Credits

Concept, Research, Creation and Writing Claus Børnich

Cover Art Elvira Børnich

Editing and Layout Claus Børnich

Text Boxes and Borders Elvira Børnich

Thanks to medical illustrator Patrick J. Lynch and MD cardiologist C. Carl Jaffe, MD for sharing their work under the Cre-
ative 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 illus-
trations in this book are courtesy of the National Library of Medicine. Finally a salute to the long dead Henry Gray for the
legendary Gray’s Anatomy and all the other talented people who through history have contributed to humanity’s 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

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Writing and roleplaying are creative arts and we can all benefit from
sharing and supporting each other. So please respect the copyright, but do
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our usual terms and conditions.

© 2010 Claus Børnich, all rights reserved.

2
Table of Contents
TRAUMA 2ND EDITION.................................5
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
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
20 - STROKE.............................................................58
HEAD......................................................................59
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
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
HEAD: SUPERFICIAL WOUND.....................................156
HEAD: NASTY WOUND............................................157
HEAD: GRIEVOUS WOUND........................................158
HEAD: GRIM WOUND..............................................159
HEAD: MORTAL WOUND..........................................160
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
ELECTRICITY BURN: GRIM & MORTAL WOUNDS.........181
ELECTRICITY BURN: GRIM & MORTAL WOUNDS.........182
WINGS..................................................................183
WING: NASTY & GRIEVOUS WOUNDS.......................184
WING: GRIM & MORTAL WOUNDS...........................185
4
Trauma 2nd Edition
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 con-
ditions. 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 condi-
tions. 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 refer-
ences 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 con-
sequences. Sucking chest wounds, internal bleeding, mis-
aligned fractures, infected burns, brain damage, kidney
failure and many other complications may develop de-
pending 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 su-
periority or perhaps avoiding combat all together may
soon seem much more appealing.
Under The Hood
This book allows you to peek under the hood of the body
and figure out exactly what keeps your characters tick-
ing. 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.
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 character’s 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”.
Everyone Rejoice
Detailed, gory and realistic descriptions of the trauma
inflicted is fun. It adds spice.
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.
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.
Medieval Treatments
In a historic or fantasy setting the results of trauma can
be much more devastating due to the lack of proper treat-
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 ag-
onising death, and even if he lives result in a long recov-
ery that may leave him crippled. Physical threats take on
a more menacing air and the players should be more in-
clined 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.
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.
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.
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 charac-
ter who does not rest will eventually collapse.
Normal fatigue is recovered by one stage simply by rest-
ing an hour or so and a character can recover fully if rest-
ing 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
Post Trauma
The rules in this book will rarely be relevant in the heat
of battle. Damage during combat is handled by the com-
bat system and referred to as immediate trauma. The
trauma detailed in this book is only determined and re-
vealed later, usually during healing and recovery, and is
referred to as post trauma.
This not only helps keep combat fast paced but also real-
istic. 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 exam-
ine the wound of a fallen friend or foe, is it time to re-
solve 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 experi-
enced by the combatants and so can be used to add col-
our 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 con-
sequences resolved during combat. The immediate
trauma may incapacitate and even indicate that a charac-
ter is dead. However in most cases, such as when the im-
mediate 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 didn’t 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. Be-
cause of this those with medical skills might wish to ex-
amine 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 any-
thing but the most obvious.
Post Trauma
The post trauma describes short and long term con-
sequences beyond the immediate trauma, further risks
and possible complications. The effects from the imme-
diate 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.
7
In addition any significant bleeding is also indicated.
Bleeding is fully explained under bleeding in the Trauma
Explained chapter.
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.
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 op-
ponent 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 in-
jury. 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.
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 repres-
ents 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 super-
ficial wound in three weeks.
Grievous Wound
Grievous wounds are truly gruesome and can easily lead
to permanent disability or death. Heals to a nasty wound
in four weeks.
Grim Wound
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 treat-
ment 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 sug-
gests 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 sur-
vival. 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 ran-
domly 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 sugges-
ted. 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:
● The players should roll long term effects of any-
one 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 If particularly relevant survival of a NPC can also be de-
termined by chance. Make an attribute roll, typically
Often the damage will refer to an eye, ear, cheek and so Spirit, against the difficulties specified below. If success-
on without specifying left or right side. Often it will not ful the NPC survives.
matter which it is and it can be determined randomly or
logically, as the situation dictates. NPC Survival Roll
Wound Severity Difficulty
Superficial -
One eyed Eric is hit by an arrow in an eye. If Nasty Easy
the immediate trauma was incapacitating the Grievous Tricky
GM may decide it was Eric’s good eye which Grim Severe
was hit. The incapacitation then makes sense as Mortal Extreme
Eric is left blind having lost both eyes. If the
Reduce the risk according to available treatment. An in-
damage was not incapacitating it must of jured guard on duty is likely to receive prompt treatment
course have been Eric’s blind eye which was and thus more likely to survive than a wounded bandit
hit, as he was obviously not blinded. abandoned in the forest.

When a player, or important character. is wounded and

the GM thinks the post trauma effects may have import-
ant 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 ef-
fects will leave the combatant incapacitated anyway.

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 fight-
ing 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.

9
Treatment
What follows is a brief overview of treatment in various setting and difficulties and possible treatments adjusted
settings. accordingly.

Setting Spells

In the descriptions of possible treatments the terms
modern, medieval and futuristic are used. Suggested
spells are listed too.
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.
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.
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 an-
other system than the DICE system decide upon an ap-
propriate permanent penalty for the wound.

Inferior technology and medical knowledge will mean an

increase in the difficulty and will often mean that no
treatment is possible.

