnosing pneumonia during the incubation period is usually impossible. Once symptoms start the difficulty starts at tricky but by the time the character is coughing phlegm it is easy. Stethoscope, x-ray and
Treatment

In about half of all cases the lower part of the chest turns pale and cold, or clammy. For the rest there are no obvious signs. As the bleeding is usually heavy or massive shock soon follows.
Surgery

Treatment of bacterial pneumonia is done with antibiotics. With antibiotics pneumonia is usually cured in a week. Viral infections cannot be treated with antibiotics but if available, antiviral drugs may help if the infection is caught early. Pneumonias resulting from chest infections are always bacterial. If the type and cause is unknown it will be a bacterial infection 60% of the time. Respiratory failure can be treated with concentrated oxygen and as a last effort a mechanical ventilator.
Surgery

Modern: Medieval: Futuristic: Spell:

Close Artery (tricky) Replace Artery (tricky) Close Artery (hard) Replace Artery (hard) Welding beam or self guided instruments might make this easy. Bloodmagic III (heavy), Bloodmagic IV (massive)

Modern: Medieval: Futuristic: Spell:

Drainage (tricky) Not usually possible Hightech Drainage (tricky) Purify II

Surgery is necessary to close the artery or replace damaged parts with artificial tubes. Difficulty depends on severity, but is at the very least tricky and often hard or worse depending on the damage and equipment available.

201B Great Vessel Rupture

With a complete tear or rupture blood rushes into the chest leading to exsanguination and death in minutes. This happens the most quickly for the massive aorta which pumps blood directly from the heart. Shock quickly sets in.

Drainage of pus and fluids in the lungs can be done through surgery to reduce the risk or prevent respiratory failure.

89

Surgery

202A Myocardial contusion

Close Artery (severe) Replace Artery (severe) Close Artery (extreme) Replace Artery (extreme) Some sort of welding beam or self guided instruments might make this tricky. Bloodmagic IV

Modern: Medieval: Futuristic:

Bruising of the heart causes accumulation of blood and inflammation in the heart muscle which can lead to abnormal heart movement and stunning of the heart muscle (cardiac dysrhythmia).
Symptoms

Uneven or rapid heartbeat.

Risks

Spell:

There is rarely time for treatment but if surgery is available immediately there is always a tiny chance that a brilliant surgeon can save the day.

Abnormal heart movement will usually resolve on its own but there is always a risk of complication. Roll 1D100; 1-5 fibrillation, 6-12 cardiac tamponade [202D]. In the case of fibrillation the heart does not recover its normal rhythm and in instead gets worse. This results in a serious arrhythmia known as fibrillation where the heart is no longer able to pump blood. Fibrillation leads to a heart attack [202C] in under a minute.
Treatment

202 - Heart
The heart is a vital muscle pumping blood through the body. It is around 12 cm long, 8 cm wide and 6 cm thick, weighing from 230 grams in females up to 340 grams in males. The heart is made up of four chambers. The two upper chambers where blood enters the heart are called atriums. The atriums collect the blood and then force it into a ventricle, from where it is pumped back into the body. Oxygenated blood returns to the right side of the heart from the lungs through the pulmonary veins. It enters the right atrium from where it is forced into the right ventricle chamber and forced into the aorta artery. The aorta artery transports the oxygenated blood into the body. The blood returns from the body on the left side. It enters the left atrium through the large inferior vena cava vein and from the head through the superior vena cava vein. The left atrium then forces the blood into the left ventricle. It in turn contracts to force the blood into the pulmonary artery. The pulmonary artery takes the blood to the lungs where it is oxygenated. It then returns to the heart through the pulmonary vein and the cycle starts over again. A normal heart rate is around 70 beats per minute. A rise in physical or emotional demands increases the heart rate up to a maximum of about 140 beats per minute. The heart will continue to beat even after being removed from the body and despite being cut into pieces. Heart injuries are frequently fatal as they cause massive internal bleeding which starves the brain and other organs from oxygen. Heart injuries nearly always lead to shock and death.

Will resolve on its own but any tamponade or heart attack will need treatment.

202B - Cardiac Penetration

Penetration of the heart is usually fatal, but rapid treatment may save the characters life.
Symptoms

Unconsciousness, weak pulse and uneven heartbeat.

Risks

The damage to the heart always causes life-threatening bleeding and in most cases the heart will stop pumping without treatment. All four heart chambers may be damaged but the ventricles are the most vulnerable and the right side of the heart more likely to be hit. Penetrating trauma rarely cause a tamponade [202D] but there is a 5% risk. Make an attribute roll, typically Spirit, soon after the cardiac penetration and then again every hour. The difficulty starts at easy but increases by one level every four hours. If the roll fails the heart gives up and goes into heart attack [202C]. The character will always lose consciousness but may awaken again. However, he will be too weak to do anything and usually mentally confused. 90

Treatment and Surgery

Modern: Medieval: Futuristic: Spell:

Heart Surgery (hard) Hearth surgery will not usually be possible, but if allowed at least severe. Hightech Heart Surgery (tricky) Regrow III, Bloodmagic III (heavy), Bloodmagic IV (massive)

Minutes 4 6 7 10

Heart Attack Effect Minor Brain Damage [105B] Major Brain Damage [105C] Massive Brain Damage [105D] Unlikely to be revived

It should be noted that the above times can be much longer in very cold temperatures. Especially in the case of heart attack from hypothermia the times above should be at least tripled.
Treatment

Treatment before the heart stops is more likely to be successful. If the heart has stopped the damage must first be repaired and then the heart attack [202C] must be treated to start the heart again. Success is unlikely even in a hospital setting. Cardiac penetration must be treated with surgery. The difficulty should depend on the severity of the wound and equipment available. Even if well equipped heart surgery will usually be hard or worse.

Modern: Medieval: Futuristic: Spell:

Electrical Defibrillation (see below) CPR (see below) If understood CPR is the only treatment normally possible. Hightech Defibrillation reduces difficulty by one or more levels. Arouse II

Cardiopulmonary resuscitation (CPR) is meant to prolong life and prevent brain damage by maintaining the flow of oxygen to the brain and heart. With luck and skill it can even restart the heart. It consists of chest compression and may also include mouth-to-mouth ventilation. CPR is usually not known in a medieval or fantasy setting, although primitive versions may exist. In a modern or futuristic setting it should be part of general medical knowledge. The difficulty defaults to normal, but may be increased if there are problematic rib fractures or other hindrances. It may be easier if life support equipment is available, such as heart rate monitors and medication. A marginal success will increase the time before onset of brain damage by four minutes. A normal success will increase it six minutes. An exceptional success will restart the heart if possible. Resuscitation is an ongoing effort and so only one attempt can be made. Another person can of course jump in and take over and then a new roll is made. The GM can keep the result of the roll secret to make the decision of whether to continue or abort more difficult and instead narrate the effort according to the result. Unless the CPR is an exceptional success the heart must be restarted by using a defibrillator and administering intravenous medication. If the heart is damaged it may need emergency surgery, such as for a cardiac penetration [202B], before it can be restarted. If under pressure and constricted by fluids, such as in a cardiac tamponade 91

202C Heart Attack

Cardiac Arrest The heart stops pumping which leads to oxygen starvation of the brain and body. The character immediately loses consciousness and stops breathing.
Symptoms

Unconscious with no pulse or signs of breathing.

Risks

A character suffering a heart attack effectively suffocates. This leads to brain damage and then death within minutes. Use the table below. The minutes in each row represent time since the onset of the heart attack.

[202D], drainage or pumps must first clear the pericardial sac before the heart can be restarted. Defibrillation, an electric shock used to restart the heart, performed in the first three minutes after a heart attack is of tricky difficulty. This time is extended with successful CPR. For every minute after this increase the difficulty by one. This makes it tricky at four minutes. Hard at five, severe at six, extreme at 7 and insane after eight or more minutes. This difficulty is reduced by one with the right medication and may be further reduced with high quality equipment. One attempt of defibrillation can be made each minute.

The effects and treatment is the same as for a cardiac tamponade [202D].

202F- Commotio Cordis

A very unlucky hit of the heart during the most vulnerable period of its cycle. Immediate collapse is the norm, although some have a brief period of consciousness before collapse. Survival is very rare despite immediate resuscitative efforts. Treat as a heart attack [202C] but any attempts at CPR or other treatment should have its difficulty increased.
Symptoms

202D Cardiac Tamponade

Blood fills the pericardial sac that surrounds the heart. This compresses the heart and eventually renders the heart unable to beat.
Symptoms

Sudden Death

202G Shattered Heart

Ruptured Ventricle If one or both the ventricle chambers are ruptured or otherwise destroyed death is usually rapid with shock starting almost at once. Treat as a heart attack [202C] but first aid or any other treatment will not have an effect on the condition. Only surgery may save the character, but only an immediate heart transplant is likely to have any chance of success.
Treatment and Surgery

Diminished heart sound, distended jugular veins and fast heart rate.
Risks

Unless relieved with surgery leads to shock as the blood fills the pericardial sac. Halve the time for shock to set in given in the blood loss table under bleeding [2]. If the bleeding stops before shock occurs the heart will be able to keep working for another 1D6 days before it tires and gives in.
Surgery

Modern: Medieval: Futuristic: Spell:

Heart Surgery (extreme) Heart Transplant (hard) No treatment possible Hightech Heart Surgery (tricky) Hightech Heart Transplant (tricky) Regrow IV

Modern: Medieval: Futuristic: Spell:

Puncture Pericardial Cavity (tricky) Hearth surgery will not usually be possible, but if allowed at least hard. Hightech Surgery (easy) Bloodmagic I (some), Bloodmagic II (moderate), Bloodmagic III (heavy), Bloodmagic IV (massive), Cleanse II (remove clotted blood)

203 Digestive Tract

Esophagus Carrying food from the mouth down into the stomach, the esophagus passes behind the heart, but in front of the aorta.

Oxygen and intravenous can prolong life, but surgical puncture of the pericardial cavity is required and is tricky even with appropriate surgical tools. An untreated tamponade is always fatal.

202E- Pneumopericardium
Air enters the pericardial cavity through a penetrating wound but is unable to leave.

203A Damaged Esophagus

Blunt trauma rarely damages the esophagus in the chest as it is well protected. When it is damaged other organs 92

are usually also damaged and the spilling of gastrointestinal contents into the chest carries a very high infection risk. See the same for the throat [110C].

Breathing is possible with the healthy lung, but for any trauma worse than a nasty wound the pressure builds and the healthy lung is pushed aside, along with the heart and other structures in the chest. This decreases blood flow and inevitably leads to shock and death.
Symptoms

204 Lungs
The two lungs fill a lot of the chest cavity and are completely protected by the ribs. The right lung has three lobes while the left lung has only two lobes to make room for the heart. Each lung is enclosed in a thin membrane called the pleura. The pressure within the pleura is below atmospheric pressure allowing the lungs to stay expanded. If the pleura is penetrated the pressure will increase until it reaches atmospheric pressure collapsing the lung. This is called an open pneumothorax [204A]. Any surgery inside the pleura therefore requires a lung machine to keep the lung from collapsing. The lungs most import function is to retrieve carbon dioxide from the blood and replace it with oxygen (respiration). It is possible to live with a part of a lung missing or even with only one lung but this will reduce stamina.

Shortness of breath, coughing of blood, small bubbles in the bleeding from the wound and of course the tell tale sucking sound. Eventually turns blue and falls unconscious.
Risks

The most immediate danger is the threat of shock from the lack of oxygen. There is also a small risk of a hemothorax developing in the next 24 hours as well as a risk of chest infection. Any wound infection is a chest infection. A hemothorax develops if there is moderate, heavy or massive bleeding. Sucking Chest Wound Risks
Trauma

Recovery
Superficial sucking chest wound. Lack of oxygen means small risk of shock until healed. Roll for shock if any strenuous activity is performed. Difficulty should depend on how exerting and prolonged the activity is. Short, slow walk (easy), jog (easy), heavy lift (tricky), etc. Complications Infection [200A]
Hemothorax [204C]

Superficial

Nasty

As above. Complications Infection [200A]

Hemothorax [204C]

Grievous

Terrible sucking chest wound. Shock is inevitable if not treated with surgery or first aid. Every half-hour roll shock with difficulty starting at easy but increasing by one every time. Any straining physical exertion means an extra shock roll. Infection [200A] Complications Hemothorax [204C] Severe sucking chest wound. Shock risk as above but roll and increase difficulty every fifteen minutes. Complications Infection [200A]
Hemothorax [204D]

204A Sucking Chest Wound

Open pneumothorax The famous sucking chest wound. It occurs when the chest is penetrated and air is sucked in and out of that hole instead of through the windpipe. Breathing becomes difficult and the affected lung collapses, if it hasnt already been punctured, as air collects in the chest cavity.

Grim

Mortal

Massive sucking chest wound. Shock risk as above but roll and increase difficulty every five minutes. Infection [200A] Complications
Hemothorax [204C]

93

Diagnosis

Modern: Medieval: Futuristic: Spell:

Examination (easy) Examination (easy) Examination (easy) Healing Vision

closed pneumothorax [204B] as the lung is probably leaking air. The percentage risk depends on the surgery. Marginal success 60%, normal success 30% and exceptional success carries no risk. This risk can be avoided if the wound is left open with a dressing as explained under first aid for 5 - 10 days before being closed. There is a risk that damaged or scarred lung tissue need to be removed to allow the pneumothorax to heal. Lesser traumas do not have this risk, but the risk is 10% for grievous trauma, 20% grim trauma and 30% for mortal trauma. If this is the case see treatment under [204B] below for how the surgery results may affect constitution.
Special Considerations

Treatment and Surgery

Modern:

Grievous Wound Stitching (easy) Grim Wound Surgery (tricky) Mortal Wound Surgery (hard) Grievous Wound Surgery (easy) Grim Wound Surgery (tricky) Mortal Wound Surgery (extreme) Hightech surgery will usually be one degree lower difficulty. Regrow I (superficial and nasty), Regrow II (grievous), Regrow III (grim), Regrow IV (mortal)

Medieval:

If the weapon remains in the wound it may seal it and also function as a plug for any internal bleeding. The wound only becomes a sucking chest wound at the point which the weapon is removed. Also, any significant change of altitude will prompt a shock roll when suffering from a sucking chest wound.

Futuristic: Spell:

204B Punctured Lung

Closed pneumothorax, Tension pneumothorax A pneumothorax is a collection of air inside the chest, between the lung and inner chest wall, which causes the lung to collapse. Most often caused by a penetrating wound or by a broken rib. Superficial and nasty traumas are considered simple closed pneumothoraxes. They will heal on their own without surgery. For grievous or greater trauma the damage is severe enough to lead to a tension pneumothorax as the amount of trapped air accumulates. The pressure builds pushing the windpipe (trachea), great blood vessels and heart towards the healthy side. The pressure may cause compression of the healthy lung and restricts the hearts ability to function by distorting the superior vena cava, and so decreasing the blood return to the heart. Tension pneumothorax is a critical condition which leads to shock and death from lack of oxygen.
Symptoms

Immediate wound care consists of closing the wound with an impervious material (like field dressing), but leaving a flutter valve open to allow air out but not back in. Completely sealing the wound (normal or exceptional failure) leads to a closed pneumothorax [204B]. The difficulty starts at easy for a superficial wound and increases by one per wound severity. Adjust for what is used as field dressing. Initial wound care removes risk of unprovoked shock and reduces the difficulty by two levels for strenuous activity. A large syringe can also be used to extract air, easing breathing and preventing shock as long as air is evacuated periodically. A superficial or nasty sucking chest wound will heal with rest with no further treatment. A grievous sucking chest wound requires stitching or will take twice the time to heal and scar badly. A grim sucking chest wound requires minor surgery or will not heal at all and a mortal sucking chest wound requires extensive surgery. When a sucking chest wound is sealed a tube should be inserted into a new surgical incision to suck out any air, surgery (tricky). The tube will need to be connected to some form of suction and needs to be left in place for 1D10 days. If such a tube and suction system is not available when the wound is sealed there is a high risk of developing a

Closed pneumothorax is associated with shortness of breath and stabbing chest pain on deep breaths. If tension pneumothorax develops the shortness of breath becomes more severe, with rapid breathing and a high heart rate and as lack of oxygen becomes more severe the character may turn bluish. 94

Risks

Treatment and Surgery

The most immediate danger is the threat of shock from the lack of oxygen. There is also a small risk of a hemothorax developing in the next 24 hours as well as a risk of chest infection. Any wound infection is a chest infection. A hemothorax develops if there is moderate, heavy or massive bleeding. Punctured Lung Risks
Trauma

Modern:

Grievous Punctured Lung (tricky) Grim Punctured Lung (hard) Mortal Punctured Lung (severe) A suction tube will not normally be available, but surgery to convert the trauma to an open pneumothorax is possible same as for modern surgery. Hightech surgery will usually be one degree lower difficulty. Regrow I (superficial and nasty), Regrow II (grievous), Regrow III (grim), Regrow IV (mortal)

Medieval:

Recovery
Simple pneumothorax, no further risks. Infection [200A] Complications Hemothorax [204C] Simple pneumothorax. Lack of oxygen means small risk of shock until healed. Roll for shock if any strenous activity is performed. Difficulty should depend on how exerting and prolonged the activity is. Short, slow walk (easy), jog (easy), heavy lift (tricky), etc. Complications Infection [200A] Hemothorax [204C]
Futuristic: Spell:

Superficial

Nasty

A large syringe can be used to extract air, easing breathing and preventing shock as long as air is evacuated periodically. Pain relief can also help ease breathing and therefore delay shock. A superficial or nasty punctured lung wound will heal with rest with no further treatment. A grievous or worse punctured lung requires surgery or pressure will quickly kill the character. A chest tube can be inserted to suck out the air and keep the pressure negative, surgery (tricky). Without such a tube there is little a surgeon can do except to convert it to an open pneumothorax [204A] and treat that. There is a risk that damaged or scarred lung tissue need to be removed to allow the pneumothorax to heal. Lesser traumas do not have this risk but the risk is 10% for grievous trauma, 20% grim trauma and 30% for mortal trauma. The result of the surgical removal of lung tissue will determine how badly the patients stamina is affected. If the operation fails it must be attempted again to heal the pneumothorax. Every time the surgeon fails the characters constitution suffers and may become chronically winded or even exhausted in extreme cases. For exceptional failures the character will most likely die unless another surgeon is on hand to make an heroic save and even so the lung will be lost leaving the character chronically winded at best.

Grievous

Tension pneumothorax. Pressure builds quickly leading to shock. Every fifteen minutes roll shock with difficulty starting at easy but increasing by one degree every time. Any straining physical exertion means an extra shock roll. Infection [200A] Hemothorax [204C] Severe tension pneumothorax. Shock risk as above but roll and increase difficulty every ten minutes. Infection [200A] Complications Hemothorax [204D] Complications Massive tension pneumothorax. Shock risk as above but roll and increase difficulty every five minutes. Complications Infection [200A] Hemothorax [204C]

Grim

Mortal

Diagnosis

Modern: Medieval: Futuristic: Spell:

Examination (easy) Examination (easy) Examination (easy) Healing Vision

204C Hemothorax
A hemothorax is a collection of blood between the lung and chest wall that makes breathing harder. It is similar to a pneumothorax [204B] except that it is blood instead of air which is doing the compressing of the lungs and putting pressure on the heart and other structures in the chest. 95

The blood collecting in the chest comes of course from internal bleeding in the chest. Either directly from an injured heart or from any of the blood vessels in the chest. A common source of significant and persistent bleeding are branches of the internal mammary artery, also known as the internal thoracic artery. It branches off from the subclavian artery and travels beneath the ribs in the chest. Heart injury produces hemothorax if communication exists between the pericardium and pleural space. Pulmonary injury may cause hemothorax, but is usually self-limited because the pulmonary vascular pressure is low. It is more likely to develop into a pneumothorax. Because the chest cavity has room enough for more or less all the blood in the body it is possible to bleed dry with no external evidence of blood loss. Shock will of course kill long before this happens and because the blood takes up lung space breathing becomes difficult making it even worse. Clotting and the resultant chemical reactions can make the volume increase even after the bleeding has stopped.
Symptoms

lung developing is the same as for the empyema developing in the first place.
Diagnosis

Modern: Medieval: Futuristic: Spell:

Examination (hard) Scan (tricky) Examination (hard) Examination (hard) Hightech Scan (easy) Healing Vision

Diagnosing a hemothorax is difficult mostly because the associated trauma masks symptoms.
Surgery

Modern:

Intercostal Incision (tricky) Close Wound (easy) Reopening for cleaning (tricky) Suction Tube Drainage (tricky) A suction tube will not normally be available, but the other forms of surgery are potentially possible, although likely more difficult with primitive tools. Hightech surgery will usually be one degree lower difficulty. Bloodmagic I (some), Bloodmagic II (moderate), Bloodmagic III (heavy), Bloodmagic IV (massive), Cleanse II (remove clotted blood)

Symptoms are usually masked by the damage that caused the hemothorax but shortness of breath and shock can both indicate a hemothorax.
Risks

Medieval:

The primary risk of the hemothorax depends on the amount of bleeding. Blood fills the pleural space. This interferes with breathing increasing the risk of shock from a combination of blood loss and reduced circulation. Halve the time before shock from blood loss occurs and even with moderate bleeding shock occurs after about thirty minutes. Bacterial contamination of the retained blood can lead to a special form of chest infection known as empyema. Treat as any other chest infection [200A] but one that cannot get better if not treated by removing the retained blood and draining away pus. Check for empyema about one week after the hemothorax occurred. The chance of empyema developing 10% for moderate bleeding, 20% for heavy bleeding and 40% for massive bleeding. If the blood collected in the chest is left untreated for a week it can result in a trapped lung. This is known as fibrothorax as it is the fibrin in the blood which sticks to the lung and traps it. So trapped, it is unable to fully expand leading to a reduction in pulmonary function. This reduces constitution by one. The chance of a trapped

Futuristic: Spell:

The surgeon can either create an incision between the ribs (intercostal incision) to drain away the blood or close the wound. The first method of creating an incision carries a significant risk of creating a life threatening sucking chest wound. The benefit of this method is that it halves the risk of an empyema infection or trapped lung. A marginal failure simply means the surgeon failed to drain all the blood and the result will be the same as for a failure when closing the wound right away below. A normal failure, however, punctures the lung leading to an open pneumothorax [204A] with the severity of a nasty wound. An exceptional failure leads to a tension pneumothorax [204B] with the severity of a trauma of a grievous wound. 96

The second method of closing the wound right away allows internal pressure to help stop the bleeding. This halves the time before bleeding stops, remembering that it was initially doubled by the hemothorax. However it does nothing to reduce the risk of empyema infection and possibility of a trapped lung. The surgeon can of course do both. First drain the blood through the wound and if the bleeding persists the wound is closed in the hope that the pressure in the chest will help halt the bleeding. If the bleeding stops the wound is reopened several days later (up to a week), to remove clotted blood and fluids that have built up in the cavity. This reopening is necessary to reduce the risk of infection (empyema) and the lung becoming trapped. Reduce the risk by about one third. If possible the best solution is drainage with a suction tube. Also it should be noted that sharp ends from rib fractures may need to be filed down and softened to prevent further injury.

Symptoms

Redness around the injury turns purple from the blood of ruptured vessels along with tenderness, swelling and pain. If the trauma is a grim or worse wound the symptoms also include shortness of breath, pain when breathing and it is possible to feel a defect in the fracture area.
Risks

When the sternum is broken there is a great risk that the heart has also been bruised [202A] or penetrated [202B]. Because the force required to damage the sternum is so great there is also more than likely further problems such as a cardiac tamponade [202D], hemothorax [204C] or a punctured lung [204B]. Since all these risks occur at the time of the injury they are dealt with in the trauma table. Otherwise the GM must determine complications randomly depending on the force of the impact.

205 Windpipe
Trachea The trachea is the windpipe. It continues from the throat [110] down to above the heart where it divides to each lung. It lies in front of the esophagus, but behind arteries, veins and the breastbone (sternum).

205A Damage to Windpipe

Because of its position behind the breastbone it is unlikely to get damaged. However if it does the victim will choke same as for the same injury in the throat [110A].

206 Breastbone
Sternum Flat bone on the front of the chest, between the ribs, protecting the heart.

206A Broken Breastbone

The breastbone is a massive bone that is very hard to break. However, it is very dangerous when it does break as it may be driven into the heart behind it.

97

Diagnosis

Modern:

Examination (hard) X-Ray (tricky) Examination, grim (tricky) X-Ray, grim (tricky) Examination (hard) Examination, grim (tricky) Examination (hard) Hightech Scan (tricky) Examination, grim (tricky) Hightech Scan, grim (easy) Healing Vision

specified at the time of injury the main risks are contusion [202A] or penetration [202B] of the heart. Cardiac tamponade [202D], hemothorax [204C] and punctured lung [204B].
Diagnosis

Medieval: Futuristic:

Modern: Medieval: Futuristic: Spell:

Examination (tricky) X-Ray (tricky) Examination (tricky) Examination (tricky) Hightech Scan (easy) Healing Vision

Spell:

Diagnosis of a broken sternum can be difficult because the sternum can be painful and tender for a long time even when it is not fractured but only bruised.
Treatment

Like a broken breastbone a flail sternum can be difficult to correctly diagnose because the sternum can be painful and tender for a long time even when it is not fractured but only bruised.
Treatment

Although seldom broken without massive damage to the surrounding area, the breastbone itself usually heals straightforward and can be treated as a normal closed fracture [1A]. It is splintered by strapping of the chest and sternum to hold the fracture still and so ease the pain when breathing. However, if the wound is grim or worse the breastbone is badly displaced and requires surgery to reduce the displacement and fix the ends together. Treat this as a malunion that needs resetting as described under closed fracture surgery [1A]. Failure to do so results in a permanent impairment of 1D. The longer it is left, counting in months, the more difficult any surgery will be.

Splintering can be done by strapping fractured ribs to relieve pain when breathing. This doubles the risk of pneumonia because it impedes breathing. Which means the lungs are not properly cleaned out. Any treatment is usually for underlying lung or heart damage and to allow adequate oxygenation and drainage of blood or pus. The fracture itself will usually heal on its own. However, if the wound is grim or worse the breastbone is badly displaced and requires surgery to reduce the displacement and fix the ends together. Treat this as a malunion that needs resetting as described under closed fracture surgery [1A]. Failure to do so results in a permanent impairment of 1D. The longer it is left, counting in months, the more difficult any surgery will be.

206B Flail Sternum

Multiple fractures of the sternum result in a free floating and unstable segment.
Symptoms

207 Ribs
Rib pairs run down the length of the chest protecting the lungs and other underlying organs. They easily break but also heal easily. The greatest problem is the danger of internal bleeding and injuries to the organs under the ribs. Those are the lungs spleen and liver.

Pain and tenderness. Breathing pain and shortness of breath, often with rapid breathing and a high heart rate.
Risks

A flail sternum takes a long time to heal and requires rest. Triple the basic healing time. There is a 10% chance of Pneumonia [200E] developing as a result of flail sternum. Any force strong enough to fracture the sternum is likely to produce severe damage to underlying organs. Usually

98

207C Fragmented Ribs

One or more ribs are splintered into fragments. Usually resulting in serious damage to underlying parts. This should be treated as a normal fragmented bone [1C]. If not treated properly there is no permanent impairment but a risk of rib fragments puncturing a lung [204B] and chronic chest pains. The lung may be punctured as a result of any future blows to the chest. The risk is 5% for superficial blunt chest trauma, 10% nasty trauma, 15% grievous trauma, 20% grim trauma and 25% mortal blunt chest trauma. There is also a 1% risk for lesser chest impacts or if heavy pressure is applied to the chest.

207D Shattered Ribs

The ribs are completely shattered probably resulting in lethal damage to underlying tissue. If survived the shattered ribs can be treated as any shattered bone [1D]. There will likely be many complications of having pieces of ribs floating around in the chest cavity. Since the associated injuries are unlikely to be survived it is left up to the GM to work out the details if the character actually lives.

207E Flail Chest 207A Simple Rib Fracture

Single break in one or more ribs.
Symptoms

Multiple fractures of the ribs result in a free floating and unstable segment. Flail chest is the result of a severe blow and a common serious injury to the chest.
Symptoms

Pain when breathing and swelling.

Risks

Pain and tenderness. Breathing pain and shortness of breath, often with rapid breathing and a high heart rate. The affected chest segment appears to move in the opposite direction of the rest of the chest when breathing.
Risks

None.
Treatment

A flail chest takes a long time to heal and requires rest. Triple the basic healing time. There is a 10% chance of Pneumonia [200E] developing as a result of flail chest. Hemothorax [204C] and punctured lung [204B] are not uncommonly found with flail chest. This will normally be specified at the time of the injury. They can however also occur later as a result of the character being moved or performing some action. The sharp edges of the broken ribs may cut a blood vessel or puncture a lung. The risk will gradually decrease as the flail chest heals and is greatest the first three weeks. Careful actions and gentle handling will not require a roll but for normal ac99

Strapping fractured ribs to relieve pain when breathing. No further treatment is necessary.

207B Open Rib Fracture

Compound Rib Fracture An open wound exposes the fracture. This has the same increased risk of infection and method of treatment as for any open fracture [1B]. However any infection will likely be a chest infection [200A].

tions and handling the initial risk is 15%. For harsh or careless actions and handling the initial risk is 30% and if downright violent or malicious the initial risk is at least 50%. If the roll is below the percentage there is a fifty-fifty chance which complication occurs.
First Aid

failure to heal correctly and chronic pain, deformity and permanently reduced function of arm.
Diagnosis

Modern: Medieval: Futuristic: Spell:

Examination (tricky) X-Ray (easy) Examination (tricky) Examination (tricky) Hightech Scan (easy) Healing Vision

Strapping fractured ribs to relieve pain when breathing can be done. This doubles the risk of pneumonia because it impedes breathing. Which means the lungs are not properly cleaned out.
Treatment

Any treatment is usually for underlying lung or heart damage and to allow adequate oxygenation and drainage of blood or pus. The fracture itself will usually heal on its own and can be treated as a normal closed fracture [1A]. However, if the wound is grim or worse the flail chest is badly displaced and requires surgery to reduce the displacement and fix the segments together. Treat this as a mal-union that needs resetting as described under closed fracture surgery [1A]. Failure to do so results in a permanent impairment of 1D. The longer it is left, counting in months, the more difficult any surgery will be.

Treatment

The scapula will often heal on its own with immobilisation using a sling, but damage to the scapula usually means the injury is very serious and there may be further damage. A sling should usually be worn for 2 to 4 weeks, but it can otherwise be treated as a normal closed fracture [1A]. However, if the wound is grim or worse the shoulder fracture is badly displaced and requires surgery to reduce the displacement and fix the segments together. This often requires the use of plates and screws to hold the scapula together. Treat this as a mal-union that needs resetting as described under closed fracture surgery [1A]. Failure to Immobilise the arm or surgery in the case of grim or worse injury will result in chronic pain, deformity and a permanent 1D impairment when using the affected arm.

208 Shoulder Blades

Scapula Two triangular, flat bones in the upper back forming the shoulder joint with the humerus of the upper arm.

208B Flail Shoulder

Scapulathoracic Dissociation In this very uncommon trauma the scapula is pulled away from the thorax, seriously damaging muscular, vascular and nervous components of the shoulder and arm.
Symptoms

208A Shoulder Fracture

Scapula Fracture The scapula is very mobile and padded by thick muscles and so seldom broken.
Symptoms

Extreme pain when moving arm and in the upper back as well as tenderness and swelling.
Risks

Decreased pulse in arm, loss of sensation and use, as well as severe pain.
Risks

As high force is required to fracture the scapula it is nearly always accompanied by other severe injuries to the head, chest or abdomen. Extreme pain makes use of arm more or less impossible. Ignoring the pain and using the arm anyway will result in

Loss of sensation and motor function to the shoulder and arm. The arm cannot be used without restoration surgery to repair the damage. There is also a risk that the damage is too great and insufficient blood supply will result in tissue dying and the 100

arm developing gangrene [4B]. The risk is 10% for grim trauma, 20% for mortal trauma and 1% for any lesser trauma.
Diagnosis

210 Bronchial Injury

Laceration, tear or other disruption of a major bronchus. Similar to tracheal injuries and just as deadly.
Symptoms

Modern: Medieval: Futuristic: Spell:

Examination (tricky) X-Ray (easy) Examination (tricky) Examination (tricky) Hightech Scan (easy) Healing Vision

See tracheal injuries [110A].

Treatment

Requires surgical repair as for tracheal injuries [110A] but the operation is much more difficult and unlikely to succeed. Usually severe or worse.

211 - Pulmonary Contusion

Surgery

Modern: Medieval: Futuristic: Spell:

Amputation (easy) Stabilise shoulder (severe) Amputation (easy) Stabilise shoulder (extreme) Amputation (easy) Hightech Surgery (tricky) Regrow III

The smallest vessels in the lungs (microvasculature) burst and blood and other fluids invade the tissue. Can be caused by any sharp object or by rib lacerations.
Symptoms

Takes 1D12 hours for symptoms to appear. Then shortness of breath, often with rapid breathing and a high heart rate.
Risks

Amputation above elbow may be needed if blood supply to arm is insufficient and gangrene sets in. If limb remains viable surgery may restore shoulder stability but this is a severe operation at best. If surgery is successful it will heal correctly but triple basic healing time. Otherwise severe pain, loss of sensation and loss of motor function in the arm leaves amputation the only solution.