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 treat-
ment 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 dia-
gnosis 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 treat-
ment is based entirely on external symptoms.
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 sug-
gested difficulty is not specified for the trauma then the
table below can be used as a general guideline.
Post Trauma Diagnosis
Wound Severity Difficulty
Superficial Easy
Nasty Tricky
Grievous Hard
Grim Severe
Mortal Extreme
Diagnosis Results
A seriously incorrect diagnosis (exceptional failure) res-
ults 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 dif-
ficulty of any subsequent treatment. The GM should al-
ways use his best judgement to decide how the diagnosis,
or lack of it, may affect any treatment.
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 Test
Serologic Test
A blood test is often the first test to be used when dia-
gnosing 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 dis-
eases.
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
A syringe (needle) is needed to extract the blood. Prefer-
ably 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
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
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
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.
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.
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
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-dimen-
sional 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
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.
12
The scan itself is soundless for normal humans that can-
not hear the high-frequency sounds emitted and it is com-
pletely harmless.
Using a specialised probe it is possible for a special im-
age processing computer to generate a three-dimensional
image.
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
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 intra-
cranial bleeding [100A]. It can be used to detect injury to
organs after abdominal trauma. It can detect tumours, al-
though 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 find-
ings in a normal radiograph. It is especially useful for
evaluating complex fractures, such as those in the face
and joints.
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.
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
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
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
Short lived radiactive particles are created using a
cyclotron, circular particle accelerator. An imaging scan-
ner, 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 immedi-
ate 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.
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
body’s internal structure which can be created by a
computer.
The images constructed by the computer is two-
dimensial 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
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 con-
ditions which is otherwise very difficult or impossible to
diagnose.
In cases of trauma to the head MRI scans can detect in-
tracranial 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 help-
ful in diagnosing and determining the extent of inflam-
mation, 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 find-
ings in a radiograph. It is very useful when evaluating
complex fractures, such as those in the face and joints
Equipment
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 and
technologically advanced scanners listed here.
Techniques
The character is asked to lie on a narrow table which
slides into a large, hollow cylinder containing the power-
ful 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 re-
turned 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 un-
hampered by bone or clothes.
14
A complete scan, which usually requires several sets of
images, can take more than an hour. More powerful mag-
nets and better software and computer hardware may
speed up the process.
The procedure has no risks but may interfere with pace-
makers, 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)
The nerve is stimulated by a weak electric current from
A diagnostic technique for measuring the muscle re- an electrode attached to the skin above the nerve, while
sponse to nervous stimulation. It is used to assess the other electrodes record the resulting electrical activity.
health of both muscles and nerves. The distance between the electrodes and time it takes for
the impulse to travel between them is used to calculate te
Uses
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 instru-
ment 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 max-
imum 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 sur-
gery a medieval surgeon does not have this luxury.
Medieval Medical Texts
“You must wear this amulet to ward of the evil spirits”
- King’s 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
A medical text can contain knowledge on herbal remed-
ies, 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
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
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.
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 dis-
eases, 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
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
The teachings of the theological class, scriptures and reli-
gious laws.
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.
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 pro-
hibit various surgical procedures and medical treatments.
16
Uses
Most astrological diagnosis will be useless and may in-
crease 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 effect-
ive.
Equipment
Most astrologers will not be viewing the heavens but
rather rely on calendars and charts that indicate the plan-
ets 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
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.
Futuristic Diagnosis
As we travel into the future technology and knowledge
improves. More advanced scanners and machines will al-
low 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 vi-
tal 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 physiolo-
gical parameters and automatically alert emergency re-
sponse 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.
Hightech Scanners
Scanners more sophisticated than today are a certainty.
They will be able to give a more detailed and precise in-
ternal picture and likely provide all sorts of advanced
imaging enhancement and analysis.
Uses
Just like modern scanners are invaluable in today's sur-
gery, 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 scan-
ners able to analyse the data and suggest a likely dia-
gnosis 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
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.
Likewise the scanner may have an inbuilt analyser or de-
pend on sending the scanned data to an online main-
frame. 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 ad-
vanced setting the scanner might be equipped with artifi-
cial 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.

Equipment The scanner will of course only give a diagnosis of the

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 re-
quired while to patrol and monitor the entire body mil-
lions, billions or even trillions of nanobots might be re-
quired. Because of their tiny size however they could all
be contained inside a syringe with only a few millilitres
of liquid.
sample provided, but even more advanced versions may
have optical sensors too. They may be able to scan a per-
son to create a virtual map of their anatomy, chemistry
and diagnose any detected problems. This is known as a
pocket doctor.
Technique
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

scanner’s sensor. The most basic scanners will be able to
determine the chemical structure and highlight any ab-
normal readings.