The greatest risk is the development of ARDS [212]. On day three there is a 50% chance of ARDS developing. Internal bleeding is often associated with pulmonary contusion.
Diagnosis

Modern: Medieval:

Examination (severe) Scan (tricky) Examination (severe) Examination (severe) Hightech Scan (easy) Healing Vision

209 Traumatic Asphyxia

This rare condition is caused from a severe crushing blow. The face swells up like a moon due to lack of oxygen and bleeding. It is an indication of nasty trauma to the torso or head that may require surgical intervention.
Symptoms

Futuristic: Spell:

Diagnosis is difficult and severe from physical examination alone.

Treatment

Swollen, moonlike face.

Treatment

No special treatment needed as condition will resolve on its own if the underlying injuries it indicates are treated. Elevation of head will speed the process.

Pulmonary contusions will usually resolve in 3 to 5 days. Treatment consists of keeping breathing stable and ideally supplementing with oxygen. Supplementing with oxygen and good treatment may reduce the risk of ARDS anything from a few percent to more than halving the risk. 101

212 ARDS
Acute Respiratory Distress Syndrome Not a specific disease but a type of severe lung dysfunction. It most commonly results from pneumonia, sepsis and trauma where internal lung damage or infection results in significant inflammatory reaction. It may start in one lung but quickly spreads to affect most of both lungs. The lungs are damaged making it difficult for them to absorb oxygen and get rid of carbon dioxide. As it progresses so does the risk of complete respiratory failure. As it continues over the next several days the lungs fill with inflammatory cells. Scar tissue starts forming in the lungs after about ten days and can keep spreading for up to three weeks. As it spreads it interferes with the lungs ability to exchange oxygen and carbon dioxide.
Symptoms

Treatment

Modern: Medieval:

Only care and life support. Only general care while the patient fights for survival
Drugs or nanobots to halt ARDS Lung Transplant (tricky) Artificial Lung (tricky) Regrow III

Futuristic:

Spell:

Death from ARDS is likely without life support but some hardy individuals may be lucky enough to survive on their own with only basic treatment. If the roll was failed and the character is kept alive on life support he will be unconscious most of the time but may awaken in a delirious state for short periods. Each day on life support he must make an attribute roll. The difficulty depends on the care and can range from severe for no care besides the life support to easy for professional hospital care with good medication. Failure results in heart attack [202C]. If the character is revived and survives the incident he will need to keep making the rolls each day but with the difficulty increased by one. If the character survives 3 x 1D10 days on life support the condition will start to improve and no further rolls are needed. After a few more days life support is no longer needed and the character will recover. If the character survives it will take 5 + 1D10 months to fully recover. In some cases a full recovery is not possible without a lung transplant. Weakness and shortness of breath means the character is chronically winded with fatigue.

Severe shortness of breath, often resulting in respiratory failure.

Risks

The main risk is respiratory failure. From the very first day make an attribute roll, typically Spirit, each day. The difficulty starts at easy but increases by one every other day. The difficulty will stop increasing once it reaches hard. It will stay at hard for another 1D10 days after which time it will start to decrease in difficulty at the same rate as the character starts to recover. Once it reaches easy there is no further risk of respiratory failure. If the roll fails at any stage the lungs are not able to circulate enough oxygen. The character loses consciousness and awakens periodically in a delirious state. The condition gradually deteriorates and respiration fails completely in 1D10 hours. Unless the character is placed on life support (mechanical ventilation) he will suffer the effects of suffocation [100B]. Other common complications are pneumonia [200E] developing from bacteria thriving in the blood in the lungs and punctured lung [204B] resulting from the weakened lungs. Roll 1D100 once each day until recovered. If the result is 1-2 it results in a punctured lung. If it is 3-5 pneumonia develops.

102

Abdomen
The abdomen is the reason why man does not easily take himself for a god - Friedrich Wilhelm Nietzsche The liver is on the right side just under the chest. The spleen is on the left side. The two kidneys lie on each side of the spine and are connected to the bladder in the pelvis. The pancreas is a broad and soft tissue stretching between the kidneys.

Great Vessels
Two huge blood vessels, the aorta and vena cava, lie in front of the spine.

Vital Structures
Extending from the stomach, the intestines are coiled up inside the abdomen all the way down to the anus. The diaphragm is a muscle separating the thoracic cavity from the abdominal cavity. It is critical for respiration.

Skeleton
The pelvis and lower spine are the only parts of the skeleton located in the abdomen.

300 Peritoneum
Abdominal lining A membrane lining the abdominal cavity. It protects and lubricates the abdominal organs to reduce friction when they move around.

Anatomy
Here the abdomen is the area between the chest (thorax) and down to and including the pelvis. The chest and abdomen is separated by a muscle called the diaphragm. The abdomen is protected in the rear by the spine (backbone), massive blocks of muscles on each side and a thin sheet of muscles in the front. The abdomen is lined with a thin, slippery membrane called the peritoneum. It protects the organs by reducing friction. Injuries or surgery in the abdomen are often fatal because they cause peritonitis [300A].

300A Peritonitis
If punctured or torn the peritoneum heals quickly but the risk of life threatening infection is very high. Peritonitis is an inflammation of the peritoneum resulting from bacterial infection usually resulting from penetrating trauma or surgery. Any damage, even blunt trauma, that causes leaks from the intestines may also cause peritonitis.
Symptoms

Vital Organs
The stomach lies directly under the chest and continues down into the intestines.

Severe abdominal pain, swollen stomach, nausea, vomiting and cramps. A light fever [12A] develops into a more severe fever [12B] after about 2 days which stays with the character until he recovers.

103

Risks

Diagnosis

Without treatment peritonitis develops quickly. After about 20 hours the symptoms start growing quite severe and the first shock roll must be made against easy. Every ten hours after that the difficulty is increased by one and shock must be rolled again. If the source of the infection remains the character cannot start to recover. The source may be a perforated internal organ, such as the stomach or intestines, that keeps discharging bacteria and foods into the abdomen. It may be dead tissue or it may be a foreign object stuck inside the body. However, if there is no such source, or it is removed, the character may be lucky enough to recover. As the inflammation gets worse and the danger of shock increases so does the chance that the body will be able to defeat the infection. After each shock roll also make a recovery roll. Make it the same attribute roll as the shock roll but the difficulty starts at extreme and only decreases one level every twenty hours. A successful roll means the character has fought off the infection and starts to gradually recover with no further need for shock rolls. If the character survives more than 90 hours the shock difficulty will stay at insane and the recovery at tricky until he either recovers or dies from shock. Hours 20 30 40 50 60 70 80 90 Every +10 Peritonitis Progression Shock Recovery Easy Extreme Easy Extreme Tricky Severe Tricky Severe Hard Hard Severe Hard Extreme Tricky Insane Tricky Insane Tricky

Modern: Medieval: Futuristic: Spell:

Examination (see below) Examination (see below) Examination (see below) Healing Vision

Peritonitis is usually expected after penetrating trauma to the abdomen, and either watched for or treated with antibiotics even before symptoms appear. Trying to diagnose peritonitis in the first 20 hours before symptoms appear is insane. Once symptoms appear the difficulty drops to tricky. Continue lowering the difficulty and allow a new attempt every ten hours.
Treatment and Surgery

Modern: Medieval: Futuristic:

Antibiotics Abdominal Surgery (tricky) Abdominal Surgery not possible in a lowtech society. Powerful antibiotics, ointments and possibly nanobots or friendly bacteria will exist to cleanse the infection. Purify II

Spell:

Without treatment peritonitis is nearly always fatal. Treatment consists of antibiotics for the infection and surgery to repair any damage and possibly remove infected tissue. The latter usually requires a successful CT or MRI diagnostic scan of tricky difficulty or equivalent to locate the infected tissues. If there is internal damage, foreign material or dead tissue which acts as a source for the infection the character can only recover with the help of surgery. The difficulty will of course depend on the surgery required. The treatment will slow the progression of shock. Depending on the treatment, the interval between each shock roll, and increase in difficulty, is increased by a number of hours. The recovery roll is unaffected which effectively improves the chance of recovery. The table below gives some examples.

In addition there may be other complications. Each time a shock roll is made, regardless of the outcome, also roll 1D100 for complications. Peritonitis Complication Risk Complication 1D100 1 - 90 None 91 95 Sepsis [4E] 96 99 Blood Poisoning [4F] 100 Bone Infection [4G] The onset of sepsis will of course accelerate the risk of shock greatly which makes recovery very unlikely. See sepsis [4E].

104

Treatment Effect Treatment Shock Progression Weak Antibiotics +5 hours Powerful Antibiotics +10 hours Marginally Successful Surgery +5 hours Normal Successful Surgery +10 hours Exceptionally Successful Surgery +20 hours There is no way to halt the onset of shock except to cure the peritonitis with antibiotics and surgery, and hope the character will recover before he dies from the effects of shock [3]. Keep rolling for recovery every ten hours even after a failed shock roll. With care there is some hope as the shock normally progresses one stage only every ten hours depending on the treatment of the character of course.

couple of litres a day is required. Both more water and salt is needed in hot climates. With enough water the condition improves in 4 + 1D10 days. Some amoeba can cause more havoc because of the ability to burrow through the intestinal wall and so spread to other places in the body. If the dysentery lasts for 10 or more days roll 1D100. On 1-5 it reaches the brain. The severity of the damage should be determined randomly and can range from minor brain damage [105B] to death barring advanced medical intervention. On 6-10 it causes peritonitis [300A]. On 11-20 it damages the liver with the same lethal results as for a torn liver [306A]. Otherwise the character has got away easy from a potentially very deadly condition.
Diagnosis

300B Bowel Gangrene

Gangrene in the bowels is the most fatal type of gangrene. See gangrene [4B] and necrotizing fasciitis [4C] for details.

Modern: Medieval: Futuristic:

Examination (see below) Examination (see below) Examination (see below) Healing Vision

300C Dysentry
Inflammation of the large intestine lining. Bacteria or amoeba enters the body through the mouth in food, water, faeces or from contact with infected people. Lack of sanitation with men living closely together in poor conditions and unclean water is the perfect condition for dysentery. Because of this dysentery often occurs among soldiers in wartime. Meats and other hard to digest foods in hot climates can also cause dysentery Dysentery is very contagious. Anyone living or associating with an infected individual risks catching dysentery every day. The percentage risk depends on the hygiene and how close the characters live.
Symptoms

Spell:

Diagnosing dysentery can be anything from easy to tricky depending on how much of the characters history and symptoms are known.
Treatment

Spell:

Purify III

The most important thing is to replace lost water and salts. With a careful diet of helpful oils, milks and juices, and gradually allowing more and more food, the dysentery can be tolerated better.

Stomach pains and diarrhoea, often with blood. Sometimes vomiting and fever.
Risks

301 - Abdominal Vessels

The main artery supplying blood to the lower body is the continuation of the Aorta from the chest. It runs through the abdomen before splitting into the two iliac arteries. The vena cava is the main vein carrying blood back to the heart. Both lie in front of the spine.

The constant diarrhoea causes loss of important salts and fluids causing fatal dehydration. If the lost fluids and salts are not replaced the dysentery can be lethal. If not enough water is available to replace the lost water the character will grow weaker. Eventually the unconscious character will die from acute kidney failure [305A], heart attack [202C] or accumulating brain damage [105]. Which fails first can usually be decided randomly. Old or very young will be more susceptible. It is left to the GM to decide if enough water is consumed but at least a

301A Great Vessel Tear

An incomplete tear of the aorta or any great vessel is survivable with prompt surgical repair but untreated eventually leads to the same death as for a rupture [202B]. 105

Symptoms

Symptoms

Unless there is a hole in the abdomen from where the blood can escape the bleeding is not immediately obvious but legs and then rest of body may soon feel cold. As the bleeding is usually heavy or massive shock soon follows.
Surgery

Severe abdominal pains and fever from the peritonitis.

Risks

Peritonitis [300A] is the big killer of a perforated stomach.

Diagnosis

Modern: Medieval:

Field Surgery (hard) Hospital (tricky) Surgery is usually not possible in the abdomen due to infection risk, but if performed is usually hard or worse. Hightech Surgery (tricky) Bloodmagic III (heavy), Bloodmagic IV (massive)

Modern: Medieval: Futuristic: Spell:

Scan (tricky) Exploratory surgery only Hightech Scan (easy) Healing Vision

Futuristic: Spell:

Surgery is necessary to close the artery or replace damaged parts with artificial tubes. Difficulty depends on severity, but is at the very least tricky and often hard or worse. Depending on the damage and equipment available.

A scan is usually needed to diagnose a perforated esophagus, although a penetrating injury in the abdomen near the stomach may indicate a high risk and justify exploratory surgery to repair any damage.
Surgery

Modern: Medieval:

301B Great Vessel Rupture

With a complete tear or rupture blood rushes into the abdomen, leading to exsanguination and death in minutes. This happens the most quickly for the massive aorta which pumps blood directly from the heart. Shock quickly sets in.

Repair (tricky) Clean Spilled Food (tricky) Surgery is usually not possible in the abdomen due to infection risk, but if performed is usually hard or worse. Hightech Surgery (easy) Regrow II (heal stomach), Cleanse III (clean spilled food)

Futuristic: Spell:

302 Stomach
The stomach is the sac between the esophagus which brings food from the mouth and the intestines. The stomach breaks down the food using acidic gastric juices to dissolve it. It absorbs some substances and passes the food on to the small intestines. Stomach injuries usually result from penetrating trauma, although severe blunt trauma can also damage the stomach.

Treatment usually consists of closing the perforation and cleaning out any food that has spilled into the abdominal cavity. The surgery is of tricky difficulty if there is no significant spillage. However, if the character has recently eaten a large meal, or been eating and drinking since the injury, the difficulty is at least tricky and often worse even with good surgical equipment. Successful surgery allows the character a chance to recover from the peritonitis, although it is far from certain. See peritonitis [300A].

302A Perforated Stomach

If the stomach is punctured bacteria and partially digested food spills into the normally sterile abdominal cavity of the peritoneum [300]. This invariably causes peritonitis [300A].

302B Ruptured Stomach

A ruptured stomach has either burst from a blunt blow or been cut wide open. In either case the stomach can no longer function and the bacteria and digested food that spills into the abdominal cavity cause peritonitis [300A]. 106

Symptoms

A dull pain that gradually spreads and becomes more intense. Sensitivity to any shaking or sudden movement, cramps and vomiting. Fever from the peritonitis.
Risks

forming the procedure on a badly ruptured stomach and cleaning out the resulting mess is at least hard. Even in a hospital setting.

Peritonitis [300A] is the big killer of a ruptured stomach.

Diagnosis

Modern: Medieval: Futuristic: Spell:

Scan (tricky) Exploratory surgery only Hightech Scan (easy) Healing Vision

A ruptured stomach is best diagnosed from a scan but the symptoms and a penetrating injury in the abdomen near the stomach may indicate a high risk and justify exploratory surgery.
Treatment

303 - Intestines
Gastrectomy (tricky) Gastrectomy Severe Rupture (hard) Gastrectomy is usually impossible. Hightech Gastrectomy (easy) Regrow III (heal stomach), Cleanse III (clean spilled food)

Modern: Medieval: Futuristic: Spell:

The intestines is the part of the digestive system between the stomach and anus. It is about 7.5 meters long as it coils down through the abdomen and is divided into the small and large intestine. The small intestine is six meters long, coiled in the centre of the abdominal cavity. The small intestine starts from the stomach, digesting the food until it reaches the large intestine. The large intestine is only 1.5 meters but much wider than the small intestine. The large intestine are often known as the colon. It absorbs the water into the blood and stores faeces.

To treat a ruptured stomach and allow the character a chance to survive the peritonitis [300A] the stomach must usually be removed. The surgical removal of the stomach is known as gastrectomy. It is possible to live without the stomach. The esophagus is connected to the intestines and digestion starts in the small intestines. The body adapts to this remarkably well although the diet usually needs to change. Several smaller meals must be consumed with more protein and less sugar. Gastrectomy does lead to B12 vitamin deficiency and so it must be supplemented or will eventually lead to anaemia [2B]. The surgery itself is done by making an incision just below the breastbone to the navel. Clamps are placed on the esophagus and intestines as required and the stomach is removed. The esophagus is then connected to the intestines. The procedure takes from one to three hours and is of tricky difficulty in a hospital setting. However, per-

303A Intestinal Tear

The intestines are torn or cut causing digested food and bacteria to contaminate the abdominal cavity and causing peritonitis. If the abdomen is cut the intestines may partially spill outside the body.
Symptoms

At first no obvious symptoms apart from pain and other symptoms to be expected from an abdominal wound. Peritonitis can be an indication but it can be a symptom of any trauma to the abdomen.

107

Risks

Peritonitis [300A] is easily the most dangerous and immediate complication and always results from an intestinal tear. The tear itself may heal but without surgery the character will die from the infection long before then as the body cannot fight it until the tear, which is the source of the infection, is healed.

Treatment consists of surgery to repair the damage. Failure to do so guarantees the characters death as the peritonitis can only get worse. The tear can be repaired with a bowel resection. An incision is made in the abdomen, the damaged part of the intestine is removed and the two ends are sewn together. Difficulty is usually tricky in a hospital setting but quickly becomes much harder if the right tools are not available.

303B Serious Intestinal Damage

The intestines are badly damaged and quite possibly completely severed in the process. If the abdomen is cut the intestines may partially spill outside the body.
Symptoms

At first no obvious symptoms apart from pain and other symptoms to be expected from an abdominal wound. Peritonitis can be an indication but it can be a symptom of any trauma to the abdomen.
Risks

Peritonitis [300A] is easily the most dangerous and immediate complication and always results. The intestines will not heal on their own and the body cannot fight the peritonitis until it is repaired.
Diagnosis

Diagnosis

Modern: Medieval:

Examination (tricky) Examination (tricky) Examination (tricky) Healing Vision

Modern: Medieval: Futuristic: Spell:

Examination (tricky) Examination (tricky) Examination (tricky) Healing Vision

Futuristic: Spell:

Surgery

Surgery

Modern: Bowel Resection (tricky) If a bowel resection is even possible it is likely at least hard. Hightech Bowel Resection (easy) Regrow II Spell: Medieval: Futuristic:

Colostomy (tricky) Artificial Intestine (hard) Colostomy is probably not possible and if it is likely at least severe. Hightech Colostomy (tricky) Artificial Intestine (tricky) Regrow III

Modern: Medieval: Futuristic: Spell:

108

Treatment consists of surgery to repair the damage. Failure to do so guarantees the characters death as the peritonitis can only get worse until the intestines are healed. A whole section of the intestines must be replaced artificially or a colostomy must be performed. A colostomy is an incision into the large intestine to create an artificial opening out through the abdomen. This opening serves as a substitute anus through which the intestines can eliminate waste. The waste is usually collected in a pouch. Difficulty is usually tricky in a hospital setting, but quickly becomes much harder if the right tools are not available.

Diagnosis

Modern: Medieval: Futuristic: Spell:

Examination (tricky) Examination (tricky) Examination (tricky) Hightech Scan (easy) Healing Vision

Diagnosing appendicitis is at least tricky as the symptoms are similar to many other disorders.
Surgery

304 - Appendix
Vermiform Appendix The appendix is attached to the first part of the large intestines and is about nine centimetres long. The appendix can be removed through surgery without any ill effects.

Modern: Medieval:

Appendicectomy (easy) Clean Burst Appendix (tricky) Appendicectomy is usually not possible and if it is likely at least hard. Hightech Appendicectomy (easy) Purify II (treat appendicitis before it bursts), Regrow III (heal burst appendix), Cleanse III (clean burst appendix)

Futuristic: Spell:

304A Appendicitis
Infection and swelling of the appendix due to increased activity of harmful bacteria. Usually happens when the appendix is partially or completely blocked by undigested food, because of infection and disease or even parasitic worms.
Symptoms

Pain and loss of appetite often followed with constipation or diarrhoea. As the condition gets worse nausea and vomiting are common. Finally a light fever [20A] develops and the pain becomes sharper in the lower right of the abdomen. A burst appendix results in extreme debilitating pain and a bloated stomach.
Risks

Appendicitis is best treated through surgery to remove the appendix, appendicectomy. The procedure is easy, but of course it does mean penetrating the peritoneum [300] which can easily lead to peritonitis [300A]. If the appendix has burst, a tube and drain must be inserted to drain the pus and antibiotics given. Failure to do so will result in peritonitis. Alternatively appendicitis can be treated with only antibiotics. However, any appendicitis treatment with antibiotics that is not of normal or better success will see it return in 1D12 months. Antibiotics only work before the appendix bursts. The difficulty depends on the strength of the antibiotic used. Powerful antibiotics is easy, while weak antibiotics is tricky.

Without treatment the appendix will most likely continue to swell until it bursts. This happens in roughly 1D10 days. When it bursts pus and bacteria are released into the abdominal cavity causing peritonitis [300A] unless immediate emergency surgery is performed along with antibiotics.

305 Kidneys
Renal; adjective which refers to the kidneys The kidneys are two small organs located on each side of the spine in the back. Shaped liked beans they are about 12 centimetres long and 6 centimetres wide. The size of a cupped hand. The two largest vessels, the aorta artery and the vena cava vein run along the spine between the kidneys. From either side of the aorta a very large renal 109

artery connects to each kidney carrying a quarter of the total blood circulating in the body. About 70 litres of blood flow through the kidneys an hour returning to the vena cava by the renal veins. The spleen, pancreas, stomach and upper part of the intestines lie in front of the kidneys and they are well protected from behind by muscles.

Without surgery traumatic renal failure is fatal. Every two hours since the trauma make a shock roll starting with a difficulty of easy but increasing by one each time. Renal failure from infection usually means the kidneys ability to function is reduced not stopped altogether. If the infection is cured the kidneys will usually recover enough in 1D12 days time for the character to survive. Death from infectious renal failure occurs 1D12 days after the renal failure started. If this period elapses before the kidneys have recovered, even if the infection is cured, the result is probably death. Treat as traumatic kidney failure from trauma. Dialysis can of course keep the character alive after failure. If the characters renal failure was less than 3 days from death when the character recovers the kidneys will fail again in 1D10 years due to their now reduced state. Only dialysis and a transplant can then save the characters life.

The kidneys filter the blood and pass waste on as urine into the bladder, as well as many other secondary functions, such as regulating blood pressure. The kidneys are most vulnerable to hard blows to the upper abdomen or back, and falls. They are also easily torn or cut by piercing attacks. A person can survive just fine with one healthy kidney.

Treatment

Survival rates for renal failure are not good. Dialytic treatment to remove waste and toxins not only requires a dialysis machine but also medical skill. Keeping the patient alive on dialysis is easy in the beginning but then gets harder every few months.
Surgery

305A Acute Kidney Failure

Acute Renal Failure Acute kidney failure is a sudden loss of both kidneys ability to function. It is usually a complication from an infection such as septicemia. It can also result from trauma that affects both kidneys. In short anything that disables both kidneys causes acute kidney failure.
Symptoms

Modern: Medieval: Futuristic: Spell:

Transplant (tricky) No surgery is usually possible. Hightech Transplant (tricky) Artificial Kidney (tricky) Regrow III (before failure) Regrow IV (after failure)

Initial symptoms are usually vague and little more than a general feeling of not being well. As the condition gets worse decreased urine output can be noticed, feet and legs swell, hands and feet lose sensation, tremors start in the hands, mood changes, nausea and vomiting with fatigue, foul breath and buzzing ears.
Risks

Transplant surgery is at least tricky, even under good conditions, and if the patients kidneys have already failed and he is surviving on dialysis the difficulty should be increased another level or two.

Traumatic kidney failure is usually fatal. With both kidneys destroyed or severely damaged the only hope comes from swift surgery and quite likely a kidney transplant. 110

305B Minor Kidney Damage

Grade 1-3 Renal Damage Superficial damage to the kidney causing swelling and bleeding.
Symptoms

305D Shattered Kidney

Grade 5 Renal Damage The kidney is torn into pieces from a high force impact or multiple penetration of the kidney. The kidney is no longer able to function and soon dies. Bleeding is massive.
Symptoms

Pain in the back as well as small amounts of blood in the urine often not detectable without analysis.
Risks

Pain in the back as well as large amounts of blood in the urine are the main symptoms.
Risks

There is no immediate danger from minor kidney damage aside from a surgeon who decides to operate anyway.
Treatment

The immediate risk is death from massive blood loss leading to shock. If the blood loss is stopped but there is no secondary kidney to take over for the now dead kidney it leads to acute renal failure [305A].
Surgery

No treatment is needed but this condition can be confused with more serious kidney damage and therefore prompt a dangerous and unnecessary surgical intervention.

305C Severe Kidney Damage

Grade 4 Renal Damage Deep damage to the kidney and the main renal artery or vein reduces the function of the kidney.
Symptoms

Modern: Medieval:

Stop Bleeding (tricky) No surgery is usually possible, but if allowed will be at least tricky. Hightech Stop Bleeding (easy) Regrow IV, Bloodmagic IV

Futuristic: Spell:

Pain in the back as well as blood in the urine, often not detectable without analysis.
Risks

The immediate risk is the blood loss which can be significant. The reduced function of the kidney means that it can not support the loss of the other kidney. If the other kidney is lost treat as a slow developing renal failure [305A], where shock rolls of increasing difficulty are made every month rather than every two hours.
Treatment

Emergency surgery must be performed to stop the bleeding. The surgery, which involves removing the destroyed kidney, is usually of tricky difficulty in a well equipped hospital but can be more difficult if the injury is especially messy.

305E Severed Renal Artery

Grade 5 Renal Damage The renal artery connecting the kidney to the bodies main artery, the aorta, is severed. Starved of blood the kidney quickly dies. The massive bleeding from the artery is usually fatal without treatment.
Symptoms

Spell:

Regrow III

Immediate surgery can improve the function of the kidney somewhat but is often not worth it because of the additional risk of the surgery itself. Monitoring vital signs and replacing lost blood is often the best treatment.

Unless the blood can escape through a penetrating wound the bleeding is not immediately obvious. There are no specific symptoms from the dying kidney but the blood loss leads to fatigue, cold legs and lower body and eventually shock. 111

Risks

The immediate risk is death from massive blood loss leading to shock. If the bleeding is stopped but the kidney is not reconnected it will die. If there is another healthy kidney this has no immediate consequence, otherwise it leads to acute renal failure [305A]. If the kidney dies, gangrene [4B] may develop if it is not removed. This happens if infection is indicated for the trauma.
Surgery

The liver is a very complex organ, more so in fact than the heart or kidneys. This makes making artificial livers and transplants especially difficult. Penetrating abdominal trauma commonly injures the liver and only the spleen is more vulnerable to blunt trauma. Loss of liver means death within 24 hours. A common sign of liver damage is jaundice, a yellowness of the eyes and skin. Jaundice is a result of the build up of a yellow breakdown product of the red blood cells.

306A Torn or Lacerated Liver

Field Surgery (hard) Hospital (tricky) Reconnecting (severe extreme) Surgery is usually not possible in the abdomen due to infection risk, but if performed is usually hard or worse. Hightech Surgery (tricky) Bloodmagic III (heavy), Bloodmagic IV (massive)

Modern:

Although well protected by the ribs the liver may still be torn by a heavy blow or lacerated by penetrating trauma.
Symptoms

Medieval:

Futuristic: Spell:

Tenderness on the upper right side of the abdomen and fractured ribs at the site are strong indicators of liver damage. If the liver does not recover jaundice develops.
Risks

Emergency surgery must be performed to stop the bleeding. Simply closing the bleeding and removing the kidney is tricky in a hospital and hard otherwise. Reconnecting the artery to save the kidney increases the difficulty by two. If the kidney dies and develops gangrene, the only hope for the character is to have the kidney removed, nephrectomy. See section on gangrene [4B] for treatment. The difficulty of the surgery is tricky in a hospital setting.

The liver bleeds terribly and even with prompt surgery survival is not guaranteed. Shock from the blood loss is the main cause of death.
Surgery

Modern: Medieval:

Stop Bleeding (tricky hard) Surgery is usually not possible in the abdomen due to infection risk, but if performed is usually hard or worse. Hightech Surgery (tricky) Bloodmagic III (heavy), Bloodmagic IV (massive)

Futuristic: Spell:

306 Liver
A wedge-shaped, spongy organ just under the chest, beneath the diaphragm and ribs. On the right side. It gets blood from two large vessels. One carrying oxygen-rich blood from the aorta, the other containing digested food from the small intestine. The liver is a digestion organ and the largest gland with many functions and essential to life. Its most important function is to maintain glucose levels in the blood. The brain keeps no stores and quickly dies if supplies from the liver is cut off. It filters harmful substances and toxins such as damaged blood cells, microbes, debris, ammonia, drugs and alcohol. It also produces the main substance of urine, makes amino acids, breaks down fats to produce cholesterol and stores vitamins and minerals.

Often the bleeding may stop on its own but without scanners to monitor the progress the safest approach may be immediate surgery. Once the character goes into shock the chances of successful surgery decreases as surgery always worsens and speeds up the effects of shock. Surgery on the liver is usually hard in a hospital setting. If blood transfusion is available the surgeon has more time and the difficulty can be lowered to tricky. In the case of marginal success the liver is too damaged to recover and the characters condition will deteriorate. In such a case only a transplant as described in treatment of a ruptured liver [306B] below may save the character. Because the liver is still partially functioning the decline 112

will be slow and gradual with death after 1D12 weeks of deteriorating health. The kidney itself is beyond normal surgery to repair but luckily it has a wonderful ability to regenerate given time.

307A Gall stone

A gall stone forms when the cholesterol or other parts of the bile crystallises into a stone-like material.
Symptoms

306B Ruptured Liver

The liver is ruptured and completely destroyed by a high force impact.
Symptoms

Pain and indigestion and so easily confused with stomach disorders.

Risks

The main problem with gall stones is the pain and disability it causes as well as intolerance to fatty foods.
Treatment

An impact with enough force to rupture the liver will usually cause extreme secondary damage as well, leaving the character unconscious and masking the damage from anything but exploratory surgery or scanners.
Risks

If troublesome a gall stone can be removed surgically together with the gall bladder in an easy operation. Losing the gall bladder means the digestion system is less able to digest fatty foods but this is not life threatening. It is possible to dissolve the stone with chemicals and other methods if available but this is at least hard and takes much longer.

The main cause of death from a ruptured liver is the massive blood loss which can kill in minutes. If the bleeding is stopped the loss of the liver means death in 24 hours anyway unless a replacement can be transplanted. Primarily due to lack of glucose for the brain but also due to rising levels of toxins in the body.
Surgery

308 Pancreas
A broad strip of soft tissue stretched across the back of the abdomen behind the intestines and stomach.

Modern: Medieval:

Stop Bleeding (tricky hard) Surgery is usually not possible in the abdomen due to infection risk, but if performed is usually hard or worse. Hightech Surgery (tricky) Artificial Replacement (tricky) Bloodmagic IV

It is primarily a digestive gland but it also produces insulin and glucagon which controls the use of sugar in the body. It is possible to live without a pancreas. This is similar to having diabetes [17] and insulin must be taken to regulate blood sugar and enzyme supplements taken to aid digestion.

Futuristic: Spell:

308A Damaged Pancreas

Stopping the bleeding [2] through emergency surgery is the immediate priority. If this is successful the function of the liver must be replaced with another liver or machine. The former is a tricky or hard operation in a hospital setting, while the latter is only a theoretical possibility in a futuristic setting. A heavy blow or deeply penetrating attack seriously damages the pancreas. The severity of the trauma needed to reach the pancreas usually means extensive damage to the region and a high mortality rate.
Symptoms

307 Gall Bladder

A pear shaped, green sac on the underside of the liver. It stores bile produced in the liver. After a meal the gall bladder contracts, squeezing the bile into the small intestines where it breaks down fat in the food.

A deep pain in the middle to upper stomach which radiates through to the back. Vomiting and a gradual spread of pain throughout the stomach as nearby organs are inflamed by the released enzymes from the damaged pancreas.

113

Risks

The organs surrounding the pancreas risk being autodigested by the pancreas enzymes. The leaking enzymes break down the fat and protein of the surrounding organs. The character is in effect digesting his own tissues. Although the pancreas will eventually heal the damage causes abdominal inflammation leading to peritonitis [300A]. There is an immediate 10% risk. Two more rolls must be made before the pancreas heals sufficiently. Each ten hours after the previous with the risk increased by 5% each time. These extra rolls can be avoided by surgically removing the pancreas. Any surgery may of course introduce its own risk of peritonitis. The damage to the pancreas reduces its function and the character now has to live with the effects of type two diabetes [17B].
Diagnosis

Unless the above surgery is attempted and succeeds the character must learn to live with type two diabetes [17B].

308B Mutilated Pancreas

A grim wound shreds or ruptures the pancreas, mutilating the organ beyond repair.
Symptoms

A deep pain in the middle to upper stomach which radiates through to the back. Vomiting and a gradual spread of pain throughout the stomach as nearby organs are inflamed by the released enzymes from the destroyed pancreas.
Risks

Modern:

Physical Examination (insane) Scan (hard) Surgical Exploration (easy) Physical Examination (insane) Hightech Scan (tricky) Healing Vision

The organs surrounding the pancreas risk being autodigested by the pancreas enzymes. The leaking enzymes break down the fat and protein of the surrounding organs. The character is in effect digesting his own tissues. Unless the pancreas is removed the characters health will deteriorate over the next 5 + 1D10 days. Ending in death as organs fail and from internal bleeding. More than likely peritonitis [300A] will kill the character first. There is an immediate 20% risk. Every ten hours it increases by 5% and another roll must be made until the pancreas is either removed or infection occurs. The rolls continue after the surgery but the risk is immediately reduced by 10% for every degree of success above marginal and it drops by 10% each time after that until it either reaches zero or infection occurs. The surgery may of course introduce its own risk of peritonitis. Since the pancreas is destroyed the character now has to live with the effects of type one diabetes [17A].
Diagnosis

Medieval: Futuristic: Spell:

The pancreas is usually treated secondary to most other serious abdominal injuries. Diagnosis can be difficult and only surgical exploration can determine severity and the best treatment.
Surgery

Modern: Medieval:

Removal (hard) Repair (severe) Not usually possible but removal may be possible, although likely severe or worse. Hightech Removal (tricky) Hightech Repair (tricky) Regrow III

Modern:

Physical Examination (insane) Scan (hard) Surgical Exploration (easy) Physical Examination (insane) Hightech Scan (tricky) Healing Vision

Medieval: Futuristic: Spell:

Futuristic: Spell:

Surgery can do little to treat a damaged pancreas although it may in some cases be able to repair the damage. The risk is that with significant failure, the mangled attempt mutilates the pancreas, destroying what function it had left. Treat as mutilated pancreas [308B]. On an exceptional failure the character will be lucky to survive at all.

The pancreas is usually treated secondary to most other serious abdominal injuries. Diagnosis can be difficult and only surgical exploration can determine severity and the best treatment.

114

Surgery

Risks

The main risk is death from blood loss.

Modern: Medieval: Removal (hard)
Surgery

Not usually possible but removal may be possible, although likely severe or worse. Hightech Removal (tricky) Artificial Replacement (hard) Regrow IV

Modern:

Futuristic: Spell:

Splenectomy (easy) Field Surgery, Stop Bleeding (hard) Hospital , Stop Bleeding (tricky) Surgery is usually not possible in the abdomen due to infection risk, but if performed splenectomy is usually tricky or worse. Hightech Splenectomy (easy) Hightech Stop Bleeding (easy) Bloodmagic II (moderate), Bloodmagic III (heavy), Bloodmagic IV (massive)

Medieval:

Since the pancreas is effectively destroyed the only treatment is to remove it. A difficult procedure due to its location. Failure to remove the pancreas is usually a death sentence. The character can live without the pancreas but will suffer from the effect of type one diabetes [17A].

Futuristic: Spell:

309 Spleen
The spleen is the most commonly injured organ in blunt abdominal trauma. A spongy organ full of blood the size of the heart and weighing just under a hundred grams in an adult. Located under the ribs behind the stomach on the left side. The spleen produces infection fighting white blood cells and filters out old and defective red blood cells as well as bacteria, viruses and other debris. In this way the spleen helps protect against infection. It can also act as a rudimentary blood reserve in emergencies. This last function is often more developed in carnivorous animals. It is possible to live without a spleen as most of its functions can be taken over by other organs. This will, however, make the character more vulnerable to infections, doubling all infection risks and increasing all resistance roll difficulties by one. As the most vascular organ of the body, 350 litres of blood passes through it every day and it is for this reason that damage to the spleen is easily fatal.

If the bleeding is not life threatening surgery may be avoided. If the bleeding is life threatening an easy operation may remove the spleen in a splenectomy. Less drastically, with the right equipment an operation of tricky difficulty may repair the damage by sewing the bleeding parts closed.

309B Massive Bleeding in Spleen

Grade 4 Spleen Damage Severe damage to spleen causes uncontrollable bleeding.
Symptoms

Symptoms vary widely. Some have no symptoms, while others may have a tender and swollen abdomen. Lightheadedness may develop as blood is lost.
Risks

309A Minor Spleen Damage

Grade 1-3 Spleen Damage Minor damage to the spleen causing considerable but not necessarily life threatening bleeding.
Symptoms

Bleeding is the primary cause of death. The possible loss of the spleen itself is not life threatening, although it does leave the character more exposed to future infections.
Diagnosis

Modern:

Physical Examination (severe) Scan (tricky) Surgical Exploration (tricky) Physical Examination (severe) Hightech Scan (easy) Healing Vision

Medieval: Futuristic: Spell:

Symptoms vary widely. Some have no symptoms, while others may have a tender and swollen abdomen. Lightheadedness may develop as blood is lost.

115

Diagnosing a damaged spleen is severe without advanced medical equipment or exploratory surgery.
Surgery

Diagnosing a damaged spleen is severe without advanced medical equipment or exploratory surgery.
Surgery

Modern: Medieval:

Splenectomy (easy) Repair (severe) Surgery is usually not possible in the abdomen due to infection risk, but if performed splenectomy is usually tricky or worse.

Modern: Medieval:

Splenectomy (easy) Surgery is usually not possible in the abdomen due to infection risk, but if performed splenectomy is usually tricky or worse. Hightech Splenectomy (easy) Artificial Replacement (tricky) Bloodmagic III (heavy), Bloodmagic IV (massive)

Futuristic: Futuristic: Spell: Hightech Splenectomy (easy) Hightech Repair (tricky) Spell: Bloodmagic III (heavy), Bloodmagic IV (massive)

As it is at least severe to repair the soft and spongy organ the best method is an easy splenectomy to remove the spleen surgically and seal off the blood vessels to stop the bleeding. The loss of the spleen has little effect on health, but doubles all infection risks and increases all resistance roll difficulties by one. A marginally successful operation or normal failure results in damage to one of the surrounding organs. The pancreas [308A] being the most common 50% and stomach [302A] 25% and intestines [303A] 25% occasionally.

The spleen cannot be saved. However, an easy surgical procedure called splenectomy removes the spleen and seals off the blood vessels to stop the bleeding. The loss of the spleen has little effect on health, but doubles the risk of infection. A marginally successful operation or normal failure results in damage to one of the surrounding organs. The pancreas [308A] being the most common 50% and stomach [302A] 25% and intestines [303A] 25% occasionally.

309C Ruptured Spleen

Grade 5 Spleen Damage Nearly always the result of a high force impact a ruptured spleen is completely destroyed.
Symptoms

310 Solar Plexus (celiac plexus)

The solar plexus is a cluster of nerve cells behind the stomach [302], below the diaphragm [315]. It controls functions of the abdominal organs such as the stomach and intestines. The solar plexus is not the only such cluster of cells in the body but is mentioned specially here because it is a well known location for a blow to disable an opponent. A hard blow to the solar plexus will usually disable a character as he bends over forward in great pain and struggling for breath. If the blow is powerful enough the character will end up unconscious. Any blow severe enough to damage the nerve centre will also damage other internal organs such as the stomach and diaphragm. Damage to the solar plexus will affect digestion and may stop the intestines functioning for a period or in extreme cases permanently.

The symptoms of the ruptured spleen are overshadowed by the surrounding damage and unconsciousness.
Risks

The massive bleeding is the primary cause of death. The loss of the spleen itself is not life threatening, although it leaves the character more exposed to future infections.
Diagnosis

Modern:

Physical Examination (severe) Scan (tricky) Surgical Exploration (tricky) Physical Examination (severe) Hightech Scan (easy) Healing Vision

311 Pelvis
The pelvis is a firm ring of bone with the sacrum at the centre. The tailbone is attached to the sacrum. The hip bones are part of the pelvis on each side meeting in the front at the pubis bone. The cavity of the pelvis is the lower part of the abdomen. The large intestines and the 116

Medieval: Futuristic: Spell:

bladder is located in this cavity. In females the uterus and vagina are also located here. The major blood vessels and nerves to the legs run along the bone in the pelvis. The pelvis bone is a strong bone and therefore hard to break.

A correct diagnosis will confirm that the fracture is stable.

Treatment

Treatment consists of stabilizing the fracture, rest and avoiding putting weight on the hip until the bone heals. Painkillers can reduce the pain and crutches or a walker can be used to move around.

311B Complicated Pelvis Fracture

Basically a pelvis fracture which has caused damage to internal organs. Treat as a pelvis fracture [311A] but also roll 1D100. In males 1-75 ruptures the bladder [314A], while in females 1-60 ruptures the bladder and 61-75 damages the uterus [315A]. For both on 76-85 it has caused an intestinal tear [303A]. 86-90 means the fractured pelvis has caused serious intestinal damage [303B]. 91-95 cuts the major nerves to a leg leaving it paralysed. 96-100 cuts the major artery leading to heavy internal bleeding [2]. Increase any surgery difficulty to treat the above complications by one to reflect the fractured pelvis bone getting in the way.

311A Pelvis Fracture

Avulsion Fracture This type of fracture is stable and will heal naturally without surgery.
Symptoms

311C Unstable Pelvis Fracture

This type of fracture is unstable and will not heal properly without surgery.
Symptoms

Severe pain, inability to stand, severe swelling and bruising.

Risks

The only risk is from characters who insist on moving about too early or without crutches. If not kept at rest the hip may not heal correctly. At best this may mean a permanent hobble, walking with a lame awkward movement and unable to move faster than an unsightly jog. At worst it may mean the hip is permanently unable to support weight and standing or moving without some form of crutch becomes impossible.
Diagnosis

Severe pain, inability to stand, severe swelling and bruising.

Risks

If not treated the fracture will not heal correctly and the character will end up with a permanent hobble, walking with a lame awkward movement and unable to move faster than an unsightly jog.
Diagnosis

Modern:

Physical Examination (tricky) Scan (easy) Surgical Exploration (easy) Physical Examination (tricky) Hightech Scan (easy) Healing Vision

Modern:

Physical Examination (tricky) Scan (easy) Surgical Exploration (easy) Physical Examination (tricky) Hightech Scan (easy) Healing Vision

Medieval: Futuristic: Spell:

Medieval: Futuristic: Spell:

117

A correct diagnosis will confirm that the fracture is unstable and that surgery is needed.
Surgery

In the last two cases increase the severity if the same complication is rolled. A second major nerve means both legs are paralysed. Two major arteries means massive internal bleeding and so on. Increase any surgery difficulty to treat the above complications by one to reflect the shattered pelvis getting in the way. The shattered pelvis must be treated separately. If not treated the character will not be able to walk or stand without using crutches and then only with difficulty.
Diagnosis

Modern: Medieval: Futuristic: Spell:

External Fixation (tricky) External Fixation (hard) if possible. Hightech repair may be able to heal bone pretty much instantly Regrow II

Treatment consists of stabilizing the fracture with an external fixator. After this traction may be required to pull the bones into position. Finally plates and screws of a biocompatible metal are used to hold the fracture together while it heals. They are not removed and so become a permanent part of the pelvis.

Modern:

Physical Examination (tricky) Scan (tricky) Surgical Exploration (tricky) Physical Examination (tricky) Hightech Scan (easy) Healing Vision

Medieval: Futuristic: Spell:

311D Complicated Unstable Pelvis Fracture

Same as a complicated pelvis fracture [311B] but with an unstable pelvis fracture [311C].

A shattered pelvis is usually quite obvious but correctly assessing the damage can be tricky with only a physical examination.
Surgery

311E Shattered Pelvis

A shattered pelvis has broken into several pieces and will not heal without reconstructive surgery. There is usually considerable bleeding and the character may never walk again. At least not properly and without pain.
Symptoms

Modern: Medieval: Futuristic: Spell:

External Fixation (hard) External Fixation (extreme) if possible. Hightech Surgery (tricky) Regrow III

Great pain, bleeding, inability to stand or move legs and physical deformity are some possible symptoms of a shattered pelvis.
Risks

Bleeding and associated injuries are usually the surgeons immediate priority as any trauma with enough force to shatter the pelvis will usually cause massive damage to the region. Roll 1D100 for complications. In males 1-50 ruptures the bladder [314A], while in females 1-40 ruptures the bladder and 41-50 damages the uterus [315A]. For both on 51-60 it has caused an intestinal tear [303A]. 61-65 means the fragmented pelvis has caused serious intestinal damage [303B]. 66-70 cuts the major nerves to a leg leaving it paralysed. 71-75 cuts a major artery leading to heavy internal bleeding [2]. On 76-90 roll twice for two complications and on 91-100 roll three times.

Surgical repair is hard as fragmented pieces must be literally put back into place and held in place using screws, plates and wires of biocompatible metal.

311F Pulverized Pelvis

A pulverized pelvis is the result of an extreme force and leaves the pelvis in a chaotic mess of bone fragments and splinters. It will obviously not heal without radical treatment and the character is unlikely to survive, much less walk again.
Symptoms

The trauma will usually leave the character unconscious, with massive bleeding and a clearly deformed pelvic area. 118

Risks

312A Ruptured Bladder

The bladder rests on the bone and can be torn with pelvis fractures. This is the main way the bladder is injured. A full bladder can also be ruptured by a blow to the abdomen and penetrating trauma can injure the bladder regardless. In either case urine spills into the peritoneal cavity causing peritonitis.
Symptoms

Bleeding and associated injuries are usually the surgeons immediate priority in order to save the characters life. The blow will likely cause serious damage to everything in the area, but if not specifically mentioned the following damage can be assumed. Ruptured bladder [314A], serious intestinal damage [303B]. There is a 50% chance that the major nerves of each leg have been cut leaving the leg paralysed. There will be at least heavy internal bleeding but a 10% chance it will be massive. In females there is also damage to the uterus [315A]. Increase any surgery difficulty to treat the above complications by one level to reflect the general mess of the area. The pulverized pelvis must be treated separately.
Diagnosis

The three most common symptoms is pain in the pubic area, large quantities of blood in the urine or an inability to urinate altogether.
Risks

Modern:

Physical Examination (hard) Scan (tricky) Surgical Exploration (hard) Physical Examination (hard) Hightech Scan (tricky) Healing Vision

The main risk is peritonitis [300A] from the spilled urine. Without surgery it is always fatal as the peritonitis will only get worse. With prompt surgery the character is likely to live. There is an immediate 10% risk of peritonitis. Make a new roll every day after that increasing the risk by 5% each time if no drainage is performed. If drainage is performed rolls are still made each day but the risk does not increase. Once the bladder heals or is stitched the risk of peritonitis will start to reduce. It is reduced by 5% each day if no drainage is performed or 10% if drainage is performed. Once the risk reaches zero there is no further danger of peritonitis.
Diagnosis

Medieval: Futuristic: Spell:

A pulverized pelvis is obvious, the really hard part is to correctly assess the damage.
Surgery

Modern: Medieval: Futuristic: Spell:

Repair (extreme) Repair is unlikely to be possible. Hightech Surgery (hard) Regrow IV

Modern:

Physical Examination (tricky) Scan (easy) Surgical Exploration (easy) Physical Examination (tricky) Hightech Scan (easy) Healing Vision

Medieval: Futuristic: Spell:

The difficult level for surgical repair is extreme and will require a skilled surgeon dedicating days and weeks of meticulously piecing the fragments together as best as possible. Anything but an exceptional success will leave the character with some disability, pain and probably require the use of crutches to limp around.

Surgery

Modern: Medieval: Futuristic: Spell:

Stitching bladder (tricky) Drainage (tricky) Repair is unlikely to be possible but will certainly be tricky or worse. Hightech Surgery (easy) Regrow II, Cleanse II (liquids)

312 Bladder
A flexible muscular bag collecting urine from the kidneys. It is located in the pelvis behind the pubic bone.

119

Surgery consists of drainage of the leaking urine and repairing the ruptured bladder. Failing to drain the urine will lead to peritonitis [300A] and eventually death. The bladder will heal on its own in 50% of cases and so it may not need to be stitched, although doing so will improve healing times. The pelvic drain should be kept in place until no more urine is leaking. If the bladder is not stitched but the character is lucky enough that it heals on its own this usually takes 1D6 days.

313C Damaged Ovaries

In addition to producing eggs, the ovaries produce female sex hormones. Since there are two, damage to one does not make the woman infertile. If both ovaries are damaged the woman becomes infertile. The damaged ovaries may also stop making hormones. If both ovaries are destroyed or removed this is the obvious result, otherwise if both ovaries are damaged there is a fifty-fifty chance of infertility. If the ovaries stop making hormones the woman has the symptoms of menopause, such as hot flashes and her period may become irregular or stop.

313 Reproductive Organs

Genitals, Groin The reproductive organs in men consist primarily of the penis and scrotum with the testes. In women of the vulva, uterus, fallopian tubes and ovaries The testes produce sperm to fertilise eggs produced in the ovaries. The fertilised egg grows into a baby in the womans uterus and is born after nine months.

313D Injured Scrotum & Testes

The scrotum is most often injured by a crushing blow but stab wounds and gunshots can also be the cause of the injury.
Risks

313A Uterus Trauma

Womb Trauma The uterus, also known as the womb, is about the size of a pear and connected to the two ovaries which release an egg every month into the uterus through the fallopian tubes. If the released egg is fertilised by a man it develops into a baby in the uterus. Otherwise it is shed along with the uterus lining, resulting in menstrual blood known as the period. If the uterus is damaged during surgery or from trauma fertility may be reduced or the woman could become infertile.
Spell: Regrow III

Since the testes inside the scrotum produce the sperm any injury to the scrotum and testes can leave the man sterile. The pain is severe and usually accompanied by nausea and vomiting.
Diagnosis

Modern: Medieval: Futuristic: Spell:

Scan (easy) Not possible to see if testes is functional. Hightech Scan (easy) Healing Vision

Ultrasound may show if the testes are damaged or intact.

Surgery

313B Major Uterus Trauma

Major Womb Trauma Same as uterus trauma [313A] but much more serious and high risk of infertility.
Spell: Regrow III

Modern: Medieval: Futuristic: Spell:

Repair (extreme) Repair is not possible. Hightech Surgery (tricky) Regrow III

Surgery can attempt to repair a damaged testes to restore fertility. The operation is unlikely to succeed except in the hands of a well equipped and skilled surgeon. 120

The nausea and bleeding inside the scrotum is usually not life-threatening. Ice, a jockstrap and drugs for the pain and nausea can help to tolerate the injury.

Surgery

Modern: Medieval: Futuristic:

Immediate Surgery (tricky) Microsurgery (tricky) Immediate Surgery (hard) Hightech Surgery (tricky) Hightech Microsurgery (easy) Nanosurgery (easy) Regrow III (if member available) Regrow IV (new)

313E Crushed Scrotum & Testes

A high force impact or explosion completely destroys the testes. The man will be infertile and there is no hope to repair the damage. The damage is not likely life threatening, although it may feel that way. The pain will be severe, easily leading to unconsciousness, and usually accompanied by nausea and vomiting.
Spell: Regrow IV

Spell:

The severed penis can be surgically reattached if done promptly. The difficulty of doing this successfully depends on the time since the trauma. For every three hours since the trauma increase the difficulty by one. The procedure can take considerable time, as much as 10 hours in some cases. Erectile function will be maintained with any successful surgery. Only microsurgery, using a microscope can restore all functions and leave the man fertile and then only upon a normal or better success.

313F Severed Scrotum & Testes

The scrotum and with it the testes are severed.
Risks

Not surprisingly having the scrotum and testes severed leaves the man sterile and unable to have children. The main risk is from the bleeding which will most likely be moderate.
Surgery

315 Diaphragm
The chest and abdomen are separated by a muscle called the diaphragm which is also an important muscle for breathing. It is controlled by the phrenic nerve which does not travel through the spinal cord but on its own directly from the brain. This means that those paralysed from spinal cord injury are still able to breathe.

Modern: Medieval: Futuristic: Spell:

Reattaching Scrotum (easy) Reattaching Testes (insane) Repair is not possible. Hightech Repair (hard) Regrow IV

315A Small Diaphragm Tear

Usually caused by a blunt force to the abdomen or a penetrating injury to either the chest or abdomen.
Symptoms

Reattaching the testes is normally not feasible but a brilliant surgeon may attempt an insane operation. Unless the result is a normal or better success the man will still be sterile. The scrotum can be reattached if done within a few hours and is easy. It will be of little use without testes though.

There are usually no immediate symptoms except for occasional breathing problems.
Risks

There is no immediate risk from the tear but it may have long term consequences as described below on treatments.
Diagnosis

313G Severed Penis

Because it is exposed on the outside of the body the soft penis is very vulnerable to trauma.
Risks

Modern: Medieval: Futuristic: Spell:

Long Observation (severe) Long Observation (severe) Long Observation (severe) Healing Vision

The main risk is the bleeding which will be moderate.

121

A small diaphragm tear is severe to diagnose and that is after long observation and careful examination.
Surgery

Diagnosis

Modern: Medieval:

Long Observation (hard) Long Observation (hard) Long Observation (hard) Healing Vision

Modern: Medieval:

Repair Diaphragm (tricky) Herniation Repair (hard) This surgery is usually not possible and will be at least hard if attempted despite infection risks. Hightech Repair (tricky) Hightech Herniation Repair (tricky) Regrow II (tear), Regrow IV (herniation)

Futuristic: Spell:

Futuristic: Spell:

A major diaphragm tear is hard to diagnose and that is after long observation and careful examination.
Surgery

Modern:

The character may experience breathing problems for a few days but the condition will eventually improve and resolve on its own. However, as explained below there is a future risk of hernia which can only be avoided with a tricky surgery procedure in a hospital setting. Failure to treat a torn diaphragm is not immediately fatal but will eventually lead to bowel herniation into the chest cavity at some uncertain time in the future. 1D12 years to be exact. Once the herniation starts it can only be reversed by surgery which is hard at best. 1D100 months after herniation it will result in respiratory problems as the lungs or heart is pressured. This will get gradually worse and will cause impairment and eventually, after months or years, death. Alternatively the herniation may lead to a more sudden death as circulation is cut off from vital organs or an organ ruptures.

Mesh Repair (hard) Repair without Mesh (extreme) This surgery is not possible, and certainly insane if attempted. Hightech Mesh Repair (tricky) Regrow III (tear), Regrow IV (herniation)

Medieval: Futuristic: Spell:

A mesh is required to close the hole in an operation that is at least hard and without a mesh becomes extreme or even insane to repair. Failure to treat the torn diaphragm is not immediately fatal but will eventually lead to bowel herniation in 1D10 years. Once the herniation starts it can only be reversed by surgery which is severe with a mesh and insane otherwise. 1D10 months after herniation it will result in respiratory problems as the lungs or heart is pressured. This will get gradually worse and will cause impairment and eventually after months or years, death. Alternatively the herniation may lead to a more sudden death as circulation is cut off from vital organs or an organ ruptures.

315B Major Diaphragm Tear

Usually caused by a high force impact or penetrating injury.
Symptoms

Breathing problems and shock.

Risks

The diaphragm is so damaged that breathing is impaired. Halve the time for any shock rolls and the time for each stage and increase any shock rolls by two difficulty levels. A -1D impairment penalty will not go away even after the wound has healed without surgery to repair the diaphragm. It also has long term consequences as described below under treatments. 122

Arms
Anatomy
Here the arms include everything from the hand up to the shoulder joint and even the collarbone.
Risks

The immediate concern is bleeding [2], which will usually be heavy, and can quickly lead to shock [4]. Then there is the obvious inconvenience of losing an arm.
Surgery

Modern: Medieval: Futuristic:

Microsurgery (hard) 10-14 hours Microsurgery is not possible.

Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow IV (fuses arms back on)

Great Vessels
The blood supply to the arm runs from the aorta artery, through the subclavian artery underneath the clavicle and the axillary artery in the armpit, ending up in the brachial artery in the upper arm. The brachial artery in turn divides into the radial and ulnar arteries at the elbow which supply the forearm, wrist and hand.

Spell:

Nerves
The main nerve of the arm is the brachial plexus which extends from the neck into the chest, shoulder and arm. At the elbow the brachial plexus splits into the radial and ulnar nerves.

See microsurgery under modern surgery for details on how surgery may be able to reattach the arm. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

400B Severed Arm below Shoulder

This can be treated exactly as a severed arm at the shoulder [400A]. However, because the shoulder remains unharmed the arm retains upper arm movement.

Skeleton
The arm is made up of the humerus bone, extending from shoulder to elbow, and the radius and ulna bones from the elbow to the hand. The arm includes three joints; shoulder, elbow and wrist. The wrist is made up of the bones of the forearm and eight small carpal bones of the hand. Each finger is made up of three bones.

400C Severed Arm below Elbow

Again this can be treated exactly as a severed arm at the shoulder [400A]. However, because the shoulder and elbow remain unharmed both the upper and lower arm can be moved. Only the hand and wrist are affected.

401 Blood Vessels

The main artery of the upper arm is the brachial artery. It divides into the radial and ulnar arteries at the elbow. The ulnar and radial arteries are the main arteries of the forearm, wrist and hand. The two brachial veins accompany the brachial artery on either side collecting the blood the artery pumped out for its return to the heart. There are several other veins, like the large cephalic vein that connects to the axillary vein in the shoulder.

400 General
400A Severed Arm at Shoulder
The arm is completely severed at the shoulder. It may still hang by a piece of skin or may fall to the ground.

123

Arterial blood loss will tend to be more rapid as it is under higher pressure and will often spurt forth from the wound in rhythm with the heart.

Surgery

Modern:

401A Lacerated Brachial Vessels

The brachial artery and/or one or both the brachial veins are damaged and leaking blood, but not completely severed.
Symptoms

Stop Bleeding (varies) Anastomosis, 4 first hours (tricky) Anastomosis, 5 - 8 hours (tricky) Anastomosis, 9 - 12 hours (hard) Anastomosis, 13 - 16 hours (severe) Anastomosis, 17 - 20 hours (extreme) Anastomosis, 21 - 24 hours (insane) Extract Graft Vein (easy) Depends on tools, probably more difficult. With hightech tools likely two or three difficulties lower. Bloodmagic III (heavy), Bloodmagic IV (massive)

Medieval: Futuristic: Spell:

The bleeding can be internal if it was caused by something like a blunt force, but frequently the bleeding will be obvious as blood gushes forth from the wound.
Risks

The risk is that the character will bleed to death before the blood loss stops.
Treatment

Pressure treatment as for any bleeding injury [2] is very effective and usually the only treatment needed. Even for internal injuries it is usually enough, although surgery may be attempted.

Surgery is required to save the arm. To stop the bleeding a tourniquet is usually needed because of the severity of the bleeding. This can cause problems for later surgery however as prolonged use of a tourniquet will often result in an early death of the arm as it is completely starved of all blood. Increase the difficulty by one if a tourniquet has been in place for more than four hours. The surgery to restore blood flow to the arm consists of reconnecting the two ends of the severed artery in a procedure known as anastomosis. The time since the artery was severed determines the chance of successfully saving the arm and so the difficulty of the operation. Usually a small part of the damaged artery must be removed before the connection is made. If the damaged part is too long a graft is needed to connect the ends. This will be the case on a 1D10 roll of 1 or 2. The graft consists of a vein from another part of the body. Either from the other arm, or most commonly, the saphenous vein from the leg. The vein is usually taken from the patients body but someone else can donate a vein. The use of a graft does not change the difficulty of the anastomosis surgery, but a separate easy operation is needed to extract the vein to be grafted. Regardless if a graft was needed or not the degree of success or failure determines the arms recovery. In all cases of failure the arm is paralysed without feeling or movement. In all cases of success the arm swells and warms with feeling and function gradually returning.

401B Severed Brachial Artery

The brachial artery is severed.
Symptoms

The blood loss is severe and this can usually be seen from blood gushing forth from the wound. In cases where the bleeding is internal the arm will become painful, numb and weak as it is starved from blood.
Risks

The primary risk is that the character will bleed to death before the blood loss stops. The secondary risk is the loss of the arm due to lack of blood supply. In 75% of cases the arm will die if the severed brachial artery is not repaired. The time before this happens may vary but if no surgery is attempted in the first 24 hours it can be assumed beyond recovery and dead. If the arm dies the muscles will liquidify and gangrene [4B] will develop in 1D12 weeks. Without surgery, even if the arm survives it will be without feeling or function, hanging limp down the side.

Exceptional failure means that the arm had to be amputated to save the characters life. Normal failure means the arm does not have an adequate blood supply and will die and develop gangrene [4B] in 1D10 days. 124

Marginal failure means that the arm looks like it will make it and it survives for 3D10 days before it dies and gangrene [4B] develops. Marginal success saves the arm but it will remain almost paralysed with only very limited motion and sensation. 1D impairment when used. Normal success saves the arm. It will initially be paralysed but in 2 to 3 days sensation and function starts to return. Full recovery can be slow. If surgery was performed in the first 4 hours after the artery was severed the arm recovers completely by the time the trauma heals. Otherwise it gradually recovers over 2D10 months. Start with a 3D impairment penalty which is gradually reduced until fully recovered. Exceptional success saves the arm and most of its function and sensation. The arm will initially be paralysed but in 2 to 3 days sensation and function starts to return. If surgery was performed in the first 4 hours after the artery was severed the arm recovers completely by the time the trauma heals. Otherwise it gradually recovers over 1D12 months.

Risks

The primary risk is that the character will bleed to death before the blood loss stops. The blood loss for a severed ulnar or radial is about the same as if it was lacerated because it tends to retract and in so doing partially close off the bleeding. This, however, makes repair more difficult as well. If only one of the two arteries are severed the remaining blood supply is enough to keep the hand healthy. If both the radial and ulnar artery is severed the character risks losing the hand due to lack of blood supply. The time before this happens may vary but if no surgery is attempted in the first 24 hours, it can be assumed beyond recovery and dead. If the hand dies the muscles will liquidify and gangrene [4B] will develop in 2D10 weeks.
Surgery

Modern:

401C Lacerated Radial/Ulnar Artery

One or both of the radial and ulnar arteries providing blood to the forearm, wrist and hand are damaged causing moderate or heavy bleeding.
Symptoms

Medieval: Futuristic: Spell:

Because the arteries run close to the surface of the skin there is no risk of internal bleeding and any blood loss will be obvious.
Risks

Stop Bleeding (see bleeding [2]) Anastomosis, 4 first hours (tricky) Anastomosis, 5 - 8 hours (tricky) Anastomosis, 9 - 12 hours (hard) Anastomosis, 13 - 16 hours (severe) Anastomosis, 17 - 20 hours (extreme) Anastomosis, 21 - 24 hours (insane) Extract Graft Vein (easy) Depends on tools, probably more difficult. With hightech tools likely two or three difficulties lower. Bloodmagic II (moderate), Bloodmagic III (heavy)

The primary risk is that the character will bleed to death before the blood loss stops.
Treatment

Surgery is required to save the arm. To stop the bleeding a tourniquet is usually needed because of the severity of the bleeding. This can cause problems for later surgery however as prolonged use of a tourniquet will often result in an early death of the arm as it is completely starved of all blood. Increase the difficulty by one if a tourniquet has been in place for more than 4 hours. The surgery to restore blood flow to the arm consists of reconnecting the two ends of the severed artery in a procedure known as anastomosis. The time since the artery was severed determines the chance of successfully saving the arm and so the difficulty of the operation. Reconnecting one artery is usually enough to save the arm. Reconnecting both takes two surgery attempts. Usually a small part of the damaged artery must be removed before the connection is made. If the damaged part is too long, a graft is needed to connect the ends. This will be the case on a 1D10 roll of 1 or 2.

Pressure treatment as for any bleeding injury [2] is very effective and usually the only treatment needed.

401D Severed Radial/Ulnar Artery

One or both of the radial and ulnar arteries providing blood to the forearm, wrist and hand are severed causing moderate or heavy bleeding.
Symptoms

Because the arteries run close to the surface of the skin there is no risk of internal bleeding and any blood loss will be obvious.

125

The graft consists of a vein from another part of the body, usually from the legs but it can also be from the other arm. The vein is usually taken from the patients body but someone else can donate a vein. The use of a graft does not change the difficulty of the anastomosis surgery, but a separate easy operation is needed to extract the vein to be grafted.

functionality and sensation but the healing time is twice that of normal. Exceptional success saves the hand same as normal success but time to full recovery of function is the normal healing time.

402 Elbow
The elbow is a complex joint formed by the humerus bone of the upper arm and the radius and ulna bones in the forearm. The humerus and ulna are connected with a hinge and the humerus and radius by a ball and socket. Ligaments, muscles and tendons maintain elbow stability. Blood vessels and nerves run along the bone and so may be injured or severed by a fracture.

402A Elbow Fracture

Broken Elbow A fractured elbow may be a break at the end of the upper arm bone (humerus) or in the upper part of a forearm bone (ulna or radius).
Symptoms

A pop can often be heard at the time of the injury and a grating sound when applying pressure or moving the arm. The arm is usually difficult or impossible to move at the elbow. There is always pain which increases with any arm movement. Often the elbow will look deformed or out of its normal position. The arm below the fracture and the hand may turn pale blue, cold and may feel numb or tingle. Regardless if a graft was needed or not the degree of success or failure determines the hands recovery. In all cases of failure the hand is paralysed without sensation or function. In all cases of success the hand swells and warms with feeling and function gradually returning.

There will usually be significant swelling at the elbow. If the blood supply was cut off there is no pulse at the wrist and the skin and nails of the hand turn blue and cold.
Risks

Exceptional failure means that the hand had to be amputated to save the characters life. Normal failure means the hand does not have an adequate blood supply and will die and develop gangrene [4B] in 1D10 days. Marginal failure means that the hand looks like it will make it and it survives for 10 + 1D12 days before it dies and gangrene [4B] develops. Marginal success saves the hand but it will remain partly paralysed with only limited function and sensation. -1D impairment. Normal success saves the hand. It will initially be paralysed, but in 2 to 3 days sensation and function starts to return. The hand regains full

The immediate consequence of a fractured elbow is the pain and inability to move the lower part of the arm. It has the same risk of complications as a closed fracture [1A]. Also, if the elbow is not put in a splint or cast it may end up stiff or deformed with a 1D penalty for all actions involving the arm. The risk of this happening is 25% but can be adjusted depending on the activity level of the character. The most serious complication of a fractured elbow is injury to the blood vessels and nerves running along the elbow. If not injured during the initial trauma there is still a 126

risk that handling or moving the character or arm may cause damage. If handled carefully the risk is only 2% each time but it quickly increases with careless handling. The result is loss of function and sensation to the lower arm and hand due to damage to the radial or ulnar nerve [404C]. Bleeding is usually only moderate but if nerves and vessels are not repaired the paralysis becomes permanent in about 24 hours.
Treatment

dius to form the wrist. Each finger is made up of three bones. Around the bones are tendons, bones, nerves and vessels all making the hand very flexible. The hand is well supplied with blood from the two arteries in the wrist. The ulnar artery provides blood to the outer side and the radial to the inner side.