More advanced units will be able to report the presence

of drugs, alcohol, disease and other toxins. DNA compar-
isons 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 de-
formity. It is also required to implant donor organs, cy-
bernetic 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.
Major Surgery
Major surgery is any surgery inside the skull (crani-
otomy), chest (thoractomy) or abdomen (laparotomy).
Major surgery is usually done under general anaesthesia
where the patient is unconscious and performed in an op-
erating 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.
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.
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, surgeon’s hands or on the skin of
the patient around the operation site. Infection may also
be borne on dust if the surrounding environment is not
disinfected or from the surgeon’s breathing if a mask is
not worn.
The risk of infection is treated the same as a direct infec-
tion risk [4] for any wound. However, it is the environ-
ment, type of surgery and its degree of success which de-
termines if an infection takes hold.
The base difficulty for any infection resistance roll de-
pends on the environment. Base the difficulty on the
table below, but reduce the difficulty by one if the sur-
gery is an exceptional success and increase it by one if an
exceptional failure.
Infection Resistance Roll
Surgery
Environment
Major Minor
Dirty Insane Tricky
Unclean Extreme Tricky
Clean Hard Easy
Antiseptic Tricky Easy
Aseptic Easy No risk
● 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 in-
struments. 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 patient’s ability to endure the sur-
gery and some on random luck. Not every complication
needs to be checked every time someone has surgery. In-
stead the various complications should be used when ap-
propriate to add an element of risk or drama.
Shock
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
Nerve Injury
occurs it happens in the middle of the operation.
Surgery
Location
The risk depends on blood loss [2], hypothermia [15] and Success Failure
the pain experienced, as well as the trauma caused and Severed
Damaged Olfactory
duration of the surgery. Make an appropriate attribute Nose Olfactory Nerve
Nerve [107A]
roll to resist shock against a difficulty based on the [107A]
surgery outcome as shown in the table. If the patient goes Damaged Optic Severed Optic
into shock consult the rules on shock. Eye Nerve (temporary Nerve (blind)
blindness) [107B] [107B]
Surgery Shock Roll Moderate Ear Severe Ear
Ear
Trauma [101B] Trauma [101C]
Surgery
Surgery Result Damaged Severed
Major Minor
Tongue Hypoglossal Nerve Hypoglossal
Exceptional Failure Extreme Severe
[107J] Nerve[107J]
Normal Failure Severe Tricky
Glossopharyngeal Glossopharyngeal
Marginal Failure Hard Tricky Mouth
Nerve [107G] Nerve [107G]
Marginal Success Tricky Easy
Moderate Facial Very Severe
Normal Success Easy No Risk
Face Nerve Damage Facial Nerve
Exceptional Success No Risk No Risk
[107E] Damage [107E]
As surgery patients are often in a weakened state from Damaged Severed
disease, trauma or blood loss the GM may decide to Skull Trigemenial Nerve Trigemenial
increase the difficulty of the roll if this is not already [107D] Nerve [107D]
reflected in a penalty. Damaged Accessory Damaged Vagus
Neck
Nerve [107I] Nerve [107H]
If anesthesia is not used and the patient is conscious the Shoulder Damaged Brachial Severed Brachial
difficulty of the roll must be increased. See Anaesthetics & Upper Plexus Nerve Plexus Nerve
below. Arm [404A] [404B]
Elbow Severed Radial or
Damaged Radial or
A blood transfusion cannot reduce the difficulty of the & Lower Ulnar Nerve
Ulnar Nerve [404C]
shock roll, but can save a patient who goes into shock as Arm [404D]
per the normal shock [3] rules. Pelvis Damaged Sciatic Severed Sciatic
(spine) Nerve [504C] Nerve [504D]
Blood Clots Knee
Damaged Femoral Severed Femoral
and
Nerve [504A] Nerve [504B]
If blood clots [19] are not actively prevented following above
surgery, either through drugs or through activity and Knee Damage Tibial or Severed Tibial or
care, there is a small risk of blood clot following major and Peroneal Nerve Peroneal Nerve
surgery. below [504E] [504F]
Partial Cord Damage Complete Cord
Nerve Injury Spine
[7E] Damage [7D]
Nerve injury is a only risk when doing surgery near a
Anaesthetics
nerve. Facial surgery, neck surgery, arm and leg surgery
and especially spinal surgery all carry a risk of nerve
Surgery is painful and so requires some sort of anaes-
damage. Deep surgery that goes close to the bone has a
thesia to block that pain. Operating without anaesthetics
much greater chance of causing nerve injury.
or similar sedatives is possible but not usually recom-
mended. It dramatically increases the risk of shock.
If the GM deems that there is a risk of nerve damage the
nerve is injured on a surgery result of a marginal success
If no anaesthesia is used the patient must be held down
or a normal or exceptional failure.
with strong hands and the difficulty of the shock roll is
increased by three, but not beyond insane. With mild an-
The type of nerve injury depends on the location of the
aesthesia like alcohol the patient might still need to be
surgery as shown in the table below. It also depends on
held, but the pain is somewhat numbed by being drunk
how badly the surgeon damaged the nerve. If the surgery
and the difficulty is increased by two. A more portent,
was a success the damage is not quite as serious as if it
was a failure.
20
but still less than perfect, soporific only increases the dif-
ficulty 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 conscious-
ness 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.
Modern Surgery
The uses for surgery in medicine are almost endless. Tis-
sue 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 open-
ing 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 sur-
geon 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
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 to-
gether. 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. Sur-
gical staples for example can join blood vessels much
faster than stitching.
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 op-
eration.
Anaesthesia
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 anaes-
thesia is used for minor surgery, while major surgery re-
quires 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 sup-
ply 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 com-
presses the veins.
General anaesthesia is given intravenously or inhaled.
The drug circulates throughout the bloodstream, render-
ing 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 com-
plications. Such complications are rare if the administer-
ing doctor is skilled in anaesthetics.
Managing Infection
Surgery is usually antiseptic or aseptic to avoid infection.
Antiseptic surgery uses anti-bacterial washes kill bac-
teria, 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 in-
struments. 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
An incision is made in the skin and the surgeon cuts
through the layers of the dermis to get to the desired tis-
sue 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 feasibil-
ity of any operation.
Operating Team
For a major surgery a team of doctors usually work to-
gether with the help of nurses. A chief surgeon directs
the surgery with one or more assistant surgeons. An an-
aesthesiologist controls the supply of anaesthetic and
monitors the patient’s condition. A scrub nurse passes the
instruments to the surgeon, while a circulating nurse
passes any extra equipment. A good or bad team can de-
crease 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 op-
eration 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.
Field Surgery
In remote and wild locations, on the field of battle, in
poor countries, when a fugitive or when civilisation col-
lapses surgery may have to be performed outside of a
hospital setting.
A prepared surgeon will make sure to bring a field sur-
gery kit. Below is listed what such a kit may contain.
Field Surgery Kit
● Several disposable scalpels or scalpels with re-
placeable 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 de-
pending on their purpose.
● A pack with a variety of different sized needles.
These can be reused in an emergency after be-
ing sterilised in boiling water.
● A small standard needle holder used for grasp-
ing 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 in-
cluded 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 bleed-
ing during surgery.
● Surgical scissors for cutting tissue.
● Tissue forceps with teeth. A hinged instrument
used for grasping and holding tissues when fin-
gers 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 mas-
tisol or some other medical adhesive to secure
difficult dressings.
● Several reusable plastic vials of local anaesthet-
ic, 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 inject-
ing 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 surgeon’s mask.
22
Other Useful Kit Uses

Other useful instruments might include: Microsurgery is essential when transplanting body parts
or reattaching limbs, hands and fingers to ensure blood
● A saw for amputations. vessels, nerves and other tissue is correctly connected.
● A tourniquet for stopping severe bleeding. Thus ensuring the survival of the body part and also
● Sterile eye pad increasing the level of function regained after surgery.
● Antibiotic ointment
● A scrub or brush to clean the site of a wound if It is also essential when repairing nerves, especially in
clogged with dirt or mud. the face where damaged nerves can cause disfigurement
● Antihistamine to counteract the physiological and pain. It can also be needed when operating on the
effects of allergic reactions and colds. brain, during plastic surgery, when repairing a hand or
● Dentistry instruments other delicate work.
● Water disinfection tablets
● Thermometer for taking temperature Microsurgery can, for example, be used to attach a big
● Waterproof matches, safety pins and duct tape toe in the place of a crushed thumb to keep the hand
for general purpose use. functional. It can increase the chance of success of skin
● Blanket for keeping patient warm and comfort- grafts for burn victims, replace a damaged section of the
able. esophagus with a section of the intestines or any number
● Splint kit of equally amazing things.
● Sunscreen
● Sterile eye wash Equipment
● Plasters and elastic dressings.
Obviously the most important instrument of
Microsurgery 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.
Modern: Reattach Ear (easy) 1-4 hours
Reattach Nose (tricky) 2-4 hours Equally important is the nearly invisibly thin surgical
Reattach Finger (tricky) 2-4 hours stiching threads (suture threads) and needles thinner than
Reattach Hand (hard) 10-12 hours a human hair. In fact the needles are so thin they have to
Reattach Arm (severe) 10-14 hours be held with special instruments.
Reattach Leg (severe) 10-14 hours
Nerve Repair (varies)
Most other instruments of surgery are also used during
Delicate Surgery (varies)
microsurgery, but in much smaller versions. Such as
Medieval: Microsurgery is not possible. micro-forceps, micro-scissors and microvascular-clamps.