Treatment and diagnosis of the fracture itself is the same as for a closed fracture. Treatment for any bleeding is the same as for a severed radial and ulnar artery [401D]. Treatment for damaged nerves is the same as for damage to the radial or ulnar nerve [404C].

402B Open Elbow Fracture

Compounded Elbow Fracture Same as an elbow fracture [402A] except that the bone is exposed to bacteria through an open wound with a high risk of becoming infected. See open fracture [1B] for details on infection risk and treatment.

402C Displaced Elbow Fracture

This is the same as a normal elbow fracture [402A] and will have the same symptoms, risks and treatment. However because the bones have been displaced it needs surgical repair to join the ends together or the impairment becomes permanent. Treat it as a mal-union that needs resetting as described under closed fracture surgery [1A]. The longer it is left, counting in months, the more difficult any surgery will be.

Hand injuries are common since the hands are often used reflexively as a defence. Infections spread easily through the hand and can cause stiff joints. One or more stiff joints caused by infection or damage can seriously impair the hand.

402D Open Displaced Elbow Fracture

Compounded Displaced Elbow Fracture Same as a displaced elbow fracture [402C] except that the bone is exposed to bacteria through an open wound with a high risk of becoming infected. See open fracture [1B] for details on infection risk and treatment.

403A Severed Hand

The hand is completely severed.
Risks

403 Hand
The hand is both delicate and complicated. The hand itself is made up of eight small carpal bones joining the ra-

The immediate concern is bleeding [2], which will usually be heavy and can quickly lead to shock [4]. Then there is the obvious inconvenience of losing a hand.

127

Surgery

403C Palm Injury

Reattach Hand (tricky) 10-12 hours Microsurgery is not possible.

Modern: Medieval: Futuristic:

Palm injuries can consist of damaged tendons, nerves, vessels and fractured bones.
Risks

Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow IV (fuses hand back on)

The hand cannot be used while it is healing. The main risk is deformity or further damage to tendons and nerves resulting in permanent impairment of the hand. If an infection develops it can do serious damage in the hand and be quite difficult to treat without damaging the hand further. The risk of permanent impairment is 5% with no treatment, but this drops to zero if the hand is splintered and rested. If a minor infection develops it increases to 10%. If any other form of infection develops the risk increases to 20% or more. Impairment is a permanent 1D penalty to any task involving the hand.
Treatment

Spell:

The ulnar and radial arteries, four veins, as well as the median, ulnar and superficial radial nerves are repaired in addition to as many tendons as possible. See microsurgery under modern surgery for details on how surgery may be able to reattach the hand. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

403B Crushed Hand

Impailed Hand, Ruined Hand, Mutilated Hand The hand is completely destroyed or mutilated beyond any function and with little hope of recovery. The hand may have been crushed, impaled or otherwise massacred.
Risks

There is no need for further treatment beyond a splint, which eliminates the risk of impairment if no infection develops. Any infection [4] should be treated swiftly to prevent permanent impairment.

The hand is useless and will not recover. If an infection takes hold it will not end until the hand is amputated.
Surgery

Modern: Medieval: Futuristic: Spell:

Amputation (easy) Surgical Repair (insane) Amputation (easy) Amputation (easy) Hightech Surgical Repair (hard) Regrow IV

403D Severed Finger

One or more fingers are severed from the hand. The loss of a single finger is barely noticeable, while the loss of several fingers can make the hand useless.
Risks

Amputating the useless and often messy hand is the best option as any infection that develops in the hand can become nasty. Any attempt at repairing the injury will of course depend on the nature of the trauma. It will usually be impossible due to the destroyed tendons, nerves, blood vessels and shattered carpal bones.

If only one finger is lost no penalty is incurred although tasks such as typing may be slower. If two fingers are lost there is a 1D penalty to all relevant actions involving the hand, especially when it is holding something. If three fingers are lost the hand is almost useless and holding things becomes very difficult. If all four fin128

gers are lost the hand is unable to hold practically anything and so is useless for most tasks.
Surgery

404 Nerves
A nerve is a bundle of conducting fibres, which like a cable transmits commands from the brain to the muscles and sensations back again.

Modern: Medieval: Futuristic:

Reattach Finger (tricky) 2-4 hours Microsurgery is not possible.

Hightech Microsurgery (easy) Nanosurgery (easy)

Regrow III (fuses finger back on)

Spell:

The impulses carrying the signals along the nerves can be thought of as electrical impulses. In fact they are waves of depolarisation caused by an electric current, heat, pressure or chemicals. The transmit rate varies from a hundred meters per second for the thickest nerves to one meter per second for the slowest. Reflex reactions are usually transmitted through fast nerves, while more detailed sensations travel through the slower nerves. Nerves die after only seconds without blood. Luckily any remaining stagnant blood in the vessels, even after blood is cut off, is enough to keep a nerve alive for a few minutes. Nerves, except for in the brain and spinal cord, heal if the path between the broken nerve endings is not blocked. Sensation and muscle control below a severed nerve is impossible. The degree of paralysis below the injury therefore depends on how large and central the nerve was.

See microsurgery under modern surgery for details on how surgery may be able to reattach the finger. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained, use the descriptions below rather than those under microsurgery.

Failure: Gangrene [4B] will start developing in the next 1D12 days. Marginal Success: The finger is attached but completely stiff and useless. Treat as lost. Normal Success: The finger has some sensation and movement but is very stiff. Exceptional Success: The finger recovers completely.

404A Damaged Brachial Plexus Nerve

The main nerve bundle of the arm, brachial plexus, is damaged leaving the arm weak and numb.
Symptoms

403E Injured Finger

Basically the same as a severed finger in that it is no longer usable, although it remains attached. Treat as if the finger was severed [403B] but surgery is to repair the finger not attach it. The difficulty of such surgery is easy if the trauma was recent and tricky otherwise.

The arm is weak, numb and often painful.

Risks

403F Severed Thumb

A severed thumb can be treated like a severed finger [403B] for the purpose of treatment. However if the thumb is lost the hand becomes nearly powerless and so is as useless as if four fingers had been lost.

The nerve damage results in a 2D permanent impairment to any action using the arm unless the nerve damage heals. The nerve will usually heal, but often surgery is required to repair the damage and remove clotted blood, bone fragments or otherwise relieve the nerve of unwanted pressure. If such complications are left untreated, continuous damage to the nerve results in what is effectively a severed brachial nerve. If no surgery is attempted roll 1D100. On 1-10 the damage will get worse and result in a severed brachial nerve [404B]. On 11-30 the nerve will not heal properly and 129

403G Injured Thumb

Basically the same as a severed thumb in that it is no longer usable, although it remains attached. Treat as if the thumb was severed [403B] but surgery is to repair the thumb not attach it. The difficulty of such surgery is easy if the trauma was recent and tricky otherwise.

the damage becomes permanent. Otherwise it heals as normal and the character makes a full recovery.
Diagnosis

Symptoms

The arm is completely limp, without function or sensation.

Risks

Modern: Medieval:

EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision

Futuristic: Spell:

A paralysed arm is already pretty bad and the greatest risk is that it becomes permanent. If not surgically treated quickly the nerve endings may not grow back together and the paralyses becomes permanent. Without surgery there is a 25% chance that the nerve endings will grow back together. This should be adjusted up or down to reflect the actual extent and type of trauma inflicted.
Diagnosis

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.
Surgery

Modern: Medieval:

EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision

Futuristic: Spell:

Modern: Medieval: Futuristic:

Microsurgery (tricky)

No repair possible Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Spell:

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.
Surgery

Immediate treatment consists of immobilising any fractures to prevent further injury. Then surgery to relieve pressure from such things as bone fragments, blood cloths and swelling and to make repairs to allow the nerve to heal. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

Modern: Medieval: Futuristic:

Microsurgery (hard)

No repair possible Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Spell:

404B Severed Brachial Plexus Nerve

The main nerve bundle of the arm, brachial plexus, is severed leaving the arm completely paralysed.

Immediate treatment consists of immobilising any fractures to prevent further injury. Then surgery to ensure the path between nerve endings is not blocked by bone fragments, blood cloths or other objects. This allows the nerve endings to grow back together. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Mar130

ginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

Surgery

Modern: Medieval: Futuristic:

Microsurgery (tricky)

404C Damaged Radial or Ulnar Nerve

The radial or ulnar nerve that runs along the radius and ulna bones respectively is damaged leaving the lower arm and hand numb and weak.
Symptoms

No repair possible Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Spell:

The fingers, palm and wrist are numb, weak and often painful.
Risks

Immediate treatment consists of immobilising any fractures to prevent further injury. Then surgery to relieve pressure from such things as bone fragments, blood cloths and swelling and to make repairs to allow the nerve to heal. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

The nerve damage results in a 1D permanent impairment to any action using the hand unless the nerve damage heals. The nerve will usually heal, but often surgery is required to repair the damage and remove clotted blood, bone fragments or otherwise relieve the nerve of unwanted pressure. If such complications are left untreated, continuous damage to the nerve results in what is effectively a severed radial or ulnar nerve. If no surgery is attempted roll 1D100. On 1-10 the damage will get worse and result in a severed radial or ulnar nerve [404D]. On 11-30 the nerve will not heal properly and the damage becomes permanent. Otherwise it heals as normal and the character makes a full recovery.
Diagnosis

404D Severed Radial or Ulnar Nerve

The radial or ulnar nerve that runs along the radius and ulna bones respectively is severed leaving the hand numb and weak.
Symptoms

Loss of sensation and movement of fingers, palm and wrist.

Modern: Medieval: EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision
Risks

Futuristic: Spell:

The main risk is that the impairment of the hand becomes permanent. Weakness and loss of sensation in both the palm, wrist and fingers, as well as some fingers losing their ability to grip. If not surgically treated quickly the nerve endings may not grow back together and the impairment from the trauma becomes permanent. Without surgery there is a 25% chance the nerve endings will grow back together. Adjusted this up or down to reflect the actual extent and type of trauma inflicted.

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.

131

Diagnosis

Modern: Medieval:

EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision

Futuristic: Spell:

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.
Surgery

405A Small Wrist Fracture

The wrist does not easily sprain like the ankle, but small fractures are common causing some stiffness and pain. Manipulating the bones back into place is usually easy but damaged arteries can cause blood starvation to the bone which in turn may cause deformity and therefore impairment.
Symptoms

Modern: Medieval: Futuristic:

Microsurgery (hard)

No repair possible Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Swelling, tenderness, pain, deformity and difficulty holding any weight.

Risks

Spell:

Immediate treatment consists of immobilising any fractures to prevent further injury. Then surgery to ensure the path between nerve endings is not blocked by bone fragments, blood cloths or other objects. This allows the nerve endings to grow back together. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

The risk is that the wrist will be deformed with a permanent 1D impairment to any task performed with the use of the hand. This has a 60% chance of happening with no treatment. Immobilisation reduces the risk to 25%. If this deformity occurs it can easily be corrected by resetting the bone. If done within the first 24-48 hours it usually requires no surgery, but if left for longer the bone will heal and correcting the deformity will take a surgical procedure. Another possible complication is osteonecrosis [5] due to the loss of blood supply to the bone. There is a 5% risk if the wrist is splinted in the first five hours. For every hour it is delayed beyond this, the risk increases by 5%, but never beyond a maximum risk of 40%. Make only one roll once the splinter is done or the risk reaches 40%.
Diagnosis

405 Wrist
The wrist is formed by the radius and ulna bones in the forearm and the small carpal bones at the base of the hand. Over twenty tendons pass around the wrist on their way to the hand. These tendons are well protected by strong fibrous bands. Two arteries pass on the underside of the wrist, feeding the hand with blood.

Modern: Medieval: Futuristic: Spell:

X-Ray Scan (tricky) Physical Exam (hard) Hightech Scan (easy) Healing Vision

132

Diagnosis is used both to detect the fracture and to decide if it is dislocated and so needs to be reset or just immobilised. Diagnosis is also necessary to differentiate between a simple fracture and a complicated wrist fracture [405B] since the latter requires surgery. The small size of the bones and their overlapping alignment makes accurate diagnosis by X-rays more difficult.
Surgery and Treatment

Another possible complication is osteonecrosis [5] due to the loss of blood supply to the bone. There is a 5% risk if the wrist is splinted in the first five hours. For every hour beyond this the risk increases by 5% but never beyond a maximum risk of 40%. Make only one roll once first aid is performed or the risk reaches 40%.
Diagnosis

Modern: Medieval:

X-Ray Scan (tricky) Physical Exam (hard) Hightech Scan (easy) Healing Vision

Modern: Medieval:

Manual Bone Resetting (easy) Surgical Deformity Repair (hard) Manual Bone Resetting (easy) Surgical correction usually not available, and if known at least one level higher difficulty. Manual Bone Resetting (easy) Hightech Surgical Deformity (easy) Regrow II

Futuristic: Spell:

Futuristic: Spell:

Diagnosis is necessary to differentiate from a simple fracture [405A]. The small size of the bones and their overlapping alignment makes accurate diagnosis by Xrays more difficult.
Surgery and Treatment

Supporting the wrist with a splint or some form of immobilisation is very important to allow any broken blood vessels to heal and thus prevent blood starvation to the wrist. If any dislocated bones are reset in the first 24-48 hours deformity does not occur. Surgical removal of bones can repair deformity and its resulting impairment if it occurs. This weakens the overall strength of the wrist which could result in a complicated fracture [405B] in the future. There is a 1% risk of this happening every time the hand is involved in an action placing a heavy load on the wrist. This would include heavy lifts, throwing objects, wielding close combat weapons and climbing.

Modern: Medieval:

Surgical Correction (hard) Splintering (tricky) Surgical correction usually not available, and if known at least two levels higher difficulty. Hightech Surgical Correct. (tricky) Regrow II

Futuristic: Spell:

Supporting the wrist with a splint or some form of immobilisation is very important to allow any broken blood vessels to heal and thus prevent blood starvation to the wrist and osteonecrosis [5]. Surgery to repair the dislocated fracture is the only possible treatment. The success determines the regained functionality of the wrist and hand.

405B Complicated Wrist Fracture

In a complicated wrist fracture the bones have been dislocated and shifted too far to heal without surgery. Usually resulting in more impairment of the hand than for a simple wrist fracture.
Symptoms

Swelling, tenderness, pain, deformity and difficulty holding any weight.

Risks

Marginal: Although better, the wrist remains stiff. A 1D permanent impairment remains due to some stiffness in the wrist. Normal or Exceptional : All the impairment will heal as normal after the surgery.

405C Severed Wrist Tendons

Torn Flexor Tendons Long tendons that move the fingers run from the muscles in the forearm, across the wrist, to the small bones of the 133

The deformed wrist will not heal without surgery and so the impairment is permanent.

fingers and thumb. Each finger has two tendons, except the thumb which has only one. When a fingers tendon is torn or severed, usually by a cut, the finger is unable to bend and becomes useless.
Symptoms

Surgery

Modern:

Tendon Repair (tricky) Late Reconstruction (severe) Splintering (easy) Surgical repair usually not available, and if known at least one level higher difficulty. Hightech Surgical Repair (easy) Hightech Late Reconstruction (tricky) Regrow III

Medieval:

Severe pain and inability to bend one or more fingers.

Risks

Futuristic: Spell:

Severed tendons do not heal without surgery and so without treatment gives a permanent impairment for any use of the hand. The severity of the impairment depends on the number of tendons cut. If the number of tendons severed are not specified by the trauma it can be judged by the severity of the trauma or by rolling 1D10. Each finger has two tendons and are usually severed in pairs. The number of fingers affected are equal to the number of tendons severed divided by two. If the number of tendons is uneven the tendon to the thumb is severed. Any finger which has its tendons severed is considered useless. If only one finger is affected no penalty is incurred although tasks such as typing may be slower. If two fingers are affected there is a 1D penalty to all relevant actions involving the hand, especially when it is holding something. If three fingers are affected the hand is almost useless and holding things becomes very difficult. If all four fingers are affected or the thumb is affected the hand is unable to hold practically anything and so is useless for most tasks.
Diagnosis

Immobilising the finger may prevent further damage and so make it easier to repair but surgery is needed to repair the tendon. The tendons are stretched tightly and when severed the muscle pulls its end in. Since the tendon cannot heal unless the ends are touching only surgery to sew the ends back together can heal the damage. After the surgery the wrist must be placed in a cast or splint to ensure correct healing for a minimum of four weeks. Delay in treatment increases the difficulty. For every two weeks since the tendons were severed increase the difficulty by one. Eventually, six weeks can be assumed, the tendon ends retract and get stuck in scar tissue, the muscle shortens and withers, the tunnels through which the tendons run shrink and the joint stiffens. Late reconstruction surgery is possible but very difficult and the results are not as good leaving a -1D impairment.

Modern: Medieval: Futuristic: Spell:

Physical Exam (tricky) Physical Exam (tricky) Hightech Scan (easy) Physical Exam (tricky) Healing Vision

406 Shoulder Joint

The shoulder is a ball-and-socket joint, where the humerus bone in the upper arm ends in the ball, while the scapula or shoulder blade forms the socket. The stability of the shoulder joint depends entirely on muscles.

406A Dislocated Shoulder

The shoulder is easily dislocated because of its mobility, but it can usually be manipulated back.
Symptoms

Diagnosing a severed tendon can be done with a physical examination.

Unable to move arm and great pain.

Risks

The main risk is damage to nerves or vessels below the joint which may lead to blood loss and reduce sensation and functionality in the arm. Fractures may also occur 134

because the tendons are more resilient than the bone. A fracture is less serious than torn tendons because it heals better. There is a 10% risk of nerve damage resulting in a permanent 1D impairment for the arm. Another 5% risk of a closed fracture [1A] and 20% chance of moderate bleeding [2]. In addition there is a 10% risk inflammation may cause pain and stiffness and lead to a special condition called frozen shoulder, where the arm cannot be moved and is in great pain. The condition lasts for 1D12 weeks in which time the arm cannot be used and a 1D pain impairment applies to all physical actions.
Diagnosis

406B Complicated Dislocation

A complicated dislocation involves damage to the tendons. It can be manipulated back into position as normal but the damage to the tendons makes the joint vulnerable to future dislocations. Treat the same as a normal dislocation [406A] but also whenever the GM feels that the arm is used in a way that may dislocate it, such as throwing a spear or after a fall, a roll should be made. The percentage chance depends on the action. Swinging an axe might have a 5% risk, while throwing a spear would be more like 10%. Future dislocations must be manipulated back into the joint again and have the same risk each time of damaging nerves and blood vessels.
Treatment

Modern: Medieval: Futuristic: Spell:

Physical Exam (hard) Physical Exam (hard) Hightech Scan (easy) Physical Exam (hard) Healing Vision

Modern: Medieval: Futuristic: Spell:

No treatment No treatment Medical nanobots or other hightech treatment may be available. Regrow III

A dislocated shoulder is obvious but it is hard to diagnose further complications such as fracture, nerve damage or internal bleeding.
Treatment

The tendon damage cannot normally be treated effectively.

406C Torn Shoulder Tendon

Modern: Medieval: Futuristic: Spell: Manipulate Back in Place (tricky) Manipulate Back in Place (tricky) Manipulate Back in Place (tricky) Regrow III

Severed Rotary Cuff Tendon The rotary cuff tendon is responsible for raising the arm out to the side, helps rotate the arm and keeps it from popping out of its socket. It is the most frequently damaged tendon and is usually torn from a heavy lift, fall or direct trauma.
Symptoms

Manipulating the joint back into position is fairly straight forward using first aid or for any doctor with basic medical skills. When the arm is manipulated back into position there is again the risk of nerve damage and bleeding from damaged blood vessels unless its an exceptional success. For a normal success there is a 5% risk of moderate bleeding and another 5% risk of nerve damage resulting in a permanent 1D impairment. For marginal success the risk for both are 10%, 30% for marginal failure, 50% for normal failure and guaranteed for exceptional failure.

Inability to raise the arm out to the side.

Risks

Without treatment the torn tendon will not heal making it impossible to raise the arm out to the side. This means that the impairment penalty of the trauma becomes permanent for the arm.

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Diagnosis

strong that the bone is more likely to break than the joints are to be dislocated.
Physical Examination (tricky) Scan (tricky) Physical Examination (tricky) Physical Examination (tricky) Hightech Scan (easy) Healing Vision

Modern: Medieval: Futuristic: Spell:

407A Collarbone Fracture

Fractured Clavicle The clavicle is weak and easily broken and so is one of the most common injuries in any shoulder or chest injury. The sharp bone ends can cause further damage and are often associated with pneumothorax [204A] or [204B], and heavy internal bleeding from the subclavian and axillary vessels or the jugular vein [2A].
Symptoms

A diagnostic scan using MRI is without a doubt the best way to determine the extent of the damage, although xrays and ultrasound can be useful as well.
Surgery

Modern: Medieval:

Tendon Repair (tricky) Late Reconstruction (severe) Surgical repair usually not available, and if known at least two levels higher difficulty. Hightech Surgical Repair (easy) Hightech Late Reconstruction (tricky) Regrow III

Swelling and deformity at the injury site easily seen as the collarbone is located just beneath the skin. Tenderness and pain with movement of shoulder or arm. Inability to use arm or diminished sensation and weakness.
Risks

Futuristic: Spell:

The main risk is that the fracture heals poorly. Without treatment this is very likely, 75% chance, resulting in a 1D penalty to any physical action. With treatment the risk is reduced to 10% or even zero if the character lies on his back with a pad between the shoulders as explained under treatment. There is also a 25% chance that the fracture causes a dislocation. The dislocation must be surgically repaired or the character will end up with a permanent 2D impairment penalty for physical actions. Any pneumothorax or internal bleeding will usually be specified with the damage. The risk can be assumed to be about 25% for each. Forcing further movement of the arm may cause such damage after the initial trauma but is unlikely because of the pain associated with moving the arm.
Diagnosis

A torn rotary cuff tendon does not heal without surgery. A partial tear will not heal and is likely to tear further in future if surgery is not performed. Successful surgery, where the tendon is stitched back together, results in a full recovery, but the arm will still need to be immobilised for about four weeks. Delay in treatment increases the difficulty. For every two weeks since the tendon was severed increase the difficulty by one level. Eventually, six weeks can be assumed, the tendon ends retract and get stuck in scar tissue, the muscle shortens and withers, the tunnels through which the tendons run shrink and the joint stiffens. Late reconstruction surgery is possible but very difficult and the results are not as good leaving a -1D impairment.

Modern: Medieval: Futuristic: Spell:

Physical Examination (tricky) X-Ray Scan (easy) Physical Examination (tricky) Physical Examination (tricky) Hightech Scan (easy) Healing Vision

407 Collarbone
Clavicle A bar from the breastbone (sternum) out to the shoulderblade (scapula). The ligaments in the two joints are so

136

The diagnosis must determine if there is indeed a fracture but also if the collarbone is dislocated and so requires surgery. Other complications such as pneumothorax and internal bleeding must be diagnosed separately.
Treatment

Modern: Medieval: Futuristic: Spell:

Sling and Bandage (tricky) Sling and Bandage (tricky) Sling and Bandage (tricky) Regrow II

Treatment usually consists of a bandage and sling while the fracture heals. To ensure perfect healing the character needs to lie on his back with a pad between the shoulders, thus ensuring the fracture is kept in place.
Surgery

Modern: Medieval:

Dislocation repair (easy) Surgical repair usually not available, and if known at least two levels higher difficulty. Dislocation repair (easy) Regrow III

Futuristic: Spell:

If there is a dislocation surgery is required and failure in such cases to perform surgery will result in deformity and a permanent 1D impairment penalty for physical actions.

137

Legs
Anatomy
Here the legs includes the toes, feet and everything up to the pelvis, which is covered by the abdomen.

Great Vessels
The femoral artery and vein are the main vessels of the leg. The artery runs from the iliac artery in the pelvis down into the popliteal artery in the calf. The veins runs next to it.

Nerves
The sciatic nerve is the main nerve of the leg and the largest in the body. It runs from the spine in the pelvis controlling motor function and relaying sensations to the brain. The femoral nerve runs above the knee, helping to control the straightening of the leg as well as sensation to the thigh and parts of the lower leg.

Skeleton
The thighbone, or femur, connects to the tibia in the lower part of the leg via the knee and to the pelvis in the hip joint. The foot is connected to the tibia via the ankle and is made up of many bones. The leg has three joints. The hip joint connecting the leg to the pelvis, the knee joint allowing it to bend and the ankle to allow movement of the foot.

500 General
500A Severed Leg above Knee
The leg is completely severed above the knee.
Risks

The immediate concern is bleeding [2], which will usually be heavy and can quickly lead to shock [4]. Then there is the obvious inconvenience of losing a leg. Walking is obviously no longer an option and standing is impossible without support.
Surgery

Modern: Medieval: Futuristic:

Microsurgery (hard) 10-14 hours Microsurgery is not possible.

Hightech Microsurgery (tricky) Nanosurgery (easy) 138

Spell:

Regrow IV (fuses leg back on)

attack and more likely the result of a failed manoeuvre or a fall.

Symptoms

See microsurgery under modern surgery for details on how surgery may be able to reattach the leg. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery. At least normal success is required to be able to hold any weight on the foot and allow standing. A normal success will allow standing but walking is restricted to a slow, limping movement. Only an exceptional success may restore the ability to run.

Swelling around the ankle, difficulty walking and pain when putting any weight on it.
Risks

The greatest risk is confusing a sprain with a fracture and so failing to treat a serious ankle fracture.
Diagnosis

Modern: Medieval: Futuristic: Spell:

Physical Examination (hard) X-Ray Scan (easy) Physical Examination (hard) Physical Examination (hard) Hightech Scan (easy) Healing Vision

500B Severed Leg below Knee

This can be treated much like a severed leg above the knee [500A]. However, because the knee remains unharmed the leg retains a lot more functionality. The result is that the outcome of surgery will be more favourable and even a simple prosthesis can be quite effective allowing normal movement and possibly even jogging or running. The surgical outcomes are as follows.

Diagnosing a sprain is not difficult but distinguishing between a sprain and a fracture is hard without using xrays or some other type of scan to see the actual damage. The difference is important as a fracture may require surgery.
Treatment

Marginal: The leg grows back together but does not get enough blood. It is both paralysed and bluish with ugly spots. With practice it is possible to stand and walk on the leg but injury will be common and because of lack of sensation infection and eventual gangrene is likely. Normal: Healthy and will regain some sensation and function over the next 1D12 months. If treated well this will result in what is effectively the perfect prosthesis and should allow full movement with only a slight penalty to speeds above jogging. Exceptional: Healthy and in 1D12 months almost fully functional. For practical purposes, as good as new.

Modern: Medieval: Futuristic:

Ice and elevation (easy) Ice and elevation (easy) Ice and elevation (easy) More hightech solutions to speed healing are likely available but normally not needed. Regrow I

Spell:

501 Ankle
The ankle is a simple joint involving only one bone of the foot and restricting movement in one direction.

Sprains do not require treatment besides rest but ice to reduce the swelling and elevating the ankle will speed healing times. The difficulty reflects knowing what to do rather than the treatment itself which is trivial.

501B Ankle Fracture

Potts Fracture An ankle fracture is like any other fracture and can be open, closed, fragmented, shattered, etc. with the same 139

501A Sprain
A sprain is torn or stretched ligaments in the ankle. Although common a sprain is unlikely as a result from an

risks and treatments. It is only listed here because it can be hard to distinguish from a sprain without a scan.
Symptoms

If no treatment is attempted the tendon will not heal, but in 50% of cases the tear is partial and will heal without surgery using a cast or Immobiliser. Only surgery can however fully restore the tendon and treatment using only a cast or splint to immobilise the leg with only a slight reduction in strength. There is a 1% risk in the future whenever strain is put on the tendon, such as when running, climbing or jumping, that it will rupture again.
Surgery

Swelling around the ankle, difficult or impossible to walk and pain when putting any weight on it.

501C Achilles Tendon Rupture

Severed Achilles Tendon Running from the back of the foot just above the heel to the calf muscles, the achilles tendon is vital for pushing off with the foot. It is just under the skin and so vulnerable to any trauma to the back of the ankle.
Symptoms

Modern: Medieval: higher Futuristic: Spell:

Tendon Repair (tricky) Late Reconstruction (severe) Surgical repair usually not available, and if known at least two levels difficulty. Hightech Surgical Repair (easy) Hightech Late Reconstruction (tricky) Regrow III

Severe pain, weakness, swelling and inability to stand on toes.

Risks

A fully severed tendon does not heal unless repaired but a partially torn tendon may heal if leg is immobilised. If not repaired its function is permanently lost leaving the character with a permanent 1D impairment for actions such as climbing, running and jumping. The character will also have some difficulty walking, slightly reducing movement speeds.
Diagnosis

If the tendon is severed surgery is necessary. Successful surgery, where the tendon is stitched back together, results in a full recovery, but the foot will still need to be immobilised for about four weeks. Delay in treatment increases the difficulty. For every two weeks since the tendon was severed increase the difficulty by one level. Eventually, six weeks can be assumed, the tendon ends retract and get stuck in scar tissue, the muscle shortens and withers, the tunnels through which the tendons run shrink and the joint stiffens. Late reconstruction surgery is possible but very difficult and the results are not as good leaving a -1D impairment.

Modern: Medieval: Futuristic: Spell:

Physical Examination (tricky) Scan (tricky) Physical Examination (tricky) Physical Examination (tricky) Hightech Scan (easy) Healing Vision

502 Blood Vessels

The main artery to the leg is the femoral artery. It starts from the iliac artery in the pelvis and runs along the thigh-bone (femur) along with the femoral nerve. It runs between muscles to the back of the knee. Where it continues into the calf as the popliteal artery. The femoral vein runs together with the artery collecting the blood the artery pumped out for its return to the heart. Arterial blood loss will tend to be more rapid as it is under higher pressure and will often spurt forth from the wound in rhythm with the heart.

A successful diagnosis is needed to determine if the tendon is fully or partially severed and thus the best treatment.
Treatment

Modern: Medieval: Futuristic: Spell:

Cast or splint (easy) Cast or splint (easy) Cast or splint (easy) Regrow III

140

502A Lacerated Femoral Vessels

The femoral artery and/or the veins are damaged and leaking blood, but not completely severed.
Symptoms

Surgery

Modern:

The bleeding can be internal if it was caused by something like a blunt force, but frequently the bleeding will be obvious as blood gushes forth from the wound.
Risks

Stop Bleeding (see bleeding [2]) Anastomosis, 4 first hours (tricky) Anastomosis, 5 - 8 hours (tricky) Anastomosis, 9 - 12 hours (hard) Anastomosis, 13 - 16 hours (severe) Anastomosis, 17 - 20 hours (extreme) Anastomosis, 21 - 24 hours (insane) Extract Graft Vein (easy) Depends on tools, probably more difficult. With hightech tools likely two or three difficulties lower. Bloodmagic III (heavy), Bloodmagic IV (massive)

Medieval: Futuristic: Spell:

The risk is that the character will bleed to death before the blood loss stops.
Treatment

Pressure treatment as for any bleeding injury is very effective and usually the only treatment needed. Even for internal injuries it is usually enough, although surgery may be attempted.

502B Severed femoral Artery

The femoral artery is severed.
Symptoms

Surgery is required to save the leg in most cases. To stop the bleeding a tourniquet is usually needed because of the severity of the bleeding. This can cause problems for later surgery however as prolonged use of a tourniquet will often result in an early death of the leg as it is completely starved of all blood. Increase the difficulty by one if a tourniquet has been in place for more than 4 hours. Surgery consists of reconnecting the two ends of the severed artery in a procedure known as anastomosis. The time since the artery was severed determines the chance of successfully saving the leg and so the difficulty of the operation. Usually a small part of the damaged artery must be removed before the connection is made. If the damaged part is too long a graft is needed to connect the ends. This will be the case 20% of the time. The graft consists of a vein from another part of the body. Usually the saphenous vein from the other leg. The vein is usually taken from the patients body but another character can be used to donate a vein. The use of a graft does not change the difficulty of the anastomosis surgery, but a separate easy operation is needed to extract the vein to be grafted. Regardless if a graft was needed or not the degree of success or failure determines the legs recovery. In all cases of failure the leg is paralysed without feeling or movement. In all cases of success the leg swells and warms with feeling and function gradually returning.

The blood loss is severe and this can usually be seen from blood gushing forth from the wound. In cases where the bleeding is internal the leg will become painful, numb and weak as it is starved from blood.
Risks

The primary risk is that the character will bleed to death before the blood loss stops. The secondary risk is the loss of the leg due to lack of blood supply. In 75% of cases the leg will die if the severed femoral artery is not repaired. The time before this happens may vary but if no surgery is attempted in the first 24 hours it can be assumed beyond recovery and dead. If the leg dies the muscles will liquidify and gangrene [4B] will develop. Without surgery, even if the leg survives, it will be without feeling or function. The character will be unable to stand without support and walking becomes impossible.

Exceptional failure means that the leg had to be amputated to save the characters life. Normal failure means the leg does not have an adequate blood supply and will die and develop gangrene [4B] in 1D10 days. 141

Marginal failure means that the leg looks like it will make it and it survives for 10+1D10 days before it dies and gangrene [4B] develops. Marginal success saves the leg but it will be useless and paralysed. Normal success saves the leg. It will initially be paralysed but in 2 to 3 days sensation and function starts to return. Full recovery can be slow. If surgery was performed in the first 4 hours after the artery was severed the leg recovers completely by the time the trauma heals. Otherwise it gradually recovers over 1D12 months, increasing its ability to hold more and more weight. First the character will be able to walk with support, then without and eventually an awkward jog will be possible but never a run. A permanent 1D penalty to all actions depending on the leg, such as climbing, remains. Exceptional success saves the leg and most of its function and sensation. Initially it will be paralysed but in 2 to 3 days sensation and function starts to return. If surgery was performed in the first 4 hours after the artery was severed the leg recovers completely in by the time the trauma heals. Otherwise it gradually recovers over 2D10 months.

Symptoms

The bleeding can be internal if it was caused by something like a blunt force, but frequently the bleeding will be obvious as blood gushes forth from the wound.
Risks

The primary risk is that the character will bleed to death before the blood loss stops. The blood loss for a severed artery is about the same as if it was lacerated because it tends to retract and in so doing partially close of the bleeding. This, however, makes repair more difficult as well. The secondary risk is the loss of the lower leg or foot due to lack of blood supply. In 50% of cases the lower leg or foot will die if the severed artery is not repaired. The time before this happens may vary but if no surgery is attempted in the first 24 hours it can be assumed beyond recovery and dead. If it dies the muscles will liquidify and gangrene [4B] will develop. Without surgery, even if the leg survives, the lower leg will be without feeling and the character will have great difficulty standing without support and walking becomes impossible.
Surgery

502C Lacerated Popliteal Vessels

The popliteal vessels are the continuation of the femoral vessels into the calf. The artery, vein or both are damaged causing moderate or heavy bleeding.
Symptoms

Modern:

The bleeding can be internal if it was caused by something like a blunt force, but frequently the bleeding will be obvious as blood gushes forth from the wound.
Risks

Stop Bleeding (see bleeding [2]) Anastomosis, 4 first hours (tricky) Anastomosis, 5 - 8 hours (tricky) Anastomosis, 9 - 12 hours (hard) Anastomosis, 13 - 16 hours (severe) Anastomosis, 17 - 20 hours (extreme) Anastomosis, 21 - 24 hours (insane) Extract Graft Vein (easy) Depends on tools, probably more difficult. With hightech tools likely two or three difficulties lower. Bloodmagic II (moderate), Bloodmagic III (heavy), Bloodmagic IV (massive)

Medieval: Futuristic: Spell:

The primary risk is that the character will bleed to death before the blood loss stops.
Treatment

Pressure treatment as for any bleeding injury is very effective and usually the only treatment needed.

502D Severed Popliteal Artery

The popliteal artery in the calf is severed, causing moderate or heavy bleeding.

Surgery is required to save the leg in most cases. To stop the bleeding a tourniquet is usually needed because of the severity of the bleeding. This can cause problems for later surgery however as prolonged use of a tourniquet will often result in an early death of the leg as it is completely starved of all blood. Increase the difficulty by one if a tourniquet has been in place for more than 4 hours. Surgery consists of reconnecting the two ends of the severed artery in a procedure known as anastomosis. The time since the artery was severed determines the chance 142

of successfully saving the leg and so the difficulty of the operation. Usually a small part of the damaged artery must be removed before the connection is made. If the damaged part is too long, a graft is needed to connect the ends. This will be the case 20% of the time. The graft consists of a vein from another part of the body. Usually the saphenous vein from the other leg. The vein is usually taken from the patients body but another character can be used to donate a vein. The use of a graft does not change the difficulty of the anastomosis surgery, but a separate easy operation is needed to extract the vein to be grafted. Regardless if a graft was needed or not the degree of success or failure determines the legs recovery. In all cases of failure the leg is paralysed without feeling or movement. In all cases of success the leg swells and warms with feeling and function gradually returning.

503 Foot
The anatomy of the foot is similar to a larger version of that of the hand. It has many groups of bones with large muscles close to the ankle and many smaller muscles further out in the foot. The smaller muscles are not vital to the function of the foot. Nearly all fractures of the foot are open fractures because the bones are so close to the skin.

503A Broken Toe

The fracture itself is not especially disabling, except for the pain, but the blood supply is often cut off by the damage
Risks

Exceptional failure means that the leg had to be amputated to save the characters life. Normal failure means the leg does not have an adequate blood supply and will die and develop gangrene [4B] in 1D10 days. Marginal failure means that the leg looks like it will make it and it survives for 3D10 days before it dies and gangrene [4B] develops. Marginal success saves the leg but it will be useless and paralysed. Normal success saves the leg. It will initially be paralysed but in 2 to 3 days sensation and function starts to return. Full recovery can be slow. If surgery was performed in the first 4 hours after the artery was severed the leg recovers completely by the time the trauma heals. Otherwise it gradually recovers over 1D12 months, increasing its ability to hold more and more weight. First the character will be able to walk with support, then without and eventually an awkward jog will be possible but never a run. A permanent 1D penalty to all actions depending on the leg, such as climbing, remains. Exceptional success saves the leg and most of its function and sensation. Initially it will be paralysed but in 2 to 3 days sensation and function starts to return. If surgery was performed in the first 4 hours after the artery was severed the leg recovers completely in by the time the trauma heals. Otherwise it gradually recovers over 1D12 months.

There is a 50% risk that blood starvation leads to the death of the toe. If this happens the toe will turn blue and cold. Gangrene develops in 1D12 weeks and the toe must be amputated. The loss of a toe is not serious, but if more or less all toes are lost it may affect balance.
Surgery

Modern: Medieval: Futuristic: Spell:

Vascular Repair (tricky) Amputation (easy) Lowtech Vascular Surgery (hard) Amputation (easy) Hightech Vascular Surgery (tricky) Amputation (easy) Regrow II

A compromised blood supply can be repaired with careful surgery but can be difficult. Amputation is of course easy.

143

504 Nerves
A nerve is a bundle of conducting fibres, which like a cable transmits commands from the brain to the muscles and sensations back again. The impulses carrying the signals along the nerves can be thought of as electrical impulses. In fact they are waves of depolarisation caused by an electric current, heat, pressure or chemicals. The transmit rate varies from a hundred meters per second for the thickest nerves to one meter per second for the slowest. Reflex reactions are usually transmitted through fast nerves, while more detailed sensations travel through the slower nerves. Nerves die after only seconds without blood. Luckily any remaining stagnant blood in the vessels, even after blood is cut off, is enough to keep a nerve alive for a few minutes. Nerves, except for in the brain and spinal cord, heal if the path between the broken nerve endings is not blocked. Sensation and muscle control below a severed nerve is impossible. The degree of paralysis below the injury therefore depends on how large and central the nerve was.

the action is for an extended duration or the terrain is challenging. Long leg braces and other leg supporting equipment may alleviate some or all of the problems when worn. The nerve will usually heal, but often surgery is required to repair the damage and remove clotted blood, bone fragments or otherwise relieve the nerve of unwanted pressure. Untreated, continuous damage to the nerve results in what is effectively a severed femoral nerve. If no surgery is attempted roll 1D100. On 1-10 the damage will get worse and result in a severed femoral nerve [504B]. On a 11-50 the nerve will not heal and the damage becomes permanent. Otherwise it heals as normal and the character makes a full recovery.
Diagnosis

Modern: Medieval:

EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision

Futuristic: Spell:

504A Damaged Femoral Nerve

The femoral nerve is contused or lacerated. Either as a direct result of the trauma or as a result of swelling or other pressure. Motor function and sensation is impaired beneath the site of injury. The femoral nerve group helps control the straightening of the leg and supplies sensation to the front of the thigh and part of the lower leg.
Symptoms

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.
Treatment and Surgery

The leg is weak, numb and often in pain. The knee is especially weak, which makes walking up or down stairs, steep hills and climbing in general more difficult. The knee will be numb and have difficulty locking when the leg is fully extended and so be unstable.
Risks

Modern: Medieval: Futuristic:

Microsurgery (tricky) Splintering (tricky)

No repair possible Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Balance, climbing and similar actions involving use of the knee suffer a 1D impairment penalty. When running faster than a jog there is an increased risk of falling due to the weakened knee. Make an attribute roll, typically Agility, against a difficulty of easy. Make several rolls if

Spell:

Initial treatment is usually immobilisation of any fractures to prevent further injury. Treatment consists of surgery to relieve pressure from such things as bone frag144

ments, blood cloths and swelling and to make repairs to allow the nerve to heal. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

Diagnosis

Modern: Medieval:

EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision

Futuristic: Spell:

504B Severed Femoral Nerve

The femoral nerve is completely severed disabling all motor function and sensation beneath the site of the injury. It can be a direct result of trauma inflicted or as a result of pelvic fractures or surgery to close the femoral artery. The femoral nerve group helps control the straightening of the leg and supplies sensation to the front of the thigh and part of the lower leg.
Symptoms

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.
Treatment and Surgery

Modern: Medieval: Futuristic:

Loss of movement and sensation in the leg. Especially noticeable is a weakness in the knee which makes walking up or down stairs, steep hills and climbing in general more difficult. Also the knee will be numb and unable to lock when the leg is fully extended and so be unstable.
Risks

Microsurgery (hard) Splintering (tricky)

No repair possible Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Spell:

While the severing of the femoral nerve does not result in paralysis it will have a serious impact on the use of the leg. Balance, climbing and similar actions involving use of the knee suffer a 1D impairment penalty. When jogging or running there is an increased risk of falling due to the weakened knee. Make an attribute roll, typically Agility, against a difficulty of easy for jogging and tricky for running. Make several rolls if the action is for an extended duration or the terrain is challenging. Long leg braces and other leg supporting equipment may alleviate some or all of the problems when worn. Without surgery there is a 25% chance that the nerve endings will grow back together. This should be adjusted up or down to reflect the actual extent and type of trauma inflicted.

Initial treatment is usually immobilisation of any fractures to prevent further injury. Treatment consists of surgery to ensure the path between nerve endings is not blocked by bone fragments, blood cloths or other objects. This allows the nerve endings to grow back together. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

504C Damaged Sciatic Nerve

The sciatic nerve is contused or lacerated. Either as a direct result of the trauma or as a result of swelling or other pressure. Motor function and sensation is impaired beneath the site of injury. The sciatic nerve is the main nerve of the leg and the largest nerve in the body. It is formed in the pelvis from several spinal nerves. It is deeply buried in muscles as it runs its course down the back of the thigh. Above the 145

knee it divides into tibial and peroneal nerve branches which supply all the structures below the knee.
Symptoms

Futuristic:

Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Spell:

The leg is weak, numb and often in pain.

Risks

The nerve damage results in a limping walk with no possibility of moving faster and a 2D permanent impairment to climbing or other actions requiring the use of the leg. That is, the impairment penalty from the trauma will never reduce to below 2D unless the nerve heals or is repaired. The nerve will frequently heal, but often surgery is required to repair the damage and remove clotted blood, bone fragments or otherwise relieve the nerve of unwanted pressure. Untreated, continuous damage to the nerve can result in what is effectively a severed sciatic nerve. If no surgery is attempted roll 1D10. On a 1 the damage will get worse and result in a severed sciatic nerve [504D]. On a 2 - 5 the nerve will not heal and the damage becomes permanent. Otherwise it heals as normal and the character makes a full recovery.
Diagnosis

Initial treatment is usually immobilisation of any fractures to prevent further injury. Treatment consists of surgery to relieve pressure from such things as bone fragments, blood cloths and swelling and to make repairs to allow the nerve to heal. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

504D Severed Sciatic Nerve

The sciatic nerve is completely severed disabling all motor function and sensation beneath the site of the injury. The sciatic nerve is the main nerve of the leg and the largest nerve in the body. It is formed in the pelvis from several spinal nerves. It is deeply buried in muscles as it runs its course down the back of the thigh. Above the knee it divides into tibial and peroneal nerve branches which supply all the structures below the knee.
Symptoms

Modern: Medieval:

EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision

The leg is completely limp and without feeling.

Risks

Futuristic: Spell:

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.
Surgery

A paralysed leg is already pretty bad and the greatest risk is that it becomes permanent. If not surgically treated quickly the nerve endings may not grow back together and the paralyses becomes permanent. Without surgery there is a 25% chance that the nerve endings will grow back together. This should be adjusted up or down to reflect the actual extent and type of trauma inflicted.

Modern: Medieval:

Microsurgery (tricky) Splintering (tricky)

No repair possible

146

Diagnosis

Modern: Medieval:

EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision

Starting from the sciatic nerve above the knee, the tibial and peroneal nerve branches supply all the structure below the knee.
Symptoms

Chronic pain, numb calf and no sensation in the top of the foot and ankle.
Risks

Futuristic: Spell:

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.
Surgery

While damage to the tibial or peroneal nerve does not result in paralysis it will have a serious impact on walking and running. Any manoeuvre that requires movement such as jogging, running and balancing suffers a 1D impairment penalty. The nerve will frequently heal, but often surgery is required to repair the damage and remove clotted blood, bone fragments or otherwise relieve the nerve of unwanted pressure. Untreated, continuous damage to the nerve can result in what is effectively a severed sciatic nerve. If no surgery is attempted roll 1D10. On 1 the damage will get worse and result in a severed sciatic nerve [504D]. On a 1 - 5 the nerve will not heal and the damage becomes permanent. Otherwise it heals as normal and the character makes a full recovery.
Diagnosis

Modern: Medieval: Futuristic:

Microsurgery (hard) Splintering (tricky)

No repair possible Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Spell:

Modern:

Initial treatment is usually immobilisation of any fractures to prevent further injury. Treatment consists of surgery to ensure the path between nerve endings is not blocked by bone fragments, blood cloths or other objects. This allows the nerve endings to grow back together. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision

Medieval:

Futuristic: Spell:

504E Damaged Tibial or Peroneal Nerve

Tibial or Peroneal Nerve Palsy The tibial or peroneal nerve is contused or lacerated. Either as a direct result of the trauma or as a result of swelling or other pressure. Motor function and sensation is impaired beneath the site of injury.

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.
Surgery

Modern: Medieval:

Microsurgery (tricky) Splintering (tricky)

No repair possible 147

Diagnosis

Futuristic:

Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Modern: Medieval:

Spell:

EMG & nerve conduction (tricky) EMG with MRI (tricky) Nerve damage cannot be detected, only guessed from symptoms which could also be muscle damage. Hightech Scan (easy) Healing Vision

Initial treatment is usually immobilisation of any fractures to prevent further injury. Treatment consists of surgery to relieve pressure from such things as bone fragments, blood cloths and swelling and to make repairs to allow the nerve to heal. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

Futuristic: Spell:

Diagnosis attempts to determine the severity, location and cause of the nerve damage. EMG and nerve conduction tests can be used for this purpose and to differentiate between nerve damage and muscle damage. MRI can also be useful for visualising the damage and detecting bone fragments before surgery.
Treatment and Surgery

504F Severed Tibial or Peroneal Nerve

Tibial or Peroneal Nerve Palsy The tibial or peroneal nerve is completely severed. Starting from the sciatic nerve above the knee, the tibial and peroneal nerve branches supply all the structure below the knee.
Symptoms

Modern: Medieval: Futuristic:

Microsurgery (hard) Splintering (tricky)

No repair possible Hightech Microsurgery (tricky) Nanosurgery (easy)

Regrow III

Spell:

Chronic pain, numb calf and no sensation in the top of the foot and ankle. The ankle and foot is weakened. This causes an abnormal walking pattern known as the slapping gait.
Risks

Initial treatment is usually immobilisation of any fractures to prevent further injury. Treatment consists of surgery to ensure the path between nerve endings is not blocked by bone fragments, blood cloths or other objects. This allows the nerve endings to grow back together. See microsurgery under modern surgery for details on how surgery may be able to repair the nerve. If microsurgery is not used reduce the degree of success by one. Making a normal success the best possible result. Marginal success stays as marginal success. The degree of success determines how much functionality was regained as explained under microsurgery.

The slapping gait caused by the loss of the nerve comes from the fact that the foot cannot be held horizontal when lifted, causing the toes to drag when walking. This makes walking a challenge and the foot is lifted higher than normal and swung forward and then down to land hard on the heel, making a slapping sound. All movement speeds are halved and any manoeuvre that requires movement such as jogging, running and balancing suffers a 1D impairment penalty. Without surgery there is a 25% chance that the nerve endings will grow back together. This should be adjusted up or down to reflect the actual extent and type of trauma inflicted.

148

505 Hip Joint

The hip is a ball and socket joint between the thighbone (femur) and the pelvis. It is very stable, set firmly deep in the socket, reinforced by strong tendons and held in place by the strongest muscles in the body.

blood vessels and damage nerves. Roll 1D100 on the table below.

1D100
1-5 6 10 11 15 16 30 31+

505A Dislocated Hip

It requires a high impact force to pop the thighbone out of its socket and so it is not common. When it does happen there is usually massive damage to the whole area. Fractures in the pelvis, legs and back are especially common as is damage to nerves and blood vessels.

Hip Dislocation Risk Complication The femoral artery is severed resulting in heavy bleeding [502A]. The femoral vessels are damaged resulting in moderate bleeding [502A]. The sciatic nerve is severed [504D] for posterior dislocations and femoral nerve [504B] for anterior dislocations. The sciatic nerve is damaged [504C] for posterior dislocations and femoral nerve [504A] for anterior dislocations. No complication

There is also a 30% chance of developing arthritis as a complication of the dislocation. The protective cartilage covering the bone is damaged or fragments of bone and soft tissue are trapped in the joint space. This leaves the joint permanently painful and stiff, resulting in a permanent 1D impairment for any action where the leg is involved. Every year there is a 20% chance that the condition gets worse. Every time the condition gets worse so does the pain and stiffness, resulting in an additional 1D impairment penalty. This condition is known as osteoarthritis and can only be treated by surgery to replace the hip. See total hip replacement under treatment for hip fracture [505B]. Another common complication is osteonecrosis [5] resulting from the loss of blood supply to the bone. There is a 5% risk if the dislocation is repaired in the first five hours. For every hour beyond this the risk increases by 5% but never beyond a maximum risk of 60%. Make only one roll once the repair is done or the risk reaches 60%.
Diagnosis

A posterior dislocation is the most usual, where the head of the thighbone is pushed out and back. This leaves the hip in a fixed position, bent and twisted in towards the middle of the body. If the blow comes from behind it likely results in an anterior dislocation, where the thighbone slips out and forward. The hip will only be slightly bent and the leg will twist out and away from the middle of the body.
Symptoms

Modern: Medieval: Futuristic: Spell:

Physical Exam (easy) X-Ray Scan and CT Scan (easy) Physical Exam (easy) Physical Exam (easy) Hightech Scan (easy) Healing Vision

Extreme pain and inability to move the leg. If there is nerve damage there may be no feeling in the foot or ankle.
Risks

If the blow is from behind the result is an anterior dislocation, otherwise it is a posterior dislocation. If not specified it will be a posterior dislocation in 80% of cases. In addition to any other damage caused by the force that dislocated the hip, the dislocated thighbone may disrupt

Diagnosis is easy just by looking at the position of the leg. X-rays and CT scans (computer tomography) are needed to show if the pelvis is fractured or leg broken.

149

Treatment

Modern: Medieval: Futuristic: Spell:

Manipulate Back in Place (tricky) Unassisted Manipulation (tricky) Manipulate Back in Place (tricky) Unassisted Manipulation (tricky) Manipulate Back in Place (tricky) Unassisted Manipulation (tricky) Regrow III

The greatest risk of complication is from osteonecrosis [5]. The only way to prevent the risk of this happening is by replacing the thighbone head with a prosthesis. Otherwise there is a 60% risk of necrosis developing.
Diagnosis

Modern: Medieval: Futuristic:

X-Ray Scan and CT Scan (tricky) Can be diagnosed but extent of fracture cannot be determined. Hightech Scan (easy) Healing Vision

Other injuries are usually given priority, especially if the character is unconscious. The bone can be manipulated back into position by a skilled doctor. The character should be sedated or anaesthetics administered because of the extreme pain involved during the whole procedure. An assistant is required to provide stabilizing pressure to the pelvis. If an assistant is not available increase the difficulty to tricky. Another x-ray or CT scan should be used to confirm the bones are in the proper position. Surgery is usually only used when there are other complications which also require surgery. However. each failed attempt increases the risk of osteonecrosis by 20%. Therefore if the first couple of attempts fail surgery may be a better alternative since it does not increase the risk. The dislocation will heal slowly and healing times will be three times as long as normal. The character should remain immobile for at least two weeks to ensure correct healing. As the character gets better the pain will disappear and it becomes possible to walk again using some sort of support, like a cane. Unless there has been nerve damage the limp eventually disappears and there is a full recovery.

Spell:

An x-ray or other form of scan is needed to determine where the fracture has occurred and how far out of place the pieces have moved.
Surgery

Modern:

Internal Fixation (tricky) Head Replacement (tricky) Total Hip Replacement (tricky) Failed Prosthesis Replacement (tricky) Surgery will usually not be an option. Any hightech surgery is likely one or two difficulties lower than for modern surgery. Regrow III

Medieval: Futuristic:

Spell:

Surgery consists of either anchoring the thighbone head back in place with a large screw or replacing the head of the thighbone with a prosthesis. If delayed more than three days difficulties will increase by one for each day thereafter. A third alternative is a total hip replacement, which will always be possible and have the same difficulty regardless of any delays. The first method of fixing the fracture with a screw is called internal fixation. It may involve using screws, rods, plates and pins to reattach the thighbone head and keep it secure and stable. This is a permanent repair but it has a 60% risk of osteonecrosis developing. Recovery times are five times the normal. The first week is spent in bed recovering from the operation. For the next five weeks or so the leg cannot bear any weight or the hip will fracture again. This means bed rest or assisted movement, usually using crutches. After this the leg will be able to bear some weight and a cane or walking stick is enough to get around until it heals completely. 25% of hip fractures cannot be treated with internal fixation because of damage and misalignment of the bone. In these cases only a prosthesis or total hip replacement can 150

505B Hip Fracture

Femoral Neck Fracture A break near the top of the thighbone (femur) where it angles into the hip socket.
Symptoms

Unable to stand on leg, severe pain and swelling around the hip. The leg is often shorter and turns abnormally outwards or inwards.
Risks

Hip fractures will not heal without surgery.

help the character. Surgeons will often prefer to do a prosthesis anyway, because of the high risk of osteonecrosis. The second method of replacing the head and neck of the thighbone with a prosthesis is easier than a total hip replacement. Also with a recovery time only twice as long as normal it heals significantly faster than with an internal fixation. The character can move with assistance already on the day after surgery. The leg can bear some weight right away but assistance or crutches are needed for the first three weeks. After this a walking stick or cane is enough until the hip heals completely. There is no risk of osteonecrosis with this technique but the prosthesis, which is usually of metal, will not last forever. 10% of hip fractures cannot be treated with this method and require a total hip replacement due to damage to the socket in the pelvic bone. A total hip replacement involves replacing both the upper thighbone and the socket in the pelvic bone with a prosthesis. Effectively replacing the entire joint. Recovery times are as normal and so very fast for a hip fracture. Walking using a cane or walking stick is usually possible a couple of days after surgery. No risk of osteonecrosis and speedy recovery are the upsides. The downside is an increased risk of future dislocations [505A]. Whenever the character performs any intensive action that involves the hip there is a 1% risk of dislocation. Such actions include heavy lifting, jumping, running, climbing and so on. Also the prosthesis will not last forever. Whether a total hip replacement or just a replacement of the thighbone head, the prosthesis will not last forever. A high quality prosthesis will usually last a minimum of five years. The next five years after that there is a cumulative 1% risk that the prosthesis fails. Roll once each year. Thus after ten years there is a 5% risk that the prosthesis fails. After ten years the risk increases to 5% per year. The risk is still cumulative and so after fifteen years the risk of prosthesis failure is 30%. If the character is very active, like most adventuring characters, the risk is greater. The prosthesis should still last five years but then for the next five years the risk increases by 2-5% rather than 1%. After ten years the risk increases by 10-20%. Running, jumping, heavy lifting, crawling and climbing are especially bad for the artificial joint. A failed prosthesis will make moving the leg gradually more painful and difficult. Each week the impairment increases by one until the leg can no longer be moved and causes constant pain.

Usually the failed prosthesis has come loose or been worn down and the failed part can be replaced with a tricky surgery. In all cases sexual activity is not recommended for at least the first month of recovery.

506 Knee
Patella The knee joint is made up of four bones. The two main bones are the thighbone and shinbone, while the fibula and kneecap provide stability. The knee joint functions like a hinge, allowing forward and backward motion. Four strong ligaments, several tendons and strong muscles hold the knee joint together while still allowing some side-to-side motion. The meniscus is a disk-like pillow made up of two pieces of cartilage to form a cushion between the thighbone and shinbone.

Knee fractures can be treated as any other bone fractures. The kneecap tends to break into fragments which usually heal well. 151

506A Closed Knee Fracture

The kneecap tends to break into fragments which usually heal well. A closed knee fracture like this can be treated like any closed fracture [1A].

Surgery

Modern:

Surgical Stitching (tricky) Kneecap Removal (easy) Splintering (tricky) Kneecap Removal (tricky) Hightech Surgical Repair (tricky) Kneecap Removal (easy) Regrow III

506B Open Knee Fracture

The kneecap tends to break into fragments which usually heal well. An open knee fracture like this can be treated like any open fracture [1B].

Medieval: Futuristic: Spell:

506C Fragmented Knee

Comminuted Knee Fracture The knee is splintered into fragments which unlike normal knee fractures do not align well. Surgery to repair or remove part of the kneecap (patella) will be necessary for it to heal properly.
Risks

Splintering will not help the healing, but it may prevent further injury and allow some movement if immobilised properly. The kneecap must either be held together with surgical stitching (sutures) or removed. The loss of the kneecap is not as disabling as a badly healed joint surface. The result of removing the it is a 1D impairment penalty to actions relying on the use of the knee such as jumping, climbing and running.

506D Open Fragmented Knee

Compound Comminuted Knee Fracture The knee is splintered into fragments which unlike normal knee fractures do not align well. Surgery to repair or remove part of the kneecap (patella) will be necessary for it to heal properly. It is also an open wound which has a high risk of bone infection. Treat as a fragmented knee [506C] but with risk of infection as for a open fracture [1B].
X-Ray Scan (tricky) Physical Exam (tricky) Scan (easy) Healing Vision

Without surgery it will never heal properly and so result in a permanent deformity and impairment of the knee equal to half the initial impairment. Furthermore there is a risk that ligaments and tendons have been torn. There is a 10% risk of torn knee ligaments [506G] and another 10% risk of torn knee tendons [506H].
Diagnosis

Modern: Medieval: Futuristic: Spell:

506E Shattered Knee

The knee is completely shattered beyond any hope of repair or healing. Because of the massive damage tendons and ligaments are also torn making the joint unstable and so the leg becomes impossible to stand on.
Risks

A knee fracture is pretty obvious but a careful diagnosis is needed to determine the exact extent of the damage and best treatment.

The shattered kneecap can usually just be removed surgically which leaves the character with a permanent 1D impairment penalty to actions such as climbing, heavy lifts, balancing and running due to instability of the joint. Much worse is the damage to the ligaments and tendons. See ligaments [506G] and tendons [506H] for specifics.

152

Surgery

Modern: Medieval: Futuristic: Spell:

Kneecap Removal (easy) Kneecap Removal (tricky) Kneecap Removal (easy) Regrow IV

Torn ligaments can easily be diagnosed by a skilled doctor or surgeon. A more certain and detailed diagnosis can be obtained with a MRI scan.
Treatment and Surgery

Modern: Medieval:

Therapy and Bandaging (easy) Stitching Back Together (tricky) Therapy and Bandaging (easy) Therapy and Bandaging (easy) Hightech Repair (easy) Regrow II

Removing the kneecap is not difficult but further surgery to repair ligaments and tendons are necessary.

Futuristic: Spell:

506F Open Shattered Knee

Compound Shattered Knee Same as for a shattered knee [506E]. However the shattered bone is exposed to an open wound and has the same risks of bone infection as a open fracture [1B]. Treatment is however harder because of the mess of the shattered bone. Any wound care to clean the wound will be at least hard. Any debridement surgery will be at least tricky.

If treated with bandage and therapy the ligament will heal completely but be weaker than before. Any running, jumping or other heavy strain on the knee has a 5% risk of the ligament tearing again each time. If this happens the leg suffers a 3D impairment and must heal all over again. If not treated at all, except for maybe some rest, the leg will suffer a permanent impairment equal to half the original impairment of the trauma. It will also have the risk of tearing again as mentioned above. The best treatment for durability is surgery which will allow the knee to heal completely.

506G Torn Knee Ligaments

Severed Knee Ligaments The four ligaments of the knee connect the thighbone to the shinbone. The ligaments prevent the knee from buckling inwards, outwards or to the side. Although strong, all the ligaments can be torn when the knee is damaged or cut by a piercing or slashing trauma.
Symptoms

506H Torn Knee Tendons

Severed Knee Tendons A tendon is a tough cord attaching muscles to bones and other muscles. The quadriceps tendons run across the front of the knee and provide stability from the front. The hamstring tendons connect the muscles of the thigh to the back and side of the knee. The tendons are easily injured by piercing and slashing trauma or by a crushing blow that damages the knee.
Symptoms

Pain, swelling, instability and difficulty walking or standing on the leg are typical symptoms of damaged ligaments.
Risks

Ligament damage heals poorly without surgery and is prone to future relapse.
Diagnosis

Pain, swelling, inability to straighten the knee and instability causing the character to fall over.
Physical Examination (tricky) MRI Scan (tricky) Physical Examination (tricky) Physical Examination (tricky) Hightech Scan (easy) Healing Vision
Risks

Modern: Medieval: Futuristic: Spell:

The character is unable to stand on the leg since the knee cannot be locked into place without the tendons. The severed tendon does not heal unless repaired. If not repaired the tendons function is permanently lost, making 153

walking and standing permanently impossible without aid.

Diagnosis

If the tendon is severed surgery is necessary. Successful surgery, where the tendon is stitched back together, results in a full recovery, but the foot will still need to be immobilised for about four weeks. Delay in treatment increases the difficulty. For every two weeks since the tendon was severed increase the difficulty by one. Eventually, six weeks can be assumed, the tendon ends retract and get stuck in scar tissue, the muscle shortens and withers, the tunnels through which the tendons run shrink and the joint stiffens. Late reconstruction surgery is possible but very difficult and the results are not as good leaving half the impairment.

Modern: Medieval: Futuristic: Spell:

Physical Examination (tricky) Scan (tricky) Physical Examination (tricky) Physical Examination (tricky) Hightech Scan (easy) Healing Vision

A successful diagnosis is needed to determine if the tendon is fully or partially severed and thus the best treatment. If unsure if the tear is partial, surgery is recommended.
Treatment

Modern: Medieval: Futuristic: Spell:

Cast or splint (easy) Cast or splint (easy) Cast or splint (easy) Regrow III

If no treatment is attempted the tendon will not heal, but in 50% of cases the tear is partial and will heal without surgery using a cast or Immobiliser. Only surgery can however fully restore the tendon and treatment using only a cast or splint to immobilise the leg with only a slight reduction in strength. However there is a 1% risk in the future whenever strain is put on the tendon, such as when running, climbing or jumping, that it will rupture again.
Surgery

Modern: Medieval:

Tendon Repair (tricky) Late Reconstruction (severe) Surgical repair usually not available, and if known at least two levels higher difficulty. Hightech Surgical Repair (easy) Hightech Late Reconstruction (tricky) Regrow III

Futuristic: Spell:

154

Trauma Tables
The trauma tables can be used either during or after combat. If used during combat the first paragraph in italics paints a creative picture of the damage done as experienced by the combatants. It will often need to be customised in creative terms by the GM depending on the exact nature of the attack. The second paragraph is only revealed upon examination, usually by a doctor or healer. This second paragraph includes references to the specific trauma and should be looked up for symptoms, risks and how it can be treated. Any effects of this post trauma, such as internal bleeding, will obviously be experienced whether the wound is examined or not. Bleeding and unconsciousness is
Unconscious

Unconsciousness caused by the severity of the trauma rather than any direct cause, like a fever or brain damage, lasts 1D12 hours or until roused for any trauma below mortal severity. If mortal, the unconsciousness lasts 1D12 x 2 hours and the character cannot be easily roused and will likely remain unfocused and dazed until the wound has healed enough to be a lower severity.
Dazed

Unfocused, unsteady and unable to act or react. Still able to hear and see, but the senses are dulled and the character has difficulty understanding and remembering what happened during the period he was dazed. It usually lasts 1D12 minutes but if the pain or other cause, such as lack of oxygen, is treated this is reduced to a quarter of the time.

155

Head: Superficial Wound

1D10 (1D6)

Slash
A weak spray of blood colours the hair and face before it settles into a trickle from the slash across the side of the head. Hair and face is red from blood running from a wound to the side of the head.

Crush
Headache inducing blow to the head. Nasty headache from a mild concussion [105A]. Will heal.

Pierce
The cheek is pierced and there is an open hole into the mouth.

1-2 (1)

Quick slash across the side of the head cuts of half the ear.

Smashes into the centre of the face, breaking the nose and starting a nosebleed.

Lucky hit pierces an eye. Pierced eye [102B].

3-4 (2)

A cut across the side of the head has cut off half the ear [101A]. Hit on the nose has broken it causing much pain and some bleeding.