Futuristic: Robot assisted microsurgery with In a more technologically advanced surgery, robot
more advanced imaging techniques assisted microsurgery with telemanipulators and
and sophisticated instruments will be programmable controls might be available.
one or two levels lower difficulty. See
nanosurgery for the truly amazing Techniques
advances.
Time is of the essence as body parts start to die when
Spell: Regrow II (fuses ear)
removed from the body and the chance of successful re-
Regrow III (fuses finger)
Regrow IV (fuses hand, arm, leg) attachment 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.
Surgery where a microscope is required is called
microsurgery. It is a special form of modern surgery and Microsurgery, Time Detached
usually used for operations where incredible precision is Hours Surgery Modifier
required, such as when dealing with blood vessels, Less than 2 -1 Difficulty
nerves and other minute body structures. 2-5 0
6-8 +1 Difficulty
9-12 +2 Difficulties
13+ Impossible, or at least insane
23
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 in-
crease 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 the bones in the arm and hand and then
Messy Cut +1 Difficulty
Very Messy Cut +2 Difficulties
The Result
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 gan-
grene in 1D12 months.
● Marginal Success: Body part is healthy but
numb. It will gradually regain some reduced
function over the next 1D12 months. Tasks in-
volving the body part should have their diffi-
culty increased.
● Normal Success: Body part is healthy and re-
gains 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 al-
though some sensation may never be regained.
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-at-
tachment 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
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.
24

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.
Medieval Surgery
Pain and infection are the primary causes of death in me-
dieval 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 antisep-
tics 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 surgeon’s understand-
ing.
Lack of Knowledge
In most medieval societies anatomical knowledge is very
poor and physiology often misunderstood. Even such ba-
sic things as, the purpose of breathing, the function and
location of the various organs, and so on, are typically
missing from the surgeon’s knowledge.
Not surprisingly, this also means that diagnosis and treat-
ment 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 relev-
ance 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 sur-
geon 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
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
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 avail-
able 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 extrac-
ted, or to cut along the edge of a wound.
Bone drills were also used in ancient times to remove in-
fected 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 dia-
gnostic 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.
25
Anaesthesia
Anaesthesia may not always be available and so the in-
creased risk of shock means only simple minor surgery is
likely to succeed. In some cultures potions may be avail-
able to partially, or fully, drug the patient and alcohol is
often available.
Limitations
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 heart-
lung 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
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 instru-
ments 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 dam-
aged blood vessels or tissue, correct fractures and some-
times 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 ana-
tomical knowledge. It is surgery as performed by very
simple and primitive cultures or when surgery is per-
formed under less than ideal circumstances without prop-
er tools and equipment.
Uses
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.
Equipment
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 alco-
hol 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
The operations may be ritualistic, especially if the sur-
geon’s knowledge of anatomy is limited. In primitive
cultures, if written texts are not available, the reasons be-
hind 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 pa-
tient going into shock, is usually limited to minor sur-
gery.
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 patient’s 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.
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
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 The power level of the spells provided for each trauma
separate spells, or the same spell but requiring more spell can optionally be used to determine the difficulty for
energy or more difficult to cast. healing that complication with magic as follows:

Spell Power Level I. Basic Spells: tricky

II. Intermediate Spells: hard
Numeral Power Level III. Powerful Spells: severe
I Basic spells IV. Godlike Spells: extreme
II Intermediate spells
III Powerful spells
IV Godlike spells Futuristic Surgery
Spells The surgery of the future is difficult to predict. It will
likely be more efficient, faster, safer and at the cutting
Below is a list of the various spells used to diagnose and edge of science and technology.
treat different traumas. The exact details must be decided
by the GM to fit inside the framework of the magic sys- As surgery and medicine improves, people will live
tem being used. Some may be discarded and new spells longer and eventually most traumas and diseases will be
added as the GM sees fit. The selection of spells was curable. Nanotechnology, and probably other fantastic
chosen to give some diversity but without creating too techniques and technologies we are not yet even aware
much complexity. of, will likely make death a temporary handicap. As long
as the deceased has not been dead for too long and the
● Healing Vision brain is not destroyed the body can be regenerated or the
○ Diagnose mind uploaded into a computer, android, cybershell,
● Bloodmagic I, II, III, IV clone or any number of other amazing constructs.
○ Stop bleeding
● Purify I, II, III, IV This may eventually lead to a future where trauma and
○ Cure infection and disease disease are no longer feared and death is only an incon-
● Regrow I, II, III, IV venience. This is not the level of technology assumed in
○ Heal tissue and organ damage this book, although it may be mentioned occasionally in
● Soothe I, II, III, IV treatments. Instead this book assumes a slightly more
○ Reduce pain and halt shock near future medical science, although it does not attempt
● Cleanse I, II, III, IV to define it exactly. Rather leaving it up to be worked out
○ Dispel poison and gas depending on the world setting.
● Arouse I, II, III, IV
○ Awaken and revive Future Technology

The more severe the post trauma, the higher the power It will be down to the world setting to define the techno-
level of the spell required. Lower level version can how- logy, but a few possibilities directly related to medicine
ever partially heal the trauma. and trauma are mentioned here.