Hits across the nose, breaking it and starting a serious nosebleed.

Hard swing to the side of the head is sure to leave the ears ringing and lobes throbbing. Impact to the side of the head leaves a cruel headache and dizziness from a mild concussion [105A].

Deep cut across the face. Nasty scar is likely from this deep facial wound.

5-6 (3)

A hit across the nose has broken it and started it bleeding. [104A].

7-8 (4)

Teeth are smashed and knocked loose, Hit to the back of the head, cracks the and the lip cut badly by slash across the skin and leaves a small bleeding wound. mouth. Hit to the back of the head causes some bleeding and a concussion [105A] Several teeth are broken and lost in a nasty cut across the mouth, splitting the lips [103AB].

Punctures the neck and releasing a spray of blood. The jugular vein is punctured causing heavy bleeding. Bleeding (Heavy)

Cuts a gaping gash in the back of the head, which bleeds profusely.

Smack across the eye. Smack across the eye causes blunt eye trauma [102C].

Splits the lip and breaks a couple of teeth. Lip is split and a couple of teeth lost [103AB].

9 (5)

No damage to skull. Bleeding (Moderate)

Cuts across the face and eye, splitting the eyeball and drawing blood.

Dislocates the jaw and knocks out sever- Punctures the windpipe, causing heavy al teeth in a stunning blow. wheezing and laboured breathing.

10 (6)

Cut lacerates an eye [102B] and leaves a Jaw is dislocated [108A] and a few teeth Windpipe [110A] is pierced causing scar across the face and eye. lost in the process [103B]. breathing difficulties.

156

Head: Nasty Wound

1D10 (1D6)

Slash
Splits the lower lip and knocks out several teeth.

Crush
Hit smack bang in the the face, splitting the lip and knocking out several teeth. Cut lip and teeth knocked out [103AB].

Pierce
Pierces deep into the neck and with a jerk the head seems to be involuntarily twisted to the left. The accessory nerve is damaged in the neck causing the head to be involuntarily twisted to the side [107I].

1-2 (1)

Cut lower lip and knocked out teeth [103AB].

3-4 (2)

Skull cracking hit to the back of the A spray of blood erupts as the ear is chopped clean off, but settles down to a head. Sent reeling forward, disoriented. steady flow from the deep gash to the side of the head. Cracked skull [109A]. Ear has been cut clean off [101A] and there is serious bleeding. Bleeding (Moderate) Blood is splattered everywhere from ghastly deep cut down the side of the face and across the ear. Staggers sideways as a hard hit to the side of the head lands with a satisfying crack.

Leaves a long cut along the side of the head. Nasty meat wound to the side of the head.

Pierces into the skull in a worrying wound.

5-6 (3)

Skull is fractured [109A] and the inner ear damaged [101B]. Bleeding (Moderate)

Cranial fracture [109A] and some bleedFractured skull [109A] and damaged in- ing. ner ear causing intracranial bleeding [100A]. The severity of the impact has caused a concussion [105A]. Pierces the throat leaving the victim gasping painfully for air as a small stream trickles down from each breath.

Cuts into the throat ripping out a large Teeth go flying in jaw breaking blow. wound that leaves the victim gasping for Wobbles in a stunned daze but does not fall, the disfigured face a ghastly sight. air.

7-8 (4)

A sucking sound from the throat and difficult breathing reveals a deep cut into the windpipe [110A].

Fractured jaw [108B], entire lower row Windpipe is punctured [110A] and vocal of teeth knocked out on one side [103B]. cord damaged [110B] from a pierced Severe concussion [105A] and danger of throat. suffocation. Ugly. Bleeding (Moderate) Blow across the face breaks the nose and Pierces the cheek. Not too deep but imleaves a rapidly swelling eye. Reels back mediately starts bleeding. from the blow with one eye closed and Facial fracture [109B] which will leave a the other squinting to see. big scar and possibly deformity, but no One eye has suffered blunt eye trauma visual impairment. [102C], the nose is broken [104A] and although conscious, vision is temporarily Bleeding (Moderate) impaired from a facial fracture [109B]. Penetrates straight throat the neck, leaving a sizeable hole. Blood gushes forth in great quantities colouring everything blood red. The carotid artery is pierced [106A]. Bleeding (Heavy)

Slashes across the face, breaking the nose, putting out an eye in a bloody mess.

9 (5)

One eye damaged [102B], broken nose [104A] and bleeding badly. Bleeding (Moderate)

10 (6)

Bleeding (Moderate) A wide, continuous spray of blood is re- Hard hit to the throat leaves the victim leased by a quick but deep slash across gasping for air. the neck. The windpipe has partially burst [110A] Partially severed carotid artery [106A]. making it hard to breathe and the vocal cord is damaged [110B]. Bleeding (Heavy)

157

Head: Grievous Wound

1D10 (1D6)

Slash
Nasty cut across the back of the head bleeds hard.

Crush
Staggers sideways from the hard hit across the ear. A small trickle of blood emits from the ear canal. Has damaged the workings of the inner ear [101B]. Some bleeding from the ear but it is not intracranial.

Pierce
Pierces and buries itself in the neck. Damaged vagus nerve [107H]. Bleeding (Moderate)

1-2 (1)

Deep cut. Bleeding (Moderate)

Deep slash down the side of the head, cuts into the air and causes serious bleeding.

A sharp blow cracks the temple. Takes an involuntary step backwards but does not falter.

Hit to the centre of the face, digs into the face, through the nose. Ugly. Broken nose [104A] and facial fracture [109B]. Bleeding (Moderate)

3-4 (2)

5-6 (3)

Non-depressed skull fracture [109A] has Fractured skull [109A] has caused severed arteries and nerves with serious trauma to the inner ear [101B] with blood leaking from the ear canal due to intracranial bleeding [100A]. intracranial bleeding [100A]. Bleeding (Moderate) Bleeding (Moderate) Direct hit leaves face in a bit of a mess, Mighty swing cuts into the cheek and nose shattered, one eye smacked shut jaw, tearing out teeth and leaving a bleeding cut across the face and broken and rapidly swelling and face strangely disfigured. jaw. Spitting blood and teeth.

Pierces the skull in a spray of blood. A small non-depressed skull fracture [109A] and serious bleeding.

Fractured jaw [108B]. Most teeth on one Shattered nose [104B], blunt eye trauma [102C] and a facial fracture [109B]. Bleeding (Moderate) side are lost or broken [103B]. Bleeding (Moderate) Cleaves the top of the skull in a cruel mess of blood, skull and hair. Bleeding (Moderate) Cold hearted skull breaking blow to the back of the head. Bullseye, literally.

7-8 (4)

Skull cracked [109A] in open fracture with brain infection risk, minor brain damage [105B], severe concussion [105A]. Bleeding (Moderate) Deep cut across face lacerates one eye, breaks the upper part of the nose bone and narrowly misses the other eye leaving a badly bleeding gash to the bone just below it.

Eye has been penetrated and destroyed in the process [102D]. Depressed cranial fracture [109A] has caused minor brain damage [105B] with frequent nausea, vomiting and dizziness. An open fracture risk of brain infection.

9 (5)

Lacerated eye is permanently blinded [102B]. Broken nose [104A] and open facial fracture [109B], serious bleeding. Bleeding (Moderate)

Sent reeling sideways, stunned by a bru- Pierces the throat, compromising the tal blow to the side of the head. ability the breathe. Complicated by significant bleeding. Temporal bone fractured [109A] causing severe damage to the inner ear [101C]. Damaged esophagus [110C] and damIntracranial bleeding [100A] evidenced aged the windpipe [110A] causing sufby bleeding from the ear. focation. Bleeding (Moderate) Violates the ear canal as it follows the path of least resistance into the side of the head Severe inner ear trauma [101C], intracranial bleeding [100A] and minor brain damage [105B].

10 (6)

Bleeding (Moderate) Cuts the throat with blood spilling forth Perfect swing at the larynx lands with in generous amounts from the wide devastating force, seemingly crushing wound. the pliable throat. Left gasping and gargling for air, pitiful and stunned. Vocal cord severed [110B] and the carotid artery severed [106A]. Suffocating from damaged windpipe [110A]. Damaged vocal cord [110B]. Bleeding (Heavy)

158

Head: Grim Wound

1D10 (1D6)

Slash

Crush

Pierce
Skull is pierced above eye, releasing a stream of blood as the body sinks to the ground. Skull fracture [109A]. Concussion [105]. The damage above the eye will lead to pressure blindness [102A]. Bleeding (Moderate), Unconscious

1-2 (1)

The face is left a bleeding wreck from a Brutal blow breaks and dislocates the upper jaw, severing tongue. Knock out. deep cut from the cheek diagonally across the face. Unconscious from a broken upper jaw Fractured cheek bone [109B]. Severe fa- [109B]. The dislocated maxilla bone has cial nerve damage [107E]. Unconscious pushed the teeth down and severed the tongue [103C]. Serious intracranial for 2D10 minutes from concussion [105A], followed by problems seeing as bleeding is hidden by the more obvious bleeding from nose and mouth [100A]. for any facial fracture. Bleeding (Moderate), Unconscious Cuts an opening in the cranium straight to the brain, deflating all will as the eyes roll back and the body collapses in a heap.

3-4 (2)

5-6 (3)

Bleeding (Moderate), Unconscious Hit between the eyes lands with a satisfy- Pierces neck with blood surging forth. Tongue out, eyes rolled back falls backing crack. Sinks into a pile of bones. wards like a felled tree. Disfiguring facial fracture [109B]. The Severed hypoglossal nerve [107J] and impact and secondary fracture damage has caused blunt eye trauma on one eye carotid artery [106A]. Depressed open fracture, unconscious until surgically repaired [109A]. Serious [102C], destroyed the other completely [102D]. Broken nose [104A]. The facial Bleeding (Heavy), Unconscious intracranial bleeding [100A]. nerve suffers very severe damage [107E]. Bleeding (Moderate), Unconscious Bleeding (Moderate), Unconscious Pierces skin and bone burrowing Sent flying by skull cracking hit to the Cuts into the forehead bone, splitting through the face and into the brain. side of the head. open the skull in a spray of blood and pieces of brain. Sinks to the ground as Massive cranial damage [109A] and res- Facial fracture [109B], minor brain the face is covered in blood. ulting in severe ear trauma [101C], intra- damage [105B] and intracranial bleedOpen skull fracture [109A], major brain cranial bleeding [100A] and minor brain ing [100A]. damage [105B]. Blood loss is bad but at damage [105B]. Bleeding (Moderate), Unconscious least most of it is running down the face, Bleeding (Moderate), Unconscious rather than filling up inside the skull. Bleeding (Heavy), Unconscious Heavy strike to the neck and jaw from the Body goes limp from chop across the neck, leaving deep cut bleeding heavily. side fractures the jaw in a spray of blood. Neck broken, immobilising head and causing terrible pain. A jugular vein is Fractures jaw [108B] and cut carotid in severed and the fractured vertebrae [7A] the neck [106A]. threatens spinal cord damage. Bleeding (Heavy), Unconscious Bleeding (Heavy), Unconscious Throat cut open, releasing a rush of Hefty hit crushes the forehead, pushing blood. Speechless, breathless and the pieces of cranium into the brain. Grim. quickly running out of blood. Open skull fracture [109A] with detached Severed windpipe [110A], damaged vo- segments of the cranium causing major cal cord [110B] and esophagus [110C]. brain damage [105C]. Intracranial bleeding inside the brain [106B]. Bleeding (Heavy), Unconscious Bleeding (Moderate), Unconscious Vicious slash perforates the skull caus- A killing blow crushes the back of the ing havoc as it cuts through grey matter. head in an explosion of skull and brain matter. Open skull fracture [109A], major brain damage [105C]. Heavy intracranial Back of head crushed [109A], massive bleeding from severed carotid inside the brain damage [105D]. Heavy intracranial brain [106B]. bleeding from severed carotid [106B]. Bleeding (Heavy), Unconscious Bleeding (Heavy), Pretty Much Dead Shatters teeth as it penetrates through the roof of the mouth, penetrating deep into the head. Mouth pierced [103A], shattered teeth [103B], minor brain damage [105C] and intracranial bleeding [100A]. Bleeding (Heavy), Unconscious Penetrates through the skull, exiting the head on the other side. Bloody and gory. Skull is fractured [109A] and brain tissue has suffered major damage [105C]. Bleeding (Moderate), Unconscious Enters through the eye, penetrating deep into the brain. Things fall apart, the centre cannot hold. Destroyed eye [102D], massive brain damage [105D]. Breathing has stopped [105E]. Intracranial bleeding [100A]. Bleeding (Heavy), Good as Dead

7-8 (4)

9 (5)

10 (6)

159

Head: Mortal Wound

1D10 (1D6)

Slash
A deep gash is cut across the neck, collapsing the body like cutting the strings on a puppet.

Crush
A blow of frightening force shatters the jaw completely. Drops unconscious to the ground like a log. Timber!

Pierce
The attack punches through the skull. Eyes roll back as the opposition faints from the shock.

1-2 (1)

The spine is completely severed and the Shattered jaw [108C]. The sheer force of Skull has been penetrated [109A] with spinal cord with it [7D]. The result is full the blow has caused minor brain damage minor brain damage [105B] and heavy body paralysis (quadriplegia). [105B]. intracranial bleeding [100A]. Bleeding (Moderate), Unconscious Bleeding (Moderate), Unconscious Bleeding (Heavy), Unconscious The cranium cracks and the attack penetrates deep into the brain tissue, in a messy and disturbing display of gore. Penetrating attack has cracked the cranium [109A] and caused massive brain damage [105D]. Bleeding (Heavy), Unconscious (dead) Puncturing the skull, the weapon comes away covered in brain and blood. The legs fail to support the body, which collapses in a heap. Attack penetrated through skull [109A] causing major brain damage [105C] and intracranial bleeding [100A]. Bleeding (Heavy), Unconscious Attack goes through ear and retracts with a squirt of blood. Collapses. Severe damage to the inner ear [101C] as well as major brain damage [105D] and intracranial bleeding [100A] Bleeding (Moderate), Unconscious Bleeding (Massive), Dead Bleeding (Heavy), Coma Hit between the eyes goes through the skull creating a peep hole to the soul. Crashing to the ground, blood pouring. Hit between eyes has penetrated the skull and caused massive brain damage [101D] and death. Bleeding (Heavy). Dead The neck is severed, separating the head Unable to halt or slow the impact, the from the body in a fatal parting. A foun- skull explodes in a rain of brain and tain of blood erupts to celebrate. bone fragments. Entering one ear and exiting the other covered in brain tissue, the body remains standing for a second before falling forward. Both ears are pierced [101C] with massive brain damage [105D] and breathing stop [105E]. Bleeding (Massive), Dead Skull is opened like an egg and the con- In a sickening sight, the face caves in tents spilled on the ground. Messy. from the sheer force of the blow. Now utterly unrecognisable. Massive brain damage resulting in death [105D]. Massive brain damage resulting in death [105D]. Bleeding (Massive), Dead Bleeding (Massive), Dead

3-4 (2)

Half the face is sliced open from a long, Direct hit to the larynx ruptures the windpipe. Wide eyed and on knees, undeep and brutal slash. Starting above able to act, speak, breathe or presumthe ear, to the neck. ably even live for very much longer. The facial nerve is totally severed [107E] Ruptured windpipe [110A], vocal cord and the fractured temporal bone has caused severe ear trauma [101C]. Deadly [110B] and esophagus [110C]. Suffocatpressure builds from the heavy intracra- ing [100B]. nial bleeding [100A]. Bleeding (Moderate), Shock Incapacitated Bleeding (Heavy), Unconscious A swift slash is greeted with a spray of A powerful upwards strike breaks off the nose and pushes it into the brain. blood as it opens the throat. Severed windpipe [110A], vocal cord [110B], esophagus [110C] and carotid arteries [106A]. Life is short. Bleeding (Heavy), Unconscious The broken nose [104A] is pushed into the brain causing massive brain damage [105D]. Bleeding (Moderate), Dead

5-6 (3)

7-8 (4)

The skull is hacked in two and the brain The side of the skull crumbles from the force of the impact, exposing soft brain compromised by the blade. Collapses like a sack of potatoes in a terrible mess. tissue. Collapses, blood streaming from the wound. Coma [10], major brain damage [105C] and breathing stop [105E] are the very Skull crushed [109A]. Massive brain damage [105D] and coma [10]. deadly results.

9 (5)

10 (6)

Neck severed with a great deal of blood No brain, no pain. spillage [100C]. Bleeding (Massive), Incredibly Dead Bleeding (Massive), Utterly Dead

160

Chest: Superficial Wound

1D10 (1D6)

Slash
Painful cut across the chest.

Crush
Hard blow to the chest will leave a colourful and painful bruise.

Pierce
Painful but shallow cut.

1-2 (1)

A long, but not deep cut.

Strong impact leaves chest black-andblue.

Deep cut has damaged some muscle but there's little bleeding.

3-4 (2)

Bleeding slash across the chest. Bleeding (Moderate)

A good hit to the chest, but nothing wants Bleeding cut. to break. Painful, sore and bruised chest but nothing broken.

5-6 (3)

Deep chest cut causes serious bleeding. A cracking blow makes a satisfying snap. Obviously painful, bleeding wound. Bleeding (Moderate) A couple of ribs have been fractured by the blow [207A].

7-8 (4)

Hard impact, but not a deep cut, forces half a step backwards.

Excellent crushing blow definitely broke Nasty hole in the chest releases a stream something. of blood that doesn't stop. Three ribs are broken causing quite a bit No serious internal damage, but bleeding. of pain and discomfort [207A]. Bleeding (Moderate)

9 (5)

Impact has fractured a rib [207A].

A deep gash reveals a fractured rib. Exposed fractured rib risks infection [207B]. Bleeding (Moderate)

10 (6)

The blow goes under the arm and hits the Attack penetrates chest leaving a nasty, upper back with a terrifying crack. deep and meaty wound. Whips back in obvious agony. Chest cavity is penetrated causing a Bad hit to the spine has fractured a ver- small sucking chest wound [204A]. Evidtebrae [7A]. Roll 1D100, on 1 - 5 para- enced by a slight feeling of dizziness and lysis from severed spinal cord [7D], on 6 a faint sucking sound. - 7 partially severed cord [7E].

161

Chest: Nasty Wound

1D10 (1D6)

Slash
Hard impacting slash cracks a rib and draws some blood.

Crush
Hard blow to the chest breaks a rib. Broken rib [207A].

Pierce
The chest is pierced leaving a deep wound. No immediate symptoms, but as lung tissue is soaked with blood and fluids from burst microvascular vessels, symptoms of pulmonary contusion [211] will start to appear in the next 2D10 hours

1-2 (1)

Broken rib [207A].

3-4 (2)

A long cut across the entire chest covers Hard impact to the chest gives a satisfy- A nasty meat wound in the chest. ing crack. the blade in blood. Blood immediately gushes forth from the cut. Grits teeth in Painful chest wound. pain. Several ribs have been broken by the impact [207A]. Bleeding (Moderate)

Deep chest gash immediately soaks clothing in blood.

5-6 (3)

Bleeding (Moderate)

The chest is punched in, breaking several Deep chest wound. ribs and forcing their sharp edges Bleeding (Moderate) through the skin. A grotesque wound [207B] with exposed ribs and bleeding. Compound rib fracture [207B].

A long diagonal cut spews forth a worrying amount of blood.

The chest gives way to the blow. Sent staggering backwards.

Chest is punctured causing a steady trickle of blood.

7-8 (4)

Bleeding (Moderate)

Multiple fractures in the ribcage resulting Muscles and blood vessels are damaged in flail chest [207E]. causing serious bleeding. Bleeding (Moderate)

Nasty, deep cut is stopped by the ribcage. Blood gushes from the chest.

Twisting to avoid the impact, the blow lands heavily between the shoulder blades, forcing a gasp of pain.

Deep puncture on the left side of the chest causes a trickle of blood.

9 (5)

Compound rib fracture [207B]. Bleeding (Moderate)

One lung is punctured with shortness of Heavy blow to the spine ruptures ligabreath and stabbing pains in the chest ments [7C]. Difficulty moving and pain [204B]. in the back and legs when doing so, evidencing the risk to the spinal cord. The attack penetrates deep into the chest cavity and comes out covered in blood. Aorta torn causing heavy internal bleeding [201A] with few immediate signs of the tragedy taking place. Bleeding (Heavy)

10 (6)

Disgusting wide and deep cut does hor- Hard impact to the centre of the chest rific damage to the chest muscles and makes a satisfying crack. severs enough veins and arteries to cause a torrent of blood. Several ribs are fractured by the heavy blow [207A] but more serious is the fact Bleeding (Heavy) that the heart has been bruised causing myocardial contusion felt as an uneven heartbeat. [202A].

162

Chest: Grievous Wound

1D10 (1D6)

Slash
The chest is slashed open and ribs broken in a bloody gash.

Crush

Pierce

The strike to the chest lands hard leaving The chest is pierced, leaving a nasty , no doubt to the damage done. bloody wound.

1-2 (1)

Large open gash reveals two fractured ribs [207B].

3-4 (2)

Rib is broken [207A] and has pierced the Serious internal bleeding [2A] resulting in lung, and so resulted in a tension pneu- a hemothorax building up [204C]. mothorax [204B]. Bleeding (Moderate) Bleeding (Moderate) Nasty, deep slash starts a sudden flow of The powerful blow creates a sharp snap- A deep puncture frays the skin and severs muscle tissues, creating a vulgar, bloody blood. ping sound as it crashes squarely into mess. the chest. Chest cavity breached resulting in a Multiple rib fractures result in flail chest Arteries and veins have been severed sucking chest wound [204A]. [207E]. Harder to detect, the impact and causing heavy internal bleeding [2A]. sharp ends of the broken ribs have Bleeding (Moderate) caused significant internal bleeding [2A], Bleeding (Heavy) a hemothorax is building up [204C].

5-6 (3)

Bleeding (Moderate) Severe hit to the back. Brought to knees. The chest is breached in a spray of blood that settles down to a steady flow from the Hard hit to the spine has dislocated a ver- meaty wound. A deep cut has caused the microvascular tebrae [7B]. Roll 1D100, on 1 - 40 paravessels of a lung to burst leading to pul- lysis from severed spinal cord [7D], on Nasty wound has done significant damage monary contusion [211] as well as intern- 41 - 50 partially severed cord [7E] with to muscle tissue, but apart from the blood severe pain, swelling and reduced ability loss nothing life threatening or too peral bleeding [2A]. to move. manent is damaged. The cut goes deep into the right side of the chest, the weapon covered in blood. Bleeding (Moderate) The slash travels down the back, cutting The hefty blow lands with such force that deep causing wide eyed and deep agony. it crushes the ribcage. Reels back several steps from the great force of the impact. Spine ligaments have been cut [7C]. Moving arms and legs is difficult, painful Several ribs have splintered into fragments [207C]. The damage to underlying and poses a risk to the spinal cord. tissues causing internal bleeding [2A] and pulmonary contusion [211]. Bleeding (Moderate) Bleeding (Moderate). The mighty cut slices through the chest with little resistance ending deep inside the chest and leaving a long slash. Blood erupts forth in a steady stream colouring everything red. No damage to internal organs but does cut deep enough to cause heavy blood loss. Bleeding (Moderate) A deep puncture tears a hole in the chest which immediately starts bleeding. Air enters the pericardial cavity. Unable to leave, the building air pressure increasingly constricts the heart in a classic pneumopericardium [202E]. For shock purposes treat the air build up as a cardiac tamponade of moderate bleeding.

7-8 (4)

Bleeding (Moderate) The heavy blow crushes the chest leaving The attack punches a large hole in the a grotesque sight of sharp edged, broken chest, blood streaming freely from the ribs protruding through the skin. wound. Tiny bubbles can be seen in the blood running from a large hole in the chest. Evidence of a sucking chest wound [204A]. Bleeding (Moderate) The attack penetrates into the chest cavity to a disturbing depth. Takes a step back in shock and pain. Heavy internal bleeding [2A] is causing a cardiac tamponade to quickly build up [202D]. Bleeding (Heavy)

9 (5)

Exposed, protruding broken ribs [207B]. More immediately fatal is the cardiac tamponade [202D] which is forming from the internal bleeding [2A].

Bleeding (Moderate) Bleeding (Heavy) A neat incision cuts a narrow but deep Direct hit to middle of the chest yields a slit from which thick blood wells forth in satisfying crack as the ribcage gives copious amounts. way. Forced down on one knee.

10 (6)

Short, deep gash bleeds profusely as the The sharp edge of one of several broken aorta artery has been damaged [201A]. ribs [207A] is pointed straight at and already touching the heart. Any further chest impacts or strenuous physical effort Bleeding (Heavy) will pierce the heart [202B], unless surgery is performed to repair the broken rib. Bleeding (Moderate)

163

Chest: Grim Wound

1D10 (1D6)

Slash
The chest is slashed open in a rush of blood, fracturing and exposing the ribs

Crush

Pierce
The attack is driven deep into the upper, right side of the chest. Spitting blood, eyes roll back and smashes into the ground. Deep, penetration has lacerated the major bronchus leading to suffocation [210] and death within minutes.

1-2 (1)

The blow lands hard on the upper back. The violence of the attack forces the shoulder out of position. Knocked down Several ribs fractured and exposed by the and dazed. open wound [207B]. More serious, the heart has been bruised causing myocardi- The scapula has been forced out of posial contusion felt as a very rapid heartbeat tion. Tearing muscles, blood vessels and nerves. The result, flail shoulder [208B]. [202A]. Bleeding (Moderate), Unconscious Thick, red blood gushes forth as the cruel cut slashes deep into the chest. Drops to knees dazed.

3-4 (2)

Deep cut has breached the chest cavity resulting in a sucking chest wound [204A]. Bleeding is bad. Bleeding (Heavy), Dazed

Bleeding (Moderate), Unconscious Bleeding (Moderate) Dazed Punches hole in chest that starts bleedBrutal attack crashes into the chest, cracking the rib cage. Drops like a sack ing. Drops to knees, gasping for breath. of potatoes. Shortness of breath and gradually turns Several ribs broken [207A], one has blue, together with the tell tale sucking pierced a lung and resulted in a puncsound, it all point to the rather large sucktured lung [204B]. Gradually the face ing chest wound [204A]. swells from traumatic asphyxia [209] Bleeding (Moderate), Dazed The attack pierces the chest and burrows deep inside the chest cavity. Immediately a stream of blood erupts from the wound, drenching everything in thick, deep red blood. Collapses.

Bleeding (Moderate), Unconscious The blade goes deep inside the chest and Brutal hit breaks the breastbone with a loud snap. Thrown backwards, landing retracts with thick blood and flesh. in a heap. Drops unconscious to the ground.

5-6 (3)

Breathing will get harder and harder as blood collects between the chest wall and lung compressing the lung and puts pressure on the heart, hemothorax [204C]. Bleeding (Moderate), Unconscious Vicious slash cuts deep, severing muscle and bone with equal ease. The broken ribs are clearly visible in the savage, bleeding wound. Drops hard.

Broken breastbone [206A] and bruised heart [202A], with the associated risk of a cardiac tamponade. Internal bleeding Arteries and the esophagus has been damaged [203A]. [2A]. Bleeding (Moderate), Unconscious The blow lands with devastating force on the spine. Knocked down, face first and still. Hit to the back has fractured the spine [7A]. Roll 1D100, on 1 - 40 paralysis from severed spinal cord [7D], on 41 - 60 partially severed cord [7E] with severe pain, swelling and reduced ability to move. Bleeding (Heavy), Unconscious The attack pierces deep into the back, between the shoulder blades. Immediately collapses. A vertebrae has been fractured [7A], with the associated risk of spinal cord damage. Roll 1D100, on 1 - 40 paralysis from severed spinal cord [7D], on 41 - 60 partially severed cord [7E] with severe pain, swelling and reduced ability to move.

7-8 (4)

Microvascular vessels in the lung have been lacerated by broken rib ends [207B]. Build up of blood and fluids in lung tissue will lead to pulmonary contusion [211] in 2D10 hours. Bleeding (Moderate), Unconscious Cut slashes across chest, severing ribs and cutting deep. Blood gushes forth.

Bleeding (Moderate), Unconscious Unconscious Square chest impact crushes the ribcage. Pierces chest straight to heart. Coughs Vomits blood and stoops forward. blood and faints. The heart has been pierced [202B] causing internal bleeding [2A] and quite likely impending death. Bleeding (Heavy), Unconscious Cruel attack penetrates deep into the chest. Splutters blood and tips forward. Main aorta ruptured where it connects to heart [201B]. Massive amounts of blood is pumped into the chest cavity [2A]. Bleeding (Massive), Unconscious

9 (5)

10 (6)

Several ribs are fractured [207A] and the Part of the ribcage fragmented [207C] deep cut bleeds heavily as the aorta artery pieces of which penetrated the heart has been damaged [201A]. [202B]. Internal bleeding [2A] and imminent death from the penetrated heart. Bleeding (Heavy) Bleeding (Heavy), Unconscious Cuts straight into the centre of the chest. The brutal force of the impact rams the A geyser of blood erupts. Falls like a log. ribcage into the chest with a great crack. Reels back spewing blood. Cut deep into the chest fractured ribs [207B] and ruptured the aorta artery Cracked ribcage [207A] severed aorta [201B] causing massive bleeding [2A]. [201B], massive internal bleeding [2A]. Bleeding (Massive), Unconscious Bleeding (Massive), Unconscious

164

Chest: Mortal Wound

1D10 (1D6)

Slash
Cuts a deep wedge into the shoulder, bleeding profusely. Legs fail, eyes roll back and collapses.

Crush

Pierce

1-2 (1)

Hurled backwards into a heap by smash Stab through the chest just below the throat leaves the victim gasping, wide hit to the heart of the chest. eyed and oblivious. The heart has stopped from a hard hit A lacerated windpipe causes suffocation Significant tissue damage to shoulder, during the most vulnerable part of its [205A]. Internal bleeding from serious large veins severed and arm is useless cycle. Death from commotio cordis due to a shoulder fracture [208A]. [202F]. Ribcage fragmented [207C] and damage to surrounding tissues [2A]. internal bleeding [2A]. Bleeding (Moderate), Dazed Bleeding (Heavy), Unconscious Bleeding (Moderate), Unconscious Harsh slash across the chest cuts deep, A whirling blow lands with frightful Left side of chest is pierced deep. heedless of ribs and muscle tissue. Drops force between the shoulder blades. heavily. Knocked down hard, face first. A massive sucking chest wound [204A]. Multiple rib fractures has resulted in a Dislocated vertebrae in the spine [7B]. flail chest [207E] and hemothorax [204C] Spinal cord damage is likely. Internal from the internal bleeding [2A]. bleeding [2A]. Bleeding (Heavy), Unconscious Bloody cut along the side of the chest leaves a large open wound, with blood rushing forth to soak clothing. Collapses. Bleeding (Moderate), Dazed The breastbone cracks audibly from the crushing blow, visibly pushing the ribcage back. Knocked back unconscious. Bleeding (Moderate)

3-4 (2)

Attack penetrates disturbingly deep into the chest cavity between the lung and the heart. Collapses like a deflated doll. A hemothorax is fast making breathing harder as heavy internal bleeding [2A] between the lungs and chest wall compresses the lungs [204C]. Bleeding (Heavy), Unconscious Penetrates deep into the chest. Hands grab feebly at the violation before going limp and falls backward. Heavy internal bleeding [2A] and a cardiac tamponade [202D]. Bleeding (Heavy), Unconscious

5-6 (3)

7-8 (4)

Severed several ribs [207B] and resulted Fractured breastbone in multiple locain a sucking chest wound [204A]. Blood tions [206B]. Heart bruised [202A], internal bleeding [2A] and punctured lung loss is heavy. with tension pneumothorax [204B]. Bleeding (Heavy), Unconscious Bleeding (Moderate), Unconscious Deep cut leaves severed ribs protruding Massive blow crushes the chest. Coughs and quickly covered in a stream of blood. blood before eyes roll back, legs turn to jelly and sinks into a pile of bones. Open rib fracture [207B]. Deep gash bleeds badly from ruptured aorta artery Fractured breastbone [206A] forced [201B], massive internal bleeding [2A]. through the heart [202B]. Internal bleeding [2A]. Bleeding (Massive), Dazed Bleeding (Massive), Unconscious

Heartless cut slices open chest. Gasps for Perfect hit between the shoulder blades air, eyes wide in shock and collapses in sounds like it shatters the spine. Evidagony. ence supported by the sudden collapse.

Blood rushes out in a massive, red stream through the large new hole in the chest. Everything is covered with blood. Blood rushes out of a large hole in the chest providing a window straight to the ruptured main aorta artery [201B].

9 (5)

Deep cut has punctured and caused Spine shattered beyond repair, spinal massive damage to both lungs as well as cord completely severed [7D]. surrounding tissues. Unable to breathe, suffocation [100B] is guaranteed. Unconscious

10 (6)

Bleeding (Massive), Dazed Bleeding (Massive), Unconscious Chest is split open like a turkey, a split Thrown back several meters as the chest The heart is impaled. Coughs blood and heart contracts uselessly at its centre, is crushed, leaving a crater of shattered shudders before collapsing. pumping blood into the open chest cavity. ribs and bloody mess. Ventricle heart chamber ruptured [202G]. Chest is slashed open and heart split in Shattered ribs [207D] and heart [202G]. Last desperate heart contractions only two [202B]. Both the ventricle chambers of the heart serving to pump massive amounts of have ruptured. Death should quickly fol- blood into the chest cavity. Bleeding (Massive), Unconscious low. Bleeding (Massive), Unconscious Bleeding (Heavy), Unconscious

165

Abdomen: Superficial Wound

1D10 (1D6)

Slash
Painful and bleeding cut.

Crush
Juicy, direct hit to the stomach. Blow to the stomach will leave a mark for a while but nothing serious.

Pierce
A grazing strike that leaves a nasty slash, but no deep wound.

1-2 (1)

Nasty red slash across the abdomen.

Hard hit to the abdomen is sure to leave Long cut, but not deep as evidenced by a mark. the lack of bleeding. No ill effects apart from a sore bruise.

3-4 (2)

Deep bleeding cut.

Hard hit to the abdomen. Painful to touch for some time and huge bruise.

Penetrates to the side of the stomach with some blood trickling from the wound.

5-6 (3)

Deep cut bleeds hard. Bleeding (Moderate)

Heavy hit sends reverberations through- Punctures the stomach in a bloody out the belly. wound. Painful, discoloured bruise is the only lasting long term effect. Scary hole in abdomen, but has not caused any internal damage.

7-8 (4)

Horrendous cut across the belly parts the Hard hit immediately starts to turn red. skin revealing muscle and large amounts of blood. Some internal bleeding [2A].

Does not pierce too deep, but the cut is long and bleeds badly. Serious wound with serious bleeding.

9 (5)

Messy and bloody wound that looks worse than it is. Bleeding (Moderate) Worryingly deep stomach wound bleeds liberally

Bleeding (Moderate) Bleeding (Moderate)

Satisfying blow to the belly knocks the wind out of the lungs.

Deep puncture releases a spray of blood. Attack has pierced the abdominal lining which means that any infection risks peritonitis [300A]. Lots of blood. Bleeding (Moderate)

10 (6)

Perforated abdominal lining. Although no The impact has caused serious internal internal organs were damaged there is a bleeding [2A]. lot of bleeding and any infection may lead to peritonitis [300A]. Bleeding (Moderate) Bleeding (Moderate)

166

Abdomen: Nasty Wound

1D10 (1D6)

Slash
Vicious cut leaves a bleeding slash across the abdomen.

Crush
Heavy hit to the solar plexus.

Pierce
Blood rushes forth in a tiny stream from the puncture to the lower abdomen.

1-2 (1)

Cut looks worse than it is. Bleeding (Moderate)

Heavy hit to the solar plexus has caused The small intestine is pierced causing a lot of pain, but apart from a sore and bruised belly there are no long term im- food and bacteria to contaminate the abdominal cavity [303A]. plications. Bleeding (Moderate)

Blood but no guts are spilled. Bleeding (Moderate)

Shockingly hard blow to the belly. Some internal bleeding [2A]. Bleeding (Moderate)

Nasty deep and bloody cut, bleeds over everything. Nasty deep cut bleeds a lot but otherwise not too bad. Bleeding (Moderate)

3-4 (2)

5-6 (3)

Rough stomach slash sprays forth blood. The agony caused by the hard hit to the abdomen is obvious from gritted teeth. Lots of blood. Dangerous internal bleeding [2A]. Bleeding (Moderate) Bleeding (Moderate)

Stab to the lower back, bleeds. One kidney is grazed by the penetrating trauma causing some back pain [305B]. Bleeding (Moderate)

Long slash across the belly releases a burst of blood that immediately steadies into a steady trickle.

The blow swings around and impacts the A hole in the upper abdomen is quickly lower back. Arches backwards, but does filled with blood that runs down across the belly button in a steady trickle. not falter. Kidney is bruised causing back pain and Despite the hole no internal organs were damaged. hardly detectable blood in the urine [305B]. Some internal bleeding [2A]. Bleeding (Moderate) Bleeding (Moderate) Blow to the middle of the back hits directly over the spine. Nasty penetrating wound immediately starts bleeding. Has pierced the peritoneum [300A] but otherwise caused no life threatening internal damage. Bleeding (Moderate) Deep puncture immediately starts to bleed. The spleen is perforated [309A]. Internal bleeding from the organ is significant. Bleeding (Moderate)

7-8 (4)

Cut bleeds hard. Bleeding (Moderate)

Very deep cut to the lower abdomen releases a small stream of blood. Messy.

9 (5)

The colon is perforated [303A] causing Heavy blow to the spine ruptures ligadigested food and bacteria to mix with in- ments [7C]. Difficulty moving and pain ternal bleeding [2A]. in the back and legs when doing so evidencing the risk to the spinal cord. Bleeding (Moderate) Cuts deep into the upper abdomen where Doubles over from hard hit to the stomthe stomach is situated, releasing a ach, but recovers immediately. steady trickle of blood. Spleen is damaged by the heavy impact Punctures the stomach allowing food and causing internal bleeding [309A]. bacteria into the normally sterile environment of the abdominal cavity [302A]. Bleeding (Moderate) Bleeding (Moderate)

10 (6)

167

Abdomen: Grievous Wound

1D10 (1D6)

Slash
A glistening blood-red slash across the belly immediately starts to bleed

Crush
Forceful uppercut lands hard.

Pierce
A deep stab to the side.

1-2 (1)

Wound bleeds a lot but no other serious internal damage. Bleeding (Moderate)

Caught between the force of the blow Only some visible blood loss with most and a rib the spleen has been torn result- of it being internal [2A]. ing in serious internal bleeding [309A]. Bleeding (Moderate) Bleeding (Moderate)

As the abdomen is pierced by the deep cut, deep red blood gushes forth in a steady stream.

3-4 (2)

Abdomen is pierced by deep cut which starts the spleen bleeding [309A]. Bleeding (Moderate)

The blow lands with an audible crack as The belly is punctured deep. it crashes into the pelvis. Penetrating trauma has lacerated the liver after bypassing ribs and piercing the surThe stable pelvis bone fracture [311A] does not prevent standing or running, but rounding tissues [306A]. Luckily the does cause an awkward gait. The damage damage is not great but there is internal bleeding from the liver [2A]. has led to internal bleeding [2A]. Bleeding (Moderate) Bleeding (Moderate) Pierces the lower back, just missing the spine. Gasps in pain.

5-6 (3)

The belly is pierced by the deep cut and for a second it seems to hesitate. Then a surge of deep red blood pours forth in a mighty river of blood. The liver has been cut causing heavy bleeding [306A]. Bleeding (Heavy)

Hard hit to the lower back.

Hard hit to the spine has dislocated a vertebrae [7B]. Severe pain, swelling and re- Direct hit to one kidney [305C] has perduced ability to move and great danger of manently damaged its function and serious spinal cord damage. causes moderate internal bleeding [2A]. Bleeding (Moderate)

7-8 (4)

9 (5)

10 (6)

Heavy hit to the stomach is greeted with Deep stab right in the middle of the belly a grunt and wheeze. Struggling to regain draws blood. breathing. Although bleeding is serious and the peritoneum has been pierced no internal The impact has damaged the spleen Spine ligaments have been cut [7C]. Moving arms and legs is difficult, painful [309A] causing internal bleeding [2A]. organs suffered serious damage. Not seriThe bleeding and damage is significant ous as long as an infection does not deand poses a risk to the spinal cord. velop into peritonitis [300A]. but survivable. Bleeding (Moderate) Bleeding (Moderate) Bleeding (Moderate) Cut disappears deep into the upper ab- A powerful uppercut cracks the bottom Deep puncture into the stomach starts a domen, leaving a nasty wound, dripping rib and knocks the air out of the lungs. small but steady trickle of bleeding. with blood. A lower rib is fractured [207A] and the Stomach has been punctured allowing Cut has punctured the stomach, allowing sharp end lacerates the liver [306A]. food and bacteria into the normally food and bacteria into the normally Heavy internal bleeding from the liver sterile environment of the abdominal sterile environment of the abdominal [2A]. cavity [302A]. cavity [302A]. Bleeding (Heavy) Bleeding (Moderate) Bleeding (Moderate) The cut burrows far into the abdomen, The full force of the impact reverberates The middle of the abdomen is punctured creating a gruesome wound. through the abdomen, knocking the wind by a deep stab. out of the poor sod's sails. Deep cut has damaged the aorta artery The great vessel has been pierced causcausing heavy internal bleeding [301A]. The renal artery has been ruptured from ing heavy internal bleeding [301A]. the impact causing heavy internal bleedBleeding (Heavy) ing [305E]. Bleeding (Heavy) Swift cut to the back causes a stumble, and crash to the ground, following by agonised squirming. Bleeding (Heavy)

168

Abdomen: Grim Wound

1D10 (1D6)

Slash
A slash across the stomach exposes the intestines in a mess of blood and gut.

Crush
A crushing hit to the pelvis forces a faltering step and collapse.

Pierce
A bloody wound is cut deep into the stomach. The legs falter and no arms reach out to stop the fall.

1-2 (1)

3-4 (2)

Nasty cut across the abdomen has cut The impact has created an unstable pelinto the intestines [303B] causing havoc vis fracture [311C]. Unable to stand until Deep trauma has damaged the pancreas [308A], caused internal bleeding [2A] and and bleeding [2A]. immobilised. If woman uterus also injured [313A]. If man scrotum also par- a large tear in the diaphragm [315B]. tially hit [313D]. Internal bleeding [2A]. Bleeding (Moderate), Dazed Bleeding (Moderate), Unconscious Bleeding (Moderate), Dazed Punctures the belly in a spray of blood, A long slash across the upper abdomen Doubles up from a severe blow to the stomach and crashes, face first, with the leaving a nasty, fleshy wound and unconslices deep. Collapses. scious body. ground. The pancreas is damaged [308A] and The kidney has been pierced and desthere is a lot of bleeding from a very long The liver is lacerated [306A] and the pancreas damaged [308A]. There is in- troyed [305D] causing massive internal and deep slash across the upper abdobleeding [2A]. ternal bleeding from the liver [2A]. men. Bleeding (Moderate), Unconscious Deep slash opens the stomach in a ghastly wound. Gasps in pain, dazed. Bleeding (Moderate), Unconscious Bleeding (Massive), Unconscious

A thrashing blow to the pelvis lands with Pierces the abdomen deeply, but only a small wound with light bleeding. Deflated the sharp snapping sound of bone, and unconscious. knocking life out of legs and limbs. Direct hit to the spleen is causing heavy internal bleeding with a deceptively small amount visibly bleeding from the wound [309B].

5-6 (3)

The stomach has been cut open emptying all its contents into the abdominal cavity A complicated unstable pelvis fracture [311D] has done serious internal dam[302B]. age. There is at least some internal bleeding [2A] and if the major artery has been Bleeding (Moderate), Dazed cut it will be massive. A short but very deep cut draws forth a rush of blood, quickly soaking clothes with blood and forming a pool around the collapsed body.

Bleeding (Heavy), Unconscious Bleeding (Moderate), Unconscious Vanquished by a heavy blow to the back, Burrows right into the spine in what could have been a poorly attempted spinas the body goes limp and drops like a al tap. rock. A vertebrae has been fractured in the spine with the associated risk of spinal cord damage [7A]. Bleeding (Moderate), Dazed

7-8 (4)

Hit to the lower back has fractured the The liver has been badly lacerated caus- spine with the associated risk of spinal cord damage [7A]. ing heavy bleeding [306A]. Bleeding (Heavy), Unconscious Unconscious

The bowels are eviscerated in a nasty, The abdomen takes some serious punish- Cuts through skin and muscle to penetwide cut across the belly. Blood and guts ment from direct hit to the stomach that rate deep into the abdomen and protrudspill out. Gutted! knocks the lights out. ing out the back. Knocked out.

9 (5)

The intestines are damaged and spill out The impact has ruptured the aorta artery The liver is lacerated [306A] and the panunless held in place [303B]. Bleeding is [301B] causing massive internal bleeding creas ruptured [308B]. There is internal bad. [2A]. bleeding from the liver [2A]. Bleeding (Heavy), Dazed Bleeding (Massive), Unconscious Bleeding (Moderate), Unconscious Skewered by penetrating trauma as blood pours forth from both ends of the wound. Faints. The trauma has ruptured the aorta artery [301B] and damaged the intestines [303B]. Bleeding (Massive), Unconscious

10 (6)

The cut is buried deep in the gut opening The abdomen is massacred by a smash a nauseating wound. The legs crumple hit causing vomit to spew forth before and a pool of blood start growing sinking to the ground. around the body. The spleen has been ruptured by the Deep cut has sliced open the liver caus- heavy impact causing massive internal ing massive bleeding [306B]. bleeding [309C]. The diaphragm also suffered a small tear [315A]. Bleeding (Massive), Unconscious Bleeding (Massive), Unconscious

169

Abdomen: Mortal Wound

1D10 (1D6)

Slash
The stomach is perforated in a spray of blood. Eyes roll back. Body sinks to the ground.

Crush
Sent reeling by a walloping hit to the stomach.

Pierce
Blood squirts from the wound as the stomach is pierced deep. Sinks to the ground dazed and oblivious. The stomach is pierced, the ruptured sack emptying its contents in the usually sterile cavity in the abdomen [302B]. Bleeding (Moderate), Dazed A deep puncture in the abdomen emits a jet of dark, red blood. Sinks to the ground as the pouring blood drenches clothes and stars gathering in a pool.

1-2 (1)

The spleen has been ruptured by the The stomach has been perforated [302A] heavy impact causing heavy internal and a lot of damage leading to life threat- bleeding [309C]. ening blood loss. Bleeding (Heavy), Unconscious Bleeding (Heavy), Unconscious Deep cut devastates the intestines and leaves blood pouring forth in ample amounts. Falls to the ground. Heavy blow to the back seems to crack the spine. Sent hurling to the ground, face first.

3-4 (2)

Devastated intestines [303B] with heavy Heavy blow to the back has dislocated vertebrae in the spine [7B]. Spinal cord The liver has been ruptured causing bleeding. damage is likely. Internal bleeding [2A]. massive internal bleeding [306B]. Bleeding (Heavy), Unconscious Bleeding (Massive), Unconscious Bleeding (Moderate), Unconscious Slash leaves a deep and bloody laceration across the abdomen. Collapses. Hefty blow to the belly knocks out both wind and dinner. Sinks unconscious to the ground in a mess. Nasty, bleeding stab wound. Doubles over and collapses. The pancreas has been ruptured in a rather nasty stab wound [308B]. Bleeding (Moderate), Unconscious

5-6 (3)

Intestines [303A] and liver [306A] have been lacerated causing heavy internal Both the pancreas [308B] and the stombleeding. ach [302B] has ruptured. Significant internal bleeding as well. Bleeding (Heavy), Unconscious Bleeding (Moderate), Unconscious Crumples and topples over from a hard, Goes limp and crumples to the ground from mortally deep cut into the stomach. rib shattering blow to the upper abdomen. Deep cut has sliced open the liver causA hard blow has fragmented the ribs ing massive internal bleeding [306B]. [207C] and ruptured the liver [306B]. The force of the impact has also torn the Bleeding (Massive), Unconscious diaphragm [315B]. The internal bleeding from the liver is severe. Bleeding (Massive), Unconscious Deep and wide slash opens the stomach Crushing impact shatters spine in lower in a spray of blood. The legs buckle, but back. Collapses vanquished and useless. the blood keeps coming. Shattered spine beyond repair and comDamaged intestines [303A], split open pletely severed spinal cord [7D]. Has the stomach [302B] and most seriously also done severe damage to both kidneys cut into the spleen causing massive inresulting in acute kidney failure [305A]. ternal bleeding [309C]. Unconscious Bleeding (Massive), Unconscious Disembowelling cut splits the belly wide The devastating high force impact colopen. Entrails spill to the ground along lapses the pelvis, crushing bone which with stomach contents. Blood is everypierces the skin in a bloody, gruesome where as the body sinks to the ground. mess. Sent spinning to the ground. Intestines disembowelled [303B]. Stom- Shattered pelvis [311E] and ruptured ach ruptured [302B], pancreas [308A] bladder [312] and main aorta artery and liver [306A] are both damaged. [301B]. Bleeding (Massive), Unconscious Bleeding (Massive), Unconscious

The abdomen is deeply pierced emitting an instant stream of deep, red blood. Knees buckle and give in. Having been punctured the spleen is losing a lot of blood [309C]. Bleeding (Heavy), Unconscious

7-8 (4)

9 (5)

The guts are punctured in a deep, probing stab to the lower abdomen. Doubles over with a gasp and ends up on the back, hands clasping the wound, dazed. Serious intestinal damage [303B] and rupturing the bladder [312A]. Heavy internal bleeding [2A]. Bleeding (Heavy), Dazed The stomach is rudely ruptured and torn. Falls headlong to the ground as blood starts streaming from the cruel wound. Massive internal damage. Liver ruptured [306B], stomach punctured [302B] and pancreas badly cut [308B]. Bleeding is massive, mostly from the liver. Bleeding (Massive), Unconscious

10 (6)

170

Arm: Superficial Wound

1D10 (1D6)

Slash
Nasty slash down the arm. Nasty cut but it will heal.

Crush

Pierce

Impact leaves the arm banged up, but not Small puncture in lower arm with some broken. very light bleeding. Will be sore and bruised but otherwise will heal fine. Wound hardly even bleeds and will heal without trouble.

1-2 (1)

3-4 (2)

Deep, bleeding cut along the upper arm. Flinches from the pain but the arm remains largely intact. Deep cut but no lasting damage. More painful than anything.

Pierces the upper arm in a small spray of blood that immediately settles down to a little stream. Some bleeding from the rather deep wound.

Long cut up along the arm immediately starts bleeding.

Heavy blow lands on the upper arm caus- Cuts through muscles in the upper arm ing a gasp of pain. leaving a deep, bleeding laceration. Nothing is broken, although the pain could make you think so. Muscles are pierced but will heal perfectly.

5-6 (3)

No permanent damage.

Winces from the pain of a serious, bleed- Hits the upper arm hard leaving a darkening bruise. ing cut along the lower arm.

Nasty, large, bleeding wound is cut in the arm.

7-8 (4)

Painful and serious cut, but nothing that A large black and blue bruise on the arm A large red wound that looks much is a certainty but it will heal completely. worse than it is. wont heal is hurt. Bleeding (Moderate)

Blood spurts from a rather deep slash along the length of the arm.

Crushing blow to the lower arm lands satisfyingly with a crack. The radius bone in the lower arm has been fractured [1A].

9 (5)

Deep cut has severed a large vein. Bleeding (Moderate)

A deep wound in the upper arm which bleeds significantly running down the length of the arm and dripping from the fingers. Bleeding is significant from the small but deep wound. Bleeding (Moderate)

A nasty gash in the arm leaks a lot of blood that drips and streams, covering everything in blood.

Crashes into the lower arm with a loud snap.

Wrist is pierced and blood pulsates forth running down the hand and dripping from the fingers.

10 (6)

Nothing beyond the obvious bleeding. Bleeding (Moderate)

The impact has fractured the ulna bone in the lower arm [1A]. A severed artery is losing a lot of blood. Bleeding (Moderate)

171

Arm: Nasty Wound

1D10 (1D6)

Slash
Evil bleeding cut. Evil cut that bleeds a lot.

Crush
Hard hit to the upper arm.

Pierce
Nasty, bleeding wound to the arm.

1-2 (1)

Muscles are bruised badly but no perman- Nasty wound has done very little serious ent damage. damage. Bleeding (Moderate)

Bleeding (Moderate)

Quick slash severs a finger from the hand.

3-4 (2)

Severed finger [403D].

Nice hit to the lower arm seems to snap a Ugly cut has the forearm is pierced. bone. Ugly cut narrowly misses arteries but The radius bone in the lower arm has does damage the ulnar nerve [404C]. been fractured [1A].

A long cut is made that starts bleeding quite a lot.

Direct hit to the upper arm impacts with a satisfying crack.

5-6 (3)

Length of cut causes moderate blood loss. Bleeding (Moderate)

The humerus bone of the upper arm has been partially fractured by the heavy impact [1A]. The radial artery has been punctured, the heavy bleeding [401C]. Bleeding (Heavy)

A spray of blood is followed by a pulsating stream of blood as the forearm is punctured. Blood pours forth covering everything.

7-8 (4)

Heavy, downward swing to the lower arm The forearm is pierced and bleeding. The forearm is cut deeply and blood streams forth running down to the hand seems to snap something. Punctured ulnar artery [401C]. and dripping from the fingers. The impact has fractured the ulna bone in Bleeding (Moderate) the lower arm [1A] damaging the ulnar The ulnar artery has been cut [401C]. nerve in the process [404C]. Bleeding (Moderate)

A deep, bleeding laceration is cut into the lower arm.

Hard hit to the forearm, leaves a rapidly Muscles are cut forming a deep, bleedspreading dark, red bruise. ing wound. Hard hit has broken the radius [1A] which has torn the artery [401C]. Bleeding (Moderate) Blood loss is the only immediate danger. Bleeding (Moderate)

9 (5)

Damaged ulnar nerve [404C]. Bleeding (Moderate)

10 (6)

The wrist is slashed leaving a deep gash Hits the hand crushing the fingers with a A finger is severed from the hand, but bleeding hard, drenching everything in satisfying crunch. left dangling on a piece of skin. blood. Two fingers are crushed by a heavy blow Severed finger [403D]. Heavy bleeding from a lacerated radial to the hand [403E]. artery is the most serious part of the deep cut [401C]. Bleeding (Heavy)

172

Arm: Grievous Wound

1D10 (1D6)

Slash
Slash severs two fingers from the hand. Two fingers are severed from the hand [403D].

Crush
Cracks the bone in the lower arm.

Pierce
Pierces the lower arm leaving a bleeding wound.

1-2 (1)

The ulnar bone in the lower arm has been fractured [1A]. The radial nerve has been damaged [404C]. Bleeding (Moderate)

Slices deeply across the top of the forearm, releasing a pulsating stream of blood.

Heavy hit to the forearm lands with a bone crushing force. The radius bone [1A] has been fractured damaging the radial nerve [404C].

Nasty puncture pierces the biceps muscle leaving a gaping, bleeding wound. Upper arm is pierced and the brachial plexus nerve damaged [404A]. Bleeding (Moderate)

3-4 (2)

The ulnar nerve has been damaged by the cut [404C] and the artery starts bleeding [401C]. Bleeding (Moderate) Slash across the wrist leaves a bloody gash.

The blow breaks a bone in the lower arm The arm is punctured and starts bleedand cracks the skin in a spray of blood. ing. A lot of blood. The lower arm radius bone has been broken [1A] damaging the artery [401D]. Bleeding (Moderate) Bleeding (Moderate)

5-6 (3)

Four tendons are severed in the wrist disabling two fingers [405C]. Bleeding (Moderate)

7-8 (4)

Heavy cut lands on the forearm with a The wrist snaps from the mighty impact. snap and releases a pulsating stream of The wrist has been fractured by the blow blood. [405A]. Hard impact has fractured the radius bone [1A], the cut bleeds from a damaged radial artery [401C]. Bleeding (Moderate) A long and deep cut opens the artery in The skin and bone cracks from the force the forearm as evidenced by a fountain of the blow and blood pours forth in a of blood spraying everything with blood heavy stream. in a pulsating geyser of blood. The radial bone has been broken [1A] damaging the radial nerve [404C] and the Damaged radial nerve [404C] and severed artery [401D]. radial artery [401C]. Bleeding (Heavy) Bleeding (Heavy)

Muscles are torn and bleed as the arm is punctured. Meaty wound bleeds a lot. Bleeding (Moderate)

The forearm is punctured and starts bleeding. The ulnar nerve has been severed [404D]. Bleeding (Moderate)

9 (5)

10 (6)

Hard hit cracks the wrist and cuts the The shoulder crumbles from the powerful artery which sprays blood everywhere in blow. a rhythmic geyser of blood. The collarbone has been fractured [407A] Hit to the wrist has caused a wrist frac- and shoulder tendon torn [406C]. ture [405A] and severed the artery [401D]. Bleeding (Heavy)

Direct hit penetrates right through the forearm, bleeding hard. The radius bone has been fractured [1A] and the radial artery severed [401D]. Bleeding (Heavy)

173

Arm: Grim Wound

1D10 (1D6)

Slash

Crush

Pierce
The hand is pierced, leaving a red, gaping hole. The hand has been pierced, the injury disabling it from further use while it heals [403C].

1-2 (1)

The thumb is severed from the hand and Heavy blow dislocates the shoulder. a nasty, bloody gash left in its place. The shoulder has been dislocated from the The thumb is severed from the hand heavy blow making it impossible to move [403F ]and the hand badly cut [403C]. the arm. Intense pain [406A]. Bleeding (Moderate)

Heavy hit to the forearm cuts a deep, bloody cut.

Hard hit dislocates the shoulder from its socket.

Penetrates the upper arm somewhere between the biceps and triceps.

3-4 (2)

The ulna bone is fractured [1A] and the A complicated shoulder dislocation with A deep wound to the upper arm has damaged tendons has occurred, disabling damaged the brachial plexus nerve artery damaged [401C] and nerve [404A]. the arm [406B]. severed [404D]. Bleeding (Moderate) Cut to the bone in the lower arm. A loud crack can be heard as the impact strikes the lower arm. The forearm is hit hard, flesh torn revealing the white of the bone. Blood starts streaming from the wound.

5-6 (3)

The radius bone has been fractured, the cut exposing the bone [1B]. The nerve The radius bone in the lower arm has been has also been damaged [404C]. fragmented by the hard impact [1C]. Ar- The radius bone has been broken from teries and nerves can easily be damaged the hard hit, the white of the bone visible in the vicious, open wound [1B]. by careless handling. Bleeding (Moderate) Hard impact on the wrist cuts a shallow Crushing blow to the upper arm lands but wide slash. with a satisfying crack. The thumb is severed from the hand.

7-8 (4)

The thumb has been severed from the Hit to the wrist has caused a complic- The humerus has been broken [1A] sever- hand [403F ] making the hand quite useated wrist fracture [405B] and severed 7 ing the brachial plexus nerve [404B]. The less. tendons [405C]. arm is completely limp and without sensation.

9 (5)

The triceps are sliced in a deep cut and Downward swings smashes the wrist leav- Hard hit cuts deep into the upper arm bleed heavily in regular squirts that ing the hand at an odd angle and cracks and leaves a deep, bleeding wound. drench everything in blood. the skin. Some light bleeding The humerus bone has been broken The humerus bone in the upper arm has The wrist has been smashed dislocating [1A] damaging the brachial plexus been broken [1A] and a damaged bra- the bones in a complicated wrist fracture nerve [404A]. Careless handling could chial artery bleeds heavily [401A]. [405B]. Nine of the tendons to the arm are sever the nerve completely and also severed in the process [405C]. damage or sever the artery. Bleeding (Heavy) Bleeding (Moderate) The hand is severed from the arm in a Crushing blow to the elbow leaves it de- Penetrates through the forearm in a spay of blood. formed and the arm at an odd angle. spray of blood. Severed hand [403A]. Fractured elbow [402A] making the arm difficult to move at the elbow. The elbow is deformed and the lower arm will slowly turn pale, blue, cold and numb. Its blood supply has been cut off [401D] and the nerves are damaged [404C]. Bleeding (Moderate) The lower arm has been hit and the ulna bone broken [1A]. The nerve [404D] and artery [401D] both severed. Bleeding (Heavy)

10 (6)

Bleeding (Heavy)

174

Arm: Mortal Wound

1D10 (1D6)

Slash
Powerful cut across the lower arm lands with a snap and leaves broken bone protruding through the bleeding wound.

Crush
The bones in the forearm are crushed and so deformed by the force that one is left severely protruding from the wound. The lower arm is horribly deformed at an impossible angle, blood running in a little stream down the protruding bone.

Pierce
Direct hit to the shoulder leaves a bleeding laceration. Direct hit to the collarbone has fractured it [407A].

1-2 (1)

Deep cut across the lower arm breaks Bleeding (Moderate) the radius bone, the damaged bone visible in the middle of the bleeding wound Fragmented ulna bone [1C], fractured and protruding radius bone [1B]. Unstable [1B]. fracture and arteries and nerves could easily be severed by careless handling. Bleeding (Moderate) Bleeding (Moderate) Slashes through muscle tissue, likely all The bone in the upper arm snaps and is the way to the bone with blood rushing left protruding through an open wound. forth. Protruding humerus bone [1B]. Careless Deep cut severs muscle, nerves [404B] handling can easily sever the brachial artery and nerve. and arteries [401B] in the upper arm. Bleeding (Heavy) A jet of blood is emitted as the hand is severed with a savage slash. The lower are is punctured and left bleeding heavily. Direct hit to the radius bone has fragmented it [1C] severing the nerve [404D] and artery [401D] in the process.

3-4 (2)

5-6 (3)

Severed hand [403A]. Bleeding (Heavy)

Bleeding (Heavy) Brutal blow completely crushes the hand, Direct hit to the elbow penetrates to the bone, leaving an open wound with proleaving it mangled and broken. truding bone and serious bleeding. The hand has been completely crushed by Direct hit to the elbow fractures it and the heavy blow [403B]. exposes the bone in an open elbow fracture [402B]. Bleeding (Moderate) Bleeding (Moderate) The upper arm is pierced deeply and immediately a surge of blood pours forth in epic proportions. The humerus bone is only bruised but the massive wound bleeds profusely from the severed brachial artery [401B].

7-8 (4)

With a mighty swing the arm is severed Brutal impact to the elbow splits open the skin and crushes muscle to reveal the below the elbow in a spray of blood. broken bone below in a bloody wound. The arm has been severed below the elOpen displaced elbow fracture [402D]. bow [400C]. The displacement of the elbow severed the arteries and nerves in the arm, cutting off Bleeding (Heavy) the blood supply to the lower arm. A wheeling swing severs the arm half way down from the shoulder, leaving a bloody stump gushing with blood.

Bleeding (Massive) Bleeding (Moderate) Crashes into the upper arm, crushing the The lower are is pierced, leaving a bone with its fierce force. bleeding hole straight through the arm.

9 (5)

10 (6)

Fragmented humerus bone [1C], severing The ulna bone is fractured [1A] and the both the brachial artery [401B] and the ulnar artery [401D] and ulnar nerve brachial plexus nerve [404B]. The bleed- [404D] severed. ing is internal [2A]. Bleeding (Moderate) Bleeding (Massive) Bleeding (Heavy) The arm is chopped off at the shoulder Crushing blow breaks the hefty bone in Pieces deep into the upper arm just bein a rain of blood than turns into a wide the upper arm in two and leaves one end low the shoulder. spray. sticking out of the arm. The large wound bleeds hard, drenching the arm in blood. The upper arm has been hit and the huThe arm has been completely severed at merus bone broken [1A]. The brachial the shoulder and has dropped to the Open displaced humerus fracture [1B]. plexus nerve is damaged [404A] but not ground [400A]. Both the brachial artery [401B] and the completely severed. brachial plexus nerve [404B] severed. Bleeding (Massive) Bleeding (Moderate) Bleeding (Heavy) The arm has been severed below the shoulder and fallen to the ground [400B].

175

Leg: Superficial Wound

1D10 (1D6)

Slash
Painful and deep cut. That's it, painful and deep, what more do you want from the lowest roll of a minor leg wound?

Crush

Pierce

1-2 (1)

Blow to the thigh is mostly absorbed by Lightly pierces the thigh. the muscles, but will likely leave a bruise. Small but painful cut. Big leg bruise.

A bloody cut across the calf bleeds lightly.

Hard hit just above the knee. Painful and colourful.

Penetrates the heavy muscle tissue of the thigh. Some bleeding from the deep wound.

3-4 (2)

No complications.

Long slash down the leg starts bleeding. Juicy blow to the thigh. No complications. Will leave huge bruise but otherwise no lasting complications.

Pierces the calves. Cut muscles and some bleeding.

5-6 (3)

Bleeding (Moderate)

Painful, bloody cut across the shin. No complications.

Hard hit just below knee cracks the skin.

Leaves a fairly deep, bleeding cut just below the knee.

7-8 (4)

Skin is broken but no significant bleeding Wound bleeds some but no other comor other complications. plications.

A nasty cut into the thigh immediately starts bleeding.

9 (5)

Direct hit to the shin lands with a delight- Small bleeding, puncture wound in the ful snap, almost certainly the music of thigh. broken bones. No complications beyond the bleeding. Small wound that bleeds more than it The lower leg tibia [1A] has been fracshould. Bleeding (Moderate) tured by the impact. Bleeding (Moderate)

Rough cut across the heel bites deep and draws blood.

10 (6)

Cut has severed the achilles tendon [501C]

Hefty blow to the knee leaves the kneecap Direct hit to the achilles heel. deformed and broken. Hit has broken the achilles tendon Hit to the knee fractures the kneecap [501C]. [506A].

176

Leg: Nasty Wound

1D10 (1D6)

Slash
A long cut down the leg immediately starts bleeding.

Crush
Hard hit bounces of the thigh muscles. Painful bruise, that's all.

Pierce
Pierces the calf muscles in a deep wound. Deep penetrating hit has damaged nerves in the lower leg [504E].

1-2 (1)

A long cut down the leg that is losing serious amounts of blood. Bleeding (Moderate)

Painful looking slash across the heel. Achilles tendon has been cut [501C].

Good hit to the calf. The tibia is fractured [1A].

Pierces the thigh muscles in a deep wound. Thigh is pierced but only some blood is drawn.

3-4 (2)

Nasty, bleeding cut across the shin. Will heal.

Mighty swing catches the foot with toe crushing force. Crushed 1D10 / 2 toes [503A].

Cuts across the heel. Achilles tendon has been cut [501C].

5-6 (3)

Bleeding (Moderate)

Cuts deep into the thigh, leaving a bleeding laceration.