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 moder-
ate it cannot be further reduced, unless a more powerful
version of Bloodmagic is cast. It is otherwise treated ex-
actly as if it was moderate bleeding.
Spells as Difficulties
As with Witchcraft magic in the DICE system there may
not be healing spells as such but skills which reflect ma-
gical 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 in-
creasing one difficulty for each severity beyond nasty.
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 temper-
atures 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 traumat-
ised beyond repair. The mind could be recorded and
transmitted into another living organism or into an artifi-

27
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 replace-
ments 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 cy-
borg would depend on society but also perhaps on the
percentage of the body that remained unmodified.
Genetic engineering will likely be commonplace to pre-
vent 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
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 com-
pletely replace the surgeon.
Surgery may also become more feasible outside a hospit-
al setting. Smaller and cleverly designed instruments will
likely allow for portable microsurgeries ideally suited for
warfare and remote locations.
Anaesthesia
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
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 vac-
cinated, to make them immune. Infection is therefore
only a risk when these things are not available to the pa-
tient, 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, pos-
sibly 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
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: Not possible.
Medieval: Nanosurgery would seem like magic.
Futuristic: 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)
Spell: Regrow II (fuses ear)
Regrow III (fuses finger)
Regrow IV (fuses hand, arm, leg)
28
Nanotechnology holds perhaps the most exciting prom-
ises for the future. As the name implies nanotechnology
is on the scale of nanometres. Smaller than a single mi-
crometer. 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 microsur-
gery 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
body’s blood vessels. Built in large numbers from carbon
in factories using parallel fabrication and specialized for
various medical purposes.
Uses
The tiny nanobots travel along capillaries to enter and re-
pair living cells. This makes it possible for the nanosur-
geon to not only heal any trauma, but also to reverse age-
ing, 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 im-
mune 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 disrup-
tion of blood to the body’s 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 bleed-
ing a thing of the past by detecting traumas and alerting
repair nanobots of the problem while diverting away
from the damage.
This would require very advanced nanotechnology in-
deed, but if possible only 5 millilitre of nanobots could
replace the body’s 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 nano-
technology 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
Nanobots are introduced into the bloodstream in a hospit-
al 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 individu-
ally 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 reason-
able 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 dis-
posal. Other nanobots will however stay for longer peri-
ods or even permanently. They may assist a poorly func-
tioning organ, protect against disease, act to speed heal-
ing 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 com-
puter 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, mak-
ing 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 in-
tended environment and the sophistication of nanotech-
nology.
29
Techniques
Ideally nanobots enter the body by injection into the
bloodstream using a syringe. More advanced nanotech-
nology 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.
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 at-
tached limb.

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 autonom-
ous the nanobots get and more advanced models will be
able to carry out a number of tasks based on periodic in-
structions from a doctor or mainframe. The most ad-
vanced 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 mod-
els 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 dif-

ficulty 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 usu-
ally take the maximum time indicated and possibly even

30
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 vari-
ous traumas. Although it is based on real medicine it has
been modified, simplified and interpreted to make it easi-
er 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.
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 re-
duce 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
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
Healing times assume normal conditions, rest and ad-
equate 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.
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 heal-
ing time. This can be a multiplier, such as x2, that in-
creases the number of weeks it takes to heal to a lesser
wound severity. It only applies to the first stage of heal-
ing. 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.
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
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 deform-
ity can be seen.
Risks
The greatest risk is from the fracture not healing prop-
erly. A stable fracture always heals properly with treat-
ment, 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
Modern: X-Ray Scan (easy)
Medieval: Physical Exam (tricky)
Futuristic: Scan (easy)
Spell: Healing Vision
31
Diagnosis is used both to detect a fracture and to decide
if a fracture is unstable and needs treatment beyond im-
mobilisation.
Treatment
Modern: Immobilise (tricky)
Set Bone (tricky)
Medieval: Immobilise (tricky)
Set Bone (tricky)
Futuristic: Drugs or nanobots might accelerate
healing times.
Spell: Regrow I
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 (nor-
mal 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 frac-
ture is hard. It is easier done with internal fixation sur-
gery as explained under surgery.
An untreated unstable fracture always results in a Mal-
Union. 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 ac-
tions 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
Modern: Internal Fixation (tricky)
Mal-Union Resetting (hard)
Non-Union Grafting (tricky)
Non-Union Fixation (tricky)
Medieval: Mal-Union Resetting (severe)
Internal Fixation may be possible in
sophisticated societies (tricky)
Futuristic: Hightech tools likely reduces all
modern difficulties to (easy)
Nanosurgery (easy) although bone
needs to be manipulated into place for
it to work.
Spell: Regrow II
An Unstable Fracture can be treated with internal fixa-
tion surgery. Internal fixation holds the fracture together
using screws, plates, rods and other devices of a biocom-
patible 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 prop-
erly. 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 to-
gether. This saves an operation to extract bone for graft-
ing 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.
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
An open fracture is the same as a closed fracture [1A]
with one major difference. The bone is exposed to bac-
teria through an open wound with a high risk of becom-
ing infected. An outcome which is easily fatal and cer-
tainly 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].
32
Treatment Medieval: Immobilise and Set Bone (see 1A)
Permanent external plates screwed
into the bone may eliminate the
Modern: Immobilise and Set Bone (see 1A) impairment

Medieval: Immobilise and Set Bone (see 1A) Futuristic: Hightech tools (easy)
The cause of bone infection is Nanosurgery (easy), the
obviously not understood, but some difficulty is because the fragmented
intelligent healers may understand the pieces may not be aligned properly
value of keeping a wound clean. and require a surgeon’s assistance to
align them.
Futuristic: Likely powders, ointments or beams
exist to sterilise the wound Spell: Regrow III
completely.

Spell: Purify I
Like for a closed fracture [1A] the bone should be im-
mobilised 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 nor-
mal 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.
Immobilising the fracture will not help healing, but may
prevent further injury and allow some movement or re-
duce the impairment. Only surgery can repair a fragmen-
ted 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 sur-
gery brings with it the risk of bone infection as explained
for open fractures [1B].
1D – Open Fragmented Bone
Compound Comminuted Fracture

Surgery The combination of a fragmented bone [1C] and an open

fracture [1B]. Especially nasty because treatment to pre-
Debridement, surgical removal of contaminated or dead vent infection is so difficult. Increase any treatment to re-
bone, muscle and skin tissue, may reduce the risk of the duce the risk of infection [4] by two difficulties.
initial infection as explained under infections [4]. Ampu-
tation will obviously also eliminate the risk, but is usu- 1E – Shattered Bone
ally too extreme. If bone infection occurs [4G] it must be
treated as explained under bone infection treatment.
Modern: Repair (insane)
1C – Fragmented Bone Artificial Replacement (severe)

Comminuted Fracture
Medieval: Shattered bone cannot be treated.
Instead some sort of permanent
Called a comminuted fracture, the bone is splintered into external splint or amputation, perhaps
fragments. with a prosthetic limb if possible.

Risks Futuristic: With hightech tools repair may be

(tricky) and replacement (easy).
Without surgery it will never heal properly and so result Nanosurgery (tricky), the high
in a permanent impairment, deformity or disability. The difficulty is because the shattered
exact effect depends on the location and the severity of pieces may not be aligned properly
the trauma, but will usually be -1D. and require a surgeon’s assistance to
align them.
Treatment and Surgery
Spell: Regrow IV

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 replace-
ment the impairment from the injury is permanent.
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 frac-
ture [1B]. Especially nasty because treatment to prevent
infection is so difficult. Increase any treatment to reduce
the risk of infection [4] by two difficulties.
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 con-
tracting the vessels to maintain the blood pressure and in
so doing causes the skin to turn pale. In a few hours nor-
mal 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
Even if no bleeding is indicated there may still be some
bleeding, like a nosebleed or from a cut, but it is insigni-
ficant. 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 bleed-
ing are moderate, heavy and massive.
Blocked Bleeding
This is an optional rule which adds a bit of realism and
may give bleeding characters a second chance. Use or ig-
nore 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.
Risks
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 al-
ways 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 af-
termath of combat when exact time measures are not im-
portant.
Treatment
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.
Spell: Bloodmagic I (moderate)
Bloodmagic II (heavy)
Bloodmagic III (massive)
The above is the difficulty on average to stop the bleed-
ing, but this may be adjusted up or down depending on
the wound. The difficulties may also be lowered if help-
ful 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.
• Marginal: Bleeding will resume on any signi-
ficant 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
All lethal blood loss is cumulative so a character bleed-
ing 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 blood’s 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 pale-
ness, 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 any-
where 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 danger-
ous 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].
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 anaem-
ic person becomes pale, weary, weak and may develop a
slight fever.
If the character suffers from chronic fatigue from bleed-
ing 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. Dizzi-
ness, breathlessness and eventually headache, chest pain
(angina) and possibly leg pains develop. If the anaemia
continues for more than two months chronic fatigue de-
velops 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.
2C – Blood Transfusion
Modern: Transfusion (easy)
Medieval: Transfusion (hard)
Futuristic: Transfusion (easy)
Spell: Healing Vision
Bloodmagic IV (transfers blood)
A blood transfusion is the transfer of blood from one per-
son 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 me-
dieval 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 spe-
cifies the blood type’s 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
3 - Shock
Recipient Matching Donors
O O Shock is a life-threatening condition that occurs when the
A O and A blood pressure is too low to maintain an adequate flow
B O and B and often the cause of death from injury or acute illness.
AB All While the organs can manage for a while with a reduced
supply the brain cannot.
Furthermore each type is either rhesus-positive or rhesus-
negative. This is usually denoted by a plus or minus after The main cause of shock is blood loss, but it may also
the blood type. Rhesus positive characters can receive result from internal trauma or acute illness. A character
blood from both positive and negative donors. Rhesus at any stage of shock is unable to walk or act normally.
negative donors can only receive blood from other rhesus Going into shock is extremely dangerous and usually
negative donors. fatal if the right treatment is not initiated quickly.

Stages of shock
Mismatched Transfusions

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 set-
ting, 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
Any disease carried by the donor may be transferred dur-
ing the transfusion. The risk depends on the amount of
blood and disease but is generally very high.
Stage I: Cold, clammy skin, pale, shallow rapid breath-
ing 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 un-
likely event of recovery, massive brain damage will usu-
ally have occurred.
Going into shock
The two primary causes of shock in combat are from
bleeding and severe trauma. In the first case shock al-
ways 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.

Determining Blood Type In the case of severe trauma a shock roll is usually spe-
cified by the injury along with a difficulty in brackets.
If blood type is not specified roll 1D100. An attribute roll, same as would be used for resisting stun
or poison, must then succeed against the difficulty to
Blood Type avoid going into shock.
1D100 Blood Type
1 – 37 O+ Dying from shock
38 – 72 A+
73 – 81 B+ Someone who has gone into shock will rarely recover
82 – 84 AB+ without medical treatment or at the very least some first
85 – 91 O- aid.
92 – 97 A-
98 – 99 B- The time it takes for a trauma induced shock to progress
100 AB- to the next stage depends on the trauma. If the trauma re-
quired 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 heart injury or any organ injury may induce
roll was failed as shown in the table below. shock.
● Spinal injury: The reaction of the nervous sys-
Shock Stage Progression tem to the injury may lead to shock.
Failure Interval ● Loss of body fluids: Due to extensive burns,
Marginal 1D10 hours dehydration, severe vomiting or diarrhoea.
Normal 1D12 minutes ● Septic shock: Shock from severe sepsis [4E] or
Exceptional 1D6 minutes blood poisoning [4F] resulting from an infec-
tion.
An exceptional shock roll failure takes the casualty
straight to stage III, a normal failure to stage II while Treatment
marginal failure starts from stage I.