7-8 (4)

Deep thigh cut. Bleeding (Moderate)

Crashes into the knee with crushing force. Immediately starts bleeding from a very deep puncture wound in the thigh. Hit to the knee fractures the kneecap Thigh-muscles penetrated almost to the [506A]. bone. Bleeding (Moderate)

9 (5)

Fierce swing to the calf lands with a crack as it cuts deep into the calf muscles, releasing a small but steady stream of blood. Tibia has been fractured [1A]. Bleeding (Moderate)

Lands hard on the heel, cracking the skin The calf is pierced and starts bleeding. and starting a light bleed. Only bleeding. Achilles tendon has been ruptured by the impact [501C]. Bleeding (Moderate)

10 (6)

Slices across the back of the knee, leav- Brutal hit to the thigh lands with crushing Cuts deep into the tissue as penetrates ing a nasty bleeding cut. Ouch. force. through the side and out the back of the knee. Knee ligaments at the back and sides of The femur in the thigh has fractured from the knee have been severed [506H] by a the impact [1A]. Knee ligaments are severed [506G]. nasty cut. Bleeding (Moderate)

177

Leg: Grievous Wound

1D10 (1D6)

Slash

Crush

Pierce

1-2 (1)

Slash across the shin immediately starts Ankle is broken by the heavy impact of the Bites deep into the ankle. to bleed badly. blow. Achilles tendon severed [501C]. Deep cut bleeds badly. Ankle has been fractured by impact [501B]. Bleeding (Moderate)

Slashes across the ankle and heel. Achilles tendon cut [501C].

3-4 (2)

Severe blow to the thigh lands with a loud Burrows deep into the thigh. snap. The sciatic nerve has been damaged The femur in the thigh has been broken by [504C]. the impact [1A]. Bleeding (Moderate)

Deep cut across the side of the knee draws of blood.

Compassion less blow cracks the shin bone. The tibia is fractured in the lower leg [1A], damaging nerves [504E].

Pierces deep into the upper thigh. The wound immediately starts bleeding. The femoral nerve has been damaged [504A]. Bleeding (Moderate)

5-6 (3)

Knee ligaments have been severed [506G]. Bleeding (Moderate)

7-8 (4)

Swing hits the shin hard cutting straight Brutal swing fractures the shin bone. to the bone. The tibia is fractured in the lower leg [1A], damaging the popliteal vessels The tibia is fractured and there is a [502C]. nasty open bleeding wound [1B]. Bleeding (Moderate) Bleeding (Moderate)

Pierces deep into the upper thigh. The wound immediately starts bleeding. Muscle tissue has been seriously damaged by a deep wound. Bleeding (Moderate)

9 (5)

Deep cut across the calf is greeted by a Direct hit shatters the kneecap. spray of blood, that settles into a heavy flow of blood down the leg. Direct hit has fragmented the kneecap [506C] severing the femoral nerve [504B]. The tibial nerve in the lower leg has been damaged [504E] and the popliteal artery severed [502D]. Bleeding (Heavy) The thigh is sliced like a piece of ham, Heavy blow to the the thigh lands with cutting deep in a spray of blood. The bone breaking force. gory wound bleeds hard, drenching the leg in blood. The femur in the thigh has been broken [1A] damaging the sciatic nerve [504C] The femoral artery in the thigh has been and the femoral artery [502A] resulting in lacerated [502A]. heavy internal bleeding [2A]. Bleeding (Heavy) Bleeding (Heavy)

Pierces deep into the thigh triggering a steady trickle of bleeding. The popliteal artery [502C] and the peroneal nerve [504E] have been damaged. Bleeding (Moderate) Drills deep, disappearing into the thigh. The femoral artery has been punctured [502A] leading to heavy internal bleeding [2A]. Bleeding (Heavy)

10 (6)

178

Leg: Grim Wound

1D10 (1D6)

Slash
Tears into the side of the knee, leaving a bleeding cut all the way through the back of the knee.

Crush

Pierce

1-2 (1)

The kneecap is cracked by crushing blow. Nasty laceration in the lower leg as its pierced deep. Starts bleeding. Direct knee hit has fragmented it [506C] and torn the knee tendons [506H] and the Penetrating hit in the lower leg has seriTendons in the knee have been severed femoral nerve [504A] at the same time. ously damaged muscle tissue, the tibial [506H] by a deep and nasty cut. nerve [504E] and lacerated the popliteal artery [502C]. Bleeding (Moderate) Bleeding (Moderate) Heavy swing lands with bone breaking vi- Penetrates through the kneecap. olence. The knee has been fractured [506A] and femoral nerve severed [504B] by a dirThe tibia has been fractured and left ex- The femur in the thigh has been broken [1A] damaging the sciatic nerve [504C]. ect hit. posed by the open wound [1B]. The tibial nerve is also severed [504F] and the popliteal artery lacerated [502C] Slices through the shin bone leaving it protruding in an ugly, bloody wound. Bleeding (Moderate) Cuts across the kneecap, leaving it Hefty hit to the hip cripples the leg, leavbroken and exposed in a messy wound. ing it crooked and bent unnaturally inwards. Hit to the knee has fractured it, the cut exposing the bone [506B]. The cut also The heavy impact has resulted in a hip severs the knee tendons [506H]. fracture [505B]. Unable to stand on the leg which is painful, swollen around the hip and turned unnaturally inwards. Deep cut across the back of the thigh draws blood. Crushes the knee. Drills deeply into the lower leg, tearing skin and muscle tissue. The tibia bone has been fractured [1A] and the nerve severed [504F].

3-4 (2)

5-6 (3)

Penetrates straight through the thigh and bleeds badly from both ends. The popliteal artery has been severed [502D] and the sciatic nerve damaged [504D]. Bleeding (Heavy)

7-8 (4)

The knee has been fractured [506C] with The sciatic nerve has been severed at torn knee ligaments [506G] and tendons the back of the thigh paralysing the leg [506H]. The femoral nerve has been severed [504B]. [504D]. Bleeding (Moderate) Slices through thigh muscles in a bloody cut, leaving a wide open gash. With only a slight hesitation blood surges forth. the femoral artery [502B]. Bleeding (Heavy) The leg is nearly hacked off below the knee, bone and muscle tissue severed and heavy bleeding. The thigh is clobbered, visibly breaking the thigh bone and will likely leave a massive bruise. The femur in the thigh has been broken [1A] severing both the sciatic [504D] and the femoral [504B] nerves.

Cuts deeply across the ankle. The achilles tendon has been severed [501C] along with the nerves [504F] in the ankle.

9 (5) A deep cut into the thigh has severed

The shin is broken by a crippling bone Punctures deep into the thigh with a that splits the skin with the bone protrud- steady flow of blood running down the ing and heavy bleeding. leg. The tibia has been broken [1B] severing The femur in the thigh has been fracthe tibial nerve [504F] and popliteal artery tured [1A] and the sciatic nerve dam[502D]. aged [504C]. Bleeding (Heavy) Bleeding (Moderate)

10 Although still attached by a bit of skin (6) and muscle tissue the leg is practically
severed below the knee [500B]. Bleeding (Heavy)

179

Leg: Mortal Wound

1D10 (1D6)

Slash
Cuts to the shin bone but does not stop there. The bone is severed and visible for a second before streaming blood fills the wound and rushes down to the foot.

Crush
The knee is massacred by a pulverizing blow.

Pierce
Deep, bleeding puncture through the lower leg.

1-2 (1)

Heavy blow to the knee shatters it [506E], The tibia has been broken [1A] and the tearing cartilage and ligaments in the pro- blood vessels damaged [502C]. cess [506G]. Bleeding (Moderate) Deep cut in the lower leg has broken the tibia bone, leaving it exposed [1B]. Bleeding (Moderate) Bites deep into the thigh releasing a steady stream of blood running down the leg. Hefty blow crushes the hip, the force and Cuts deeply across the heel, bleeding broken bone shredding muscle and skin, hard. leaving a messy, bleeding wound. The achilles tendon has been severed [501C] along with blood vessels [502D] Deep cut has severed the femoral nerve Hip fracture [505B]. Worse the femoral and nerves [504F] in the ankle [504B] and damaged the sciatic nerve vein has been damaged [502A] and the femoral nerve severed [504B]. [504C] and femoral artery [502A]. Bleeding (Moderate) Bleeding (Moderate) Bleeding (Moderate) Sideways impact cracks the knee, tearing Spray of blood as it penetrates to the A low but sinister cut severs the foot thigh bone in a large, fleshy wound, tissues and leaves a bleeding wound. from the leg. Blood gushes forth. which bleeds heavily. The foot has been severed from the leg Fractured knee [506A], torn tendons Open femur fracture [1B]. The femoral [506H], cartilage and ligaments [506G] [500B]. artery damaged [502A] and the femoral and severed the femoral nerve [504B]. nerve completely severed [504B]. Bleeding (Heavy) Bleeding (Moderate) Bleeding (Heavy) Direct hit to the knee has smashes it Blow knocks the hip out of its socket, A spray of blood as the leg is nearly crushing bone which punctures the skin, into fragments, exposing the bone in an hacked off just above the knee. ugly, open wound. leaving a mangled, bleeding leg. The leg has been more or less severed Open knee fracture [506B]. The femoral above the knee. Some muscle tissue and Dislocated hip [505A]. Both thighbone skin still keeps the leg hanging in place and pelvis bone is fractured [1A] severing nerve severed [504B] and both the knee the femoral nerve [504B] and damaging ligaments [506G] and tendons [506H] [500A]. are torn. both the sciatic nerve [504C] and blood vessels [502A]. Bleeding (Heavy) Bleeding (Moderate) Bleeding (Moderate) Mighty swing cleanly severs the leg be- Crushes the shin bone, shredding the del- Pierces through the lower part of the low the knee in a shower of blood. The icate skin. Blood flows freely from the leg and bleeds heavily. blood loss is horrific. wound. The popliteal artery [502D] and tibial The leg has been cleanly severed below The tibia has been fragmented by the im- nerve [504F] have been severed. the knee [500B]. pact [1C], severing the popliteal artery [502D] and tibial nerve [504F]. Bleeding (Heavy) Bleeding (Massive) Bleeding (Heavy) Heroic swing cuts clean through the thigh, severing the leg completely in a spray of blood. The blood keeps coming in disturbing quantity. The thick thigh bone is broken, its sharp edge pushed through the leg tissue. Disturbingly jutting out at a straight angle, blood rapidly pumped along its length. Punches its way right through the leg above the knee, leaving a large, shocking, see-through hole that immediately erupts in a fast flowing, pulsating stream of blood.

3-4 (2)

5-6 (3)

7-8 (4)

9 (5)

10 The leg has been cut off above the knee The femur completely broken and jutting (6) and completely detached from the host. out [1B]. The sciatic nerve [504D] and The sciatic nerve [504D], femoral nerve
The blood loss is horrendous [500A]. Bleeding (Massive) Bleeding (Massive) Bleeding (Massive) femoral nerve [504B] along the bone also [504B] and femoral artery [502B] are all severed, as is the femoral artery [502B]. severed.

180

Electricity Burn
Only grim and mortal electricity and lightning burns are rolled on this table. Less severe electricity burns are treated like any other burn, with the damage handled as explained under burns [6]. All electricity burns are considered to leave a bad burn at the point of contact as described under burns [6] in addition to the trauma in the table below.

Electricity Burn: Grim & Mortal Wounds

1D10 (1D6)

Head
The current burns a deep mark across the nose and forehead and both eyes bulge and explode. Utterly destroyed eyes [102D]. Blind

Chest

Abdomen

The body is convulsed like a rag doll and The body is convulsed like a rag doll tongue bitten clean off. and tongue bitten clean off. The convulsions have caused ribs to frac- Convulsed jaws severed tongue [103C]. ture [207A] and puncture the lung [204B]. Convulsed jaws severed tongue [103C]. Dazed

1-2 (1)

3-4 (2)

5-6 (3)

Dazed Collapses with shake and a rattle as the Arcs and sparks fly from the head in all The electric current burns through the directions leaving horrific burn marks chest leaving clothes smoking and a smell current tears through the body. to the face and skull. Collapses. of burnt flesh. Collapses as if strings cut. The liver has been torn by the current [306A]. Horrificly scarred face, minor brain Heart Attack [202C]. damage [105B] and coma [10]. Bleeding (Heavy), Unconscious Unconscious, Dying Unconscious An electric halo forms around the head, A black patch is burned through clothes Filaments of electricity arc across the the eyes roll back and body collapses. and etched into the chest. Spasms and col- body in all directions, creating the light show for a bizarre dance of convulsion lapses. to the tune of crackling current. ColMajor brain damage [105C]. lapses in a final bow as the show stops. Heart Attack [202C]. Unconscious The spleen is ruptured by the current Unconscious, Dying [309C]. In a brief flash the skull can be seen il- Thrown back by the shock and collapses luminated through the skin. in a heap. Bleeding (Heavy), Unconscious Sparks fly and clothes smoke in a terrific electrocution. Collapses. The stomach has been ruptured by the current [302B] with its deadly risk of Peritonitis [300A]. Unconscious Massive current tears through the body setting clothes on fire and a sickly smell of barbecue. The great vessel has been ruptured by the current [301B]. Bleeding (Massive), Unconscious Arches backwards in spasms with visible current and sparks across the body, clothes and hair catching fire. Internal organs cooked. Dead

7-8 (4)

Minor brain damage [105B] results in coma [10] and breathing stop [105E] that leads to death.

Heart Attack [202C]. Unconscious, Dying

9 (5)

Unconscious, Dying Sparks emit from the head in a show of Arms are flung wide, eyes wide and teeth mini fireworks that peaks as the hair barred in a death grin as the legs fail. catches fire. Heart is ruptured by the current [202G]. Brain is heated to a pulp, massive brain damage resulting in death [105D]. Bleeding (Massive), Unconscious Dead An electric arc forms between the eyes, Arches backwards in spasms with visible which start emitting smoke and a smell current and sparks across the body, of burnt brain. clothes and hair catching fire. Brain is burnt to cinders. Dead Internal organs cooked. Dead

10 (6)

181

Electricity Burn: Grim & Mortal Wounds

1D10 (1D6)

Arm
The jolt of the current is enough to twist the arm in an unhealthy direction with an audible snap.

Leg
The leg shakes violently as it is burnt by the powerful current. The tibia is fractured in the lower leg [1A].

1-2 Broken radial bone [1A]. (1)

The jolt of the current is enough to twist the arm in an unhealthy direction with an audible snap.

The leg shakes violently as it is burnt by the powerful current. The femur in the thigh is broken [1A].

3-4 Upper arm humerus bone broken [1A]. (2)

As the arm is burnt by the current it is also twisted out of its socket.

A loud crack announces the breaking of bones by the merciless current racing through the leg as it convulses muscles and burns flesh. the sciatic nerve [504C].

5-6 Dislocated shoulder makes it impossible to move the The femur in the thigh has been broken [1A] damaging (3) arm, intense pain [406A].

The arm is twisted around and burnt in a shower of electric sparks.

The crackling current whips the leg about violently in a freakish dance that leaves the leg out of shape and a lingering smell of burnt flesh. nerves [504E].

7-8 The radial bone has been broken [1A] damaging the The tibia is fractured in the lower leg [1A], damaging (4) radial nerve [404C] and the radial artery [401C].
Bleeding (Heavy) Violent spasm visibly dislodges the arm from its sock- The current twists the leg out of its joint, leaving it at an et, leaving it not only burnt but at an impossible and impossible angle and severely scorched. clearly uncomfortable angle. Dislocated hip [505A]. Complicated shoulder dislocation has damaged tendons disabling the arm [406B].

9 (5)

The loud crackle of the current fails to mask a very loud crack as the arm convulses and burns from the deadly current. nerve [404B]. Arm is completely limp and without sensation.

The powerful current surges through and breaks the leg in a violent spasm.

Broken tibia bone [1A] severs the popliteal artery [502D] 10 Broken humerus [1A] has severed the brachial plexus and tibial nerve [504F]. (6) Bleeding (Heavy) 182

Wings
Any post trauma to the wings should be rolled on this table. For winged creatures with arms any attack that hits the arms have a 50% chance of hitting the wings instead. The tables were created primarily for bat and dragon wings, rather than those of birds, but the difference is small enough that is should not matter much. The wings are not normally important to immediate survival (unless in mid-flight of course), although may bleed if they are damaged, and it does hurt. Impairment to the wings will affect any flying or glide rolls as tears and punctures affect aerodynamics. Any damage suffered during flight should require an immediate roll with this impairment to avoid falling. Grim and mortal wounds are so damaging that flight is usually impossible, although a flying roll might be allowed for a controlled crash landing. Wound severity is reduced by one for crush trauma if the wings are hit. So nasty wounds are reduced to superficial, grievous to nasty, grim to grievous and mortal to grim. There are no post trauma effects for superficial wounds to the wings.

183

Wing: Nasty & Grievous Wounds

1D10 (1D6)

Slash

Crush

Pierce

1-2 (1)

Clean cut through the wing leaves it A good hit, but does not seem to dam- Wing is punctured. poorly suited for flight. age the wing much. A small hole will heal. Clean cut, will heal. Bruised but not broken.

A neat incision in the wing. Clean cut, will heal.

Hard but ineffective hit. Bruised but not broken.

Pierces the wing. A small hole will heal.

3-4 (2)

Slash cuts a long jagged wound.

Direct hit, but does not tear wing.

Punctures the wing. A small hole will heal.

5-6 (3)

Long cut, will heal with some scar- Bruised but not broken. ring.

Cut across the length of the wing Wing tears from impact. does not sever it, but leaves a long, nasty cut. A small tear, will heal.

Punctures the wing leaving a small hole. A small hole will heal.

7-8 (4) Long cut, heals but leaves scar.

Nasty bleeding cut on the wing.

9 (5)

Wing tears from impact and immedi- Pierces, slightly tearing the wing. ately turns red where it was hit. Nasty cut will leave thick scarring. A hole and tear, will heal with scarA small tear and bruising, will heal. ring.

10 (6)

Long jagged cut along lacerates the Wing tears from impact and immedi- Pierces and tears a large, bleeding wing leaving it bleeding and flap- ately turns red where it was hit. hole in the wing. ping uselessly. A small tear and bruising, will heal. Will heal with nasty scarring. Will not heal without stitching. With crude stitching may leave a permanent 1D flying impairment.

184

Wing: Grim & Mortal Wounds

1D10 (1D6)

Slash
Long cut across the wing ruins its ability to flap.

Crush
Direct hit manages to snap wing. Bruised and broken.

Pierce
The wing is punctured, leaving a large hole. Large hole, will heal.

1-2 Long cut, will heal. (1)

Inability to fly

Inability to fly Inability to fly

3-4 (2) Will heal with scarring.

Inability to fly

Cruel slash cuts a red, bleeding wound across the wing. The wing hangs limply.

Hard and heavy hit catches the wing and tears it badly.

Pierces and tears the wing.

A hole and tear, will heal with scarLarge tear and bruising, but will heal. ring. Inability to fly Inability to fly Punctures an obscenely large hole in the wing.

Nasty cut badly damages wing and The blow lands hard and breaks the leaves it useless for flight. wing with a snap, creating a tear.

5-6 Nasty cut which although it heals (3) leaves thick scarring.
Inability to fly Wide, ragged cut across the wing leaves it in poor shape.

Large tear and bruising, but will heal. Large hole, will heal with nasty scarring. Inability to fly Inability to fly Mighty swing tears the wing. Leaves it broken and useless. Wing tears and bruises, heals with scarring. Inability to fly Pierces and tears the wing badly. Tear will only heal with stitching and thick scarring. Inability to fly

7-8 Only heals with stitching. Even (4) then with 1D permanent impairment to flying. Inability to fly

9 (5)

Cuts a diagonal, ragged and bleed- Hard hit snaps the wing causing it to ing wound that leaves the wing tear badly. broken. Thick scarring. Will not heal without stitching. Even then best result is 1D impair- Inability to fly ment to flying. Cruel scarring.

Tears a long scar in the wing as it burrows through it. Long tear will only heal with stitching and considerable scarring. Inability to fly

Inability to fly Perfect hit snaps the wing and causes Terrific hit both punctures and tears Badly cuts the wing leaving it nearly completely severed and flap- it to tear in a long, nasty wound on at the wing,which is left flapping ping uselessly, dripping with blood. the wing. uselessly, spraying blood as it does.

10 Gliding and flying is impossible. Long, nasty tear which only heals The hole length of the cut must be with stitching and then with 1D (6) stitched to heal. Even then best res- impairment to flying at best.
ult is 1D impairment to flying. Impressive scar. Inability to fly Inability to fly

A large hole and nasty tearing causes considerable bleeding. Not possible to repair hole completely even with stitching, so permanent 1D impairment to flying. Bleeding (Moderate), Inability to fly 185

Trauma Explained List

TRAUMA EXPLAINED..................................31

0 Healing Times..............................................31 1 Fracture.........................................................31

1A CLOSED FRACTURE...........................................31 1B OPEN FRACTURE...............................................32 1C FRAGMENTED BONE..........................................33 1D OPEN FRAGMENTED BONE.................................33 1E SHATTERED BONE.............................................33 1F OPEN SHATTERED BONE.....................................34

19 Blood Clot..................................................58 20 - Stroke..........................................................58

HEAD......................................................................59

Anatomy.............................................................59
VITAL ORGANS.........................................................59 GREAT VESSELS........................................................59 VITAL STRUCTURES...................................................59 NERVES....................................................................59 SKELETON.................................................................59

2 Bleeding .......................................................34
2A INTERNAL BLEEDING.........................................35 2B ANAEMIA.........................................................35 2C BLOOD TRANSFUSION........................................35

100 - General......................................................59
100A INTRACRANIAL BLEEDING...............................59 100B SUFFOCATION...............................................60 100C SEVERED NECK.............................................61 100D BRAIN INFECTION..........................................61

3 - Shock.............................................................36 4 - Infection........................................................38
4A FESTERING INFECTION........................................38 4B GANGRENE.......................................................39 4C NECROTIZING FASCIITIS......................................41 4D TETANUS.........................................................41 4E - SEPSIS..............................................................42 4F BLOOD POISONING.............................................43 4G BONE INFECTION...............................................44 5 OSTEONECROSIS......................................................45

101 - Ear.............................................................63
101A - SEVERED EAR...............................................63 101B MODERATE EAR TRAUMA..............................63 101C SEVERE EAR TRAUMA...................................64

102 - Eye............................................................65
102A PRESSURE BLINDNESS....................................66 102B EYE LACERATION..........................................66 102C BLUNT EYE TRAUMA....................................67 102D DESTROYED EYE..........................................69

6 Burns.............................................................46 7 Spine.............................................................49
7A VERTEBRAE FRACTURE.......................................49 7B VERTEBRAE DISLOCATION...................................50 7C RUPTURED LIGAMENTS......................................50 7D COMPLETE CORD DAMAGE................................51 7E PARTIAL CORD DAMAGE....................................51

103 Mouth.......................................................69
103A MOUTH INJURIES..........................................69 103B BROKEN TEETH............................................69 103C SEVERED TONGUE.........................................69

104 - Nose..........................................................69
104A BROKEN NOSE.............................................69 104B SHATTERED NOSE.........................................70 104C SEVERED NOSE.............................................70

8 Pain...............................................................52 9 Inflammation................................................52 10 Coma..........................................................52 11 Epilepsy......................................................53

11A - SIMPLE PARTIAL SEIZURE.................................53 11B - COMPLEX PARTIAL SEIZURE..............................54 11C - TONIC-CLONIC SEIZURE...................................54

105 - Brain..........................................................71
105A CONCUSSION................................................76 105B MINOR BRAIN DAMAGE.................................76 105C MAJOR BRAIN DAMAGE................................76 105D MASSIVE BRAIN DAMAGE..............................77 105E BREATHING STOP .........................................77

12 Fever...........................................................54
12A - LIGHT FEVER..................................................54 12B - SEVERE FEVER................................................54 12C - DEADLY FEVER...............................................54

106 Carotid Arteries........................................78

106A CAROTID SEVERED IN NECK...........................78 106B CAROTID SEVERED IN HEAD...........................78

13 Carbon Monoxide Poisoning........................54 14 Dehydration................................................55 15 Hypothermia...............................................55 16 Hyperthermia..............................................56 17 Diabetes......................................................56

17A DIABETES I....................................................56 17B DIABETES II...................................................57

107 Cranial Nerves..........................................78

107A - OLFACTORY NERVE.......................................78 107B - OPTIC NERVE................................................78 107C - OCULOMOTOR, TRACHLEAR AND ABDUCENS NERVE.....................................................................79 107D - TRIGEMENIAL NERVE.....................................79 107E - FACIAL NERVE..............................................79 107F - AUDITORY NERVE..........................................79
186

107G - GLOSSOPHARYNGEAL NERVE...........................79 107H - VAGUS NERVE..............................................79 107I - ACCESSORY NERVE.........................................80 107J - HYPOGLOSSAL NERVE.....................................80

207 Ribs...........................................................98
207A SIMPLE RIB FRACTURE..................................99 207B OPEN RIB FRACTURE.....................................99 207C FRAGMENTED RIBS........................................99 207D SHATTERED RIBS..........................................99 207E FLAIL CHEST................................................99

108 Jaw............................................................81
108A DISLOCATED JAW..........................................81 108B FRACTURED JAW...........................................81 108C SHATTERED JAW...........................................82

208 Shoulder Blades .....................................100

208A SHOULDER FRACTURE..................................100 208B FLAIL SHOULDER........................................100

109 Skull..........................................................82
109A CRANIAL FRACTURE......................................82 109B FACIAL FRACTURE.........................................83

110 Throat.......................................................83
110A DAMAGED WINDPIPE ....................................83 110B VOCAL CORD DAMAGE.................................84 110C DAMAGED ESOPHAGUS...................................84 110D VAGUS NERVE DAMAGE................................85
CHEST...................................................................86

209 Traumatic Asphyxia.................................101 210 Bronchial Injury.....................................101 211 - Pulmonary Contusion..............................101 212 ARDS.....................................................102
ABDOMEN.........................................................103

Anatomy...........................................................103
VITAL ORGANS.......................................................103 GREAT VESSELS......................................................103 VITAL STRUCTURES.................................................103 SKELETON...............................................................103

Anatomy.............................................................86
VITAL ORGANS.........................................................86 GREAT VESSELS........................................................86 VITAL STRUCTURES...................................................86 NERVES....................................................................86 SKELETON.................................................................86

300 Peritoneum .............................................103

300A PERITONITIS...............................................103 300B BOWEL GANGRENE......................................105 300C DYSENTRY.................................................105

200 - Infection....................................................86
200A CHEST INFECTION.........................................87 200B TETANUS IN CHEST.......................................88 200C CHEST GANGRENE.........................................88 200D CHEST FASCIITIS...........................................88 200E - PNEUMONIA...................................................88

301 - Abdominal Vessels.................................105

301A GREAT VESSEL TEAR..................................105 301B GREAT VESSEL RUPTURE.............................106

302 Stomach..................................................106
302A PERFORATED STOMACH................................106 302B RUPTURED STOMACH...................................106

201 - Great Vessels.............................................89

201A GREAT VESSEL TEAR....................................89 201B GREAT VESSEL RUPTURE...............................89

303 - Intestines.................................................107
303A INTESTINAL TEAR........................................107 303B SERIOUS INTESTINAL DAMAGE......................108

202 - Heart..........................................................90
202A MYOCARDIAL CONTUSION...............................90 202B - CARDIAC PENETRATION..................................90 202C HEART ATTACK............................................91 202D CARDIAC TAMPONADE...................................92 202E- PNEUMOPERICARDIUM......................................92 202F- COMMOTIO CORDIS.........................................92 202G SHATTERED HEART.......................................92

304 - Appendix.................................................109
304A APPENDICITIS.............................................109

305 Kidneys...................................................109
305A ACUTE KIDNEY FAILURE.............................110 305B MINOR KIDNEY DAMAGE.............................111 305C SEVERE KIDNEY DAMAGE............................111 305D SHATTERED KIDNEY....................................111 305E SEVERED RENAL ARTERY.............................111

203 Digestive Tract ........................................92

203A DAMAGED ESOPHAGUS..................................92

306 Liver.......................................................112
306A TORN OR LACERATED LIVER........................112 306B RUPTURED LIVER........................................113

204 Lungs........................................................93
204A SUCKING CHEST WOUND...............................93 204B PUNCTURED LUNG.........................................94 204C HEMOTHORAX...............................................95

307 Gall Bladder...........................................113

307A GALL STONE...............................................113

205 Windpipe .................................................97

205A DAMAGE TO WINDPIPE..................................97

308 Pancreas..................................................113
308A DAMAGED PANCREAS..................................113 308B MUTILATED PANCREAS................................114

206 Breastbone................................................97
206A BROKEN BREASTBONE...................................97 206B FLAIL STERNUM............................................98

309 Spleen.....................................................115
309A MINOR SPLEEN DAMAGE.............................115
187

309B MASSIVE BLEEDING IN SPLEEN.....................115 309C RUPTURED SPLEEN......................................116 310 SOLAR PLEXUS (CELIAC PLEXUS)......................116

311 Pelvis......................................................116
311A PELVIS FRACTURE.......................................117 311B COMPLICATED PELVIS FRACTURE.....................117 311C UNSTABLE PELVIS FRACTURE.......................117 311D COMPLICATED UNSTABLE PELVIS FRACTURE. . .118 311E SHATTERED PELVIS......................................118 311F PULVERIZED PELVIS.....................................118

404A DAMAGED BRACHIAL PLEXUS NERVE............129 404B SEVERED BRACHIAL PLEXUS NERVE................130 404C DAMAGED RADIAL OR ULNAR NERVE...........131 404D SEVERED RADIAL OR ULNAR NERVE.............131

405 Wrist.......................................................132
405A SMALL WRIST FRACTURE............................132 405B COMPLICATED WRIST FRACTURE...................133 405C SEVERED WRIST TENDONS...........................133

406 Shoulder Joint.........................................134

406A DISLOCATED SHOULDER...............................134 406B COMPLICATED DISLOCATION.........................135 406C TORN SHOULDER TENDON............................135

312 Bladder...................................................119
312A RUPTURED BLADDER...................................119

313 Reproductive Organs.................................120

313A UTERUS TRAUMA........................................120 313B MAJOR UTERUS TRAUMA.............................120 313C DAMAGED OVARIES....................................120 313D INJURED SCROTUM & TESTES.........................120 313E CRUSHED SCROTUM & TESTES.........................121 313F SEVERED SCROTUM & TESTES......................121 313G SEVERED PENIS..........................................121

407 Collarbone .............................................136

407A COLLARBONE FRACTURE..............................136
LEGS.....................................................................138

Anatomy...........................................................138
GREAT VESSELS......................................................138 NERVES..................................................................138 SKELETON...............................................................138

315 Diaphragm..............................................121
315A SMALL DIAPHRAGM TEAR............................121 315B MAJOR DIAPHRAGM TEAR............................122
ARMS....................................................................123

500 General...................................................138
500A SEVERED LEG ABOVE KNEE.........................138 500B SEVERED LEG BELOW KNEE.........................139

501 Ankle......................................................139
501A SPRAIN......................................................139 501B ANKLE FRACTURE.......................................139 501C ACHILLES TENDON RUPTURE........................140

Anatomy...........................................................123
GREAT VESSELS......................................................123 NERVES..................................................................123 SKELETON...............................................................123

502 Blood Vessels.........................................140

502A LACERATED FEMORAL VESSELS....................141 502B SEVERED FEMORAL ARTERY..........................141 502C LACERATED POPLITEAL VESSELS......................142 502D SEVERED POPLITEAL ARTERY.......................142

400 General...................................................123
400A SEVERED ARM AT SHOULDER........................123 400B SEVERED ARM BELOW SHOULDER.....................123 400C SEVERED ARM BELOW ELBOW.........................123

401 Blood Vessels.........................................123

401A LACERATED BRACHIAL VESSELS...................124 401B SEVERED BRACHIAL ARTERY........................124 401C LACERATED RADIAL/ULNAR ARTERY...............125 401D SEVERED RADIAL/ULNAR ARTERY................125

503 Foot.........................................................143
503A BROKEN TOE.............................................143

504 Nerves.....................................................144
504A DAMAGED FEMORAL NERVE............................144 504B SEVERED FEMORAL NERVE..............................145 504C DAMAGED SCIATIC NERVE...............................145 504D SEVERED SCIATIC NERVE................................146 504E DAMAGED TIBIAL OR PERONEAL NERVE.............147 504F SEVERED TIBIAL OR PERONEAL NERVE...............148

402 Elbow......................................................126
402A ELBOW FRACTURE......................................126 402B OPEN ELBOW FRACTURE..............................127 402C DISPLACED ELBOW FRACTURE.........................127 402D OPEN DISPLACED ELBOW FRACTURE.............127

505 Hip Joint.................................................149

505A DISLOCATED HIP............................................149 505B HIP FRACTURE...............................................150

403 Hand.......................................................127
403A SEVERED HAND..........................................127 403B CRUSHED HAND..........................................128 403C PALM INJURY.............................................128 403D SEVERED FINGER........................................128 403E INJURED FINGER..........................................129 403F SEVERED THUMB.........................................129 403G INJURED THUMB.........................................129

506 Knee .......................................................151

506A CLOSED KNEE FRACTURE................................151 506B OPEN KNEE FRACTURE....................................152 506C FRAGMENTED KNEE........................................152 506D OPEN FRAGMENTED KNEE...............................152 506E SHATTERED KNEE...........................................152 506F OPEN SHATTERED KNEE..................................152 506G TORN KNEE LIGAMENTS..................................153 506H TORN KNEE TENDONS.....................................153 188

404 Nerves.....................................................129

189