Fear, stress and any increase in pain will reduce the time Modern: Care and shock treatment (tricky)
until the casualty progresses to the next stage. Breathing
Medieval: Care and shock treatment (hard*)
problems, further bleeding or additional wounds may *the increased difficulty reflects a
also reduce the time. If a casualty in shock is sufficiently lack of understand for the condition.
injured or frightened he may immediately progress to the
next stage and then progress quickly through any remain- Futuristic: Care and shock treatment (tricky)
ing stages until dead. Drugs and other treatment may exist
to take the patient out of shock.
When stage III is reached the casualty eventually suffers
brain damage. When half way to stage IV the casualty Spell: Soothe I (stage I), Soothe II (stage II),
Soothe III (stage III), Soothe IV (stage IV)
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.
Shock is a deteriorating condition that usually does not
allow a casualty to recover without active medical inter-
vention. A delay of even a few minutes may mean death.
A barbarian tries to get up after having an arrow
pierce his right lung. He must roll shock (tricky). If
Even only basic shock treatment such as elevating the
the roll fails he will go into shock and his condition
legs, keeping the casualty warm, comfortable and com-
will deteriorate without treatment.
forted may delay the progression of shock and in some
cases this may allow the body to recover. How much it is
Sure enough the barbarian gets a normal failure and
delayed depends on what care is available and the skill of
collapses back down with dizziness. Because of the
the carer. A normal success may double the time it takes
degree of failure he is already at stage II shock.
for the shock to progress to the next stage and an excep-
1D12 is rolled and results in a 8, meaning that after
tional one may even triple it.
8 minutes the barbarian will progress to stage III
unless a surgeon or doctor comes to the rescue.
Treating the wound and stopping any bleeding will halt
After 4 minutes at stage III he suffers minor brain
shock at a particular stage and if the patient is treated
damage, then major brain damage at 6 minutes and
with care the stages may retreat one by one over the fol-
finally after 8 minutes he reaches stage IV and dies
lowing hours, or days, depending on severity and treat-
from massive brain damage.
ment. Some injuries may require surgery to stabilise the
casualty. Ideally some sort of infusion [2C] should be
Types of shock
done to replace the lost blood and thus immediately take
the patient out of shock.
While bleeding and trauma are the most common causes
Self Treatment
of shock, burns, infections, toxins, suffocation, severe
temperatures and even extreme fear may induce shock if
At stage I it may be possible for the character to stop his
severe enough.
own bleeding and rest to recover. This depends on the
severity of the wound(s) and if the character has the
● Loss of blood: The most common cause. The
means to heal them. All difficulties should be increased
greater the loss of blood the greater the chance
by one in addition to any penalty for self treatment. The
of going into shock.
strain of doing this may however worsen the shock to
● Trauma: Burst appendix, perforated intestine or
stage II at the GM’s discretion (normal or exceptional
stomach, intestinal obstruction, pancreatitis,
failures for example).

37
The GM might in some circumstances allow someone in Risks
stage II of shock to treat themselves but this should in-
crease difficulties by two or three. So a casualty at stage An infected wound does not start to heal until the infec-
II or III shock left to himself will most likely die as he tion is cured and the fever fatigue means that any physic-
cannot heal his own wounds. al effort will quickly exhaust the character. How it devel-
ops depends on if the result of the roll to resists the infec-
tion was a marginal or normal failure. If no such roll was
4 - Infection made then generate one randomly by rolling 1D6; where
1-2 is marginal failure and 3-6 is normal failure.
Infections are caused by invading bacteria, or other micro
organisms, usually following surgery or trauma. The risk On a marginal failure the fever stays light [12A] and
of infection from surgery is discussed under surgery. abates in two to three days. The only risk is from tetanus
[4D], which develops on a random 1D10 roll of 10.
Internal Infection Risk
On a normal failure the infection grows worse and a
Infection from internal damage, such as ruptured intest- severe fever [12B] develops 1D12 hours after the onset
ines, stomach or esophagus, allow bacteria or fungus of the light fever. Without treatment it will fester for
from one part of the body into places where they are not 1D12 + 10 days and there is a high risk of a complica-
supposed to be. Internal infection is specified as a com- tion. Roll once for a complication around half way
plication in the risk section of any trauma that carries the through the infection.
risk. If not specified treat as a festering infection.
Complication Risk
Direct Infection Risk
1D12 Complication
Any trauma that penetrates or breaks the skin carries a 1-4 None
risk of direct infection from bacteria invading the open Limb: No complication
wound. Bacteria, skin and dirt are often forced into a Abdomen: Peritonitis [300A]
5-7
wound along with the blade or projectile. If the wound is Chest: Chest Infection [200A]
treated successfully there is normally no infection. This Head: Brain Infection [100D]
may include using antibiotics, if available, and the doctor 8-9 Tetanus [4D]
believes the risk of infection to be high. 10 Sepsis [4E]
11 Blood Poisoning [4F]
However, if the wound is not treated successfully an at- 12 Bone Infection [4G]
tribute roll determines if the wound becomes infected.
Treatment
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 Modern: Antibiotics
wounds and extreme for mortal wounds. If the wound Debridement (tricky)
was caused by a natural attack (claws, bite) the difficulty Amputation (easy)
should be increased by one. Only roll once for the most
severe wound. Medieval: No treatment apart from caring for the
patient or amputation is likely to be
On a marginal or normal failure a nasty festering infec- available. Any attempted debridement
tion [4A] develops. On an exceptional failure gangrene surgery if allowed will likely be
severe or worse from the lack of
[4B] or necrotizing fasciitis [4C] develops as determined
scanners and technology.
by the situation or randomly.
Futuristic: Powerful antibiotics, ointments, and
4A – Festering Infection nanobots or friendly bacteria may
exist to cleanse the infection.
An infection is caused by opportunistic bacteria that in-
fect a wound or damaged tissue. Spell: Purify I (light fever)
Purify II (severe fever)
Symptoms

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, al-
though poor or good care may affect the recovery time
and increase, or reduce, the risk for complications. Anti-
biotics 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 complica-
tions 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 infec-
tion 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.
4B – Gangrene
Mortification, Tissue Necrosis
Gangrene is very similar to necrotizing fasciitis [4C].
However, in necrotizing fasciitis truly nasty bacteria in-
fect 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
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 sup-
ply 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 de-
velop as the body is slowly losing to the spreading gan-
grene 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.
Symptoms
● Incubation: There are no symptoms.
● Early: As tissues die, carbon monoxide and hy-
drogen gases are released, causing bubbling
around the tissue.
● Intermediate: Blue, black and red skin discol-
ouration, loss of sensation and foul smelling dis-
charge. Light fever [12A].
● Late: Necrotic tissue visible in a large area and
reaches down to bone. May crack open dischar-
ging foul smelling fluids. Deadly fever [12C].
Risks
During the incubation and early stage there is no immedi-
ate 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 be-
low.
● Incubation: no risks
● Early: no risks
● Intermediate: Shock (easy). 1-8 No Complica-
tion, 9-10 Sepsis, 11 Blood Poisoning, 12 Kid-
ney 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, result-
ing in unconsciousness and a much greater risk of shock.
When the late stage is reached keep checking for com-
plications 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 suc-
cessful the body’s defences will be winning and the char-
acter will slowly start to recover. The recovery will take
39
at least twice the time the gangrene lasted and a gradu-
ally improving fever will persist until fully cured.
Diagnosis
Modern: Physical Examination (see table)
Scan (tricky)
Medieval: Physical Examination (see table).
Futuristic: Physical Examination (see table)
Scan, reduce the difficulty at each
stage by three levels.
Spell: Healing Vision
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 diffi-
culty and if successful the surgery difficulty can be re-
duced as normal.
Surgery
Modern: Debdridement Surgery (see table)
Amputation (easy)
Medieval: 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.
Futuristic: Nanobots or engineered biological
healers may be able to consume the
dead tissue and destroy the bacteria.
Spell: Purify I (incubation), Purify II (early),
Purify III (intermediate), Purify IV (late)
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 per-
formed. The surgeon can decide upon a more aggressive
debridement surgery which decreases the difficulty by
one but which drastically increases the risk of disfigure-
ment and disability.
Gangrene Treatment
Stage Diagnosis Surgery*
Incubation Insane Tricky
Early Tricky Hard
Intermediate Easy Severe
Late Easy Extreme
* The difficulty is for a successful cure. If antibiotics are used
effectively, lower the difficulty by one degree. With no antibiot-
ics increase difficulty by one. Amputations are easier.
As always if surgery is not aseptic (sterile) secondary in-
fection 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 oper-
ation, usually around 12 hours later, will then take the in-
fection from its incubation stage to cured. Failing to per-
form further surgery within 24 hours means that the in-
fection 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 be-
cause 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 gan-
grene by two stages. An exceptional success reduces it
by three. As long as the gangrene is in a limb an amputa-
tion (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 in-
cubation 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 intermedi-
ate 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
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 in-
fections, that have in common their rapid spread, resist-
ance to treatment and high rate of fatality. As the infec-
tions spreads, muscles, tendons and other tissue is irre-
vocably destroyed.
Although not differentiated it should be noted that there
are three major types of necrotizing fasciitis.
1. Polymicrobial (several types of microbes)
2. Flesh-eating bacteria
3. Gas Gangrene
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 be-
comes a perfect breeding ground for more bacteria which
cannot be reached by the body’s defences or with antibi-
otics.
Any cut or puncture in the skin can potentially cause nec-
rotizing 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
● 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 propor-
tion to visual symptoms. Swelling and painful
dark bumps that quickly expand, first turning
purple, then gradually black with a necrotic ap-
pearance. Light fever [12A]. The progress of the
infection can be alarmingly fast, expanding vis-
ibly 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 be-
comes severe [12B]. Nausea and diarrhoea..
● Late: Symptoms may start appearing in places
away from the initial location. The pain is not as
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 gan-
grene [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
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
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 di-
minish over the next few days and the fever will gradu-
ally be reduced to a severe and then light fever. The light
fever persists for 1D10 days before a more or less com-
plete recovery is made, although fatigue from the infec-
tion may last for several more weeks.
41
Treatment
Modern: Vaccination
Medieval: No Possible Treatment
Futuristic: Nanobots can likely cure tetanus.
Spell: Purify III
4E - Sepsis
Sepsis is the body's immune response to an infection
gone berserk and the body’s defence mechanisms of in-
flammation 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. How-
ever, 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
Severe fever [12B], shaking chills, nausea, vomiting,
diarrhoea, confusion and reduced mental alertness
Risks
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 ap-
pearing and the character starts feeling ill. This is the ini-
tial 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-
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. Eventu-
ally, and likely less than two days, multiple organ failure
and death will occur.
Diagnosis
Modern: Diagnosing Sepsis (special)
Locating Infection Source (special)
Medieval: Diagnosing Sepsis (special)
Futuristic: Diagnosing Sepsis (special), likely
tests are available making it (tricky)
Locating Infection Source (special),
likely not harder than tricky with
hightech tools.
Spell: Healing Vision
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 at-
tempt.
Treatment consists of finding the infection and eliminat-
ing it with antibiotics or surgery to drain the site of infec-
tion.
The source of the infection may be obvious if there is an
infected wound. Otherwise it can only be found with ex-
ploratory surgery at suspected sites, blood tests and
scans. The difficulty can be anything from easy to in-
sane.
Treatment
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 re-
duced 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, al-
though 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 vent-
ilator can keep the patient alive.
Surgery
Modern: Draining (tricky)
Medieval: 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.
Futuristic: 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.
The surgery difficulty will vary by location, but can be
assumed tricky most of the time.
Drainage, even without use of antibiotics, gives the char-
acter 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 power-
ful antibiotics easy. Recovery is as detailed under treat-
ment.
4F – Blood Poisoning
Septicemia
This extremely deadly condition occurs when bacteria
have managed to get into the blood stream. It can origin-
ate anywhere in the body but often starts with infection
in the lungs, abdomen, bones or urinary tract.
Symptoms
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 le-
sions. Eventually shock.
Risks
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 diffi-
culty as well, but roll shock every two hours, increasing
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 diffi-
culty increase. That means a shock roll every hour in the
best case.
Diagnosing
Modern: Diagnosing (special)
Locating Infection Source (special)
Medieval: Diagnosing (special)
Futuristic: Diagnosing (special), although likely
tests are available making it (tricky)
Locating Infection Source (special),
likely not harder than tricky with
hightech tools.
Spell: Healing Vision
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
Futuristic: Powerful antibiotics and nanobots or
friendly bacteria will exist to cleanse
the infection.
Spell: Purify IV
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 fur-
ther 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
the character will likely be in shock and only fluid trans-
fusion 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 in-
fected but any bone is potentially at risk.
Symptoms
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 peri-
ods 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 1–3 None
2–5 4–8 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 min-
imum of -1D, often getting worse with any exertion, and
can only be temporarily reduced with pain killers.
Risks
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 infec-
tion was not caused by such a fracture it will either be
near the original infection that caused it or can be de-
termined by rolling randomly for location. To determine
the exact bone the GM is advised to roll 1D10 for sever-
ity, higher being worse. So a low result in the chest indic-
ates a rib, while a high result the spine.
After roughly five weeks the bone dies and becomes nec-
rotic. 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 per-
manently deformed or damaged. This will affect move-
ment 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 be-
low 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 nor-
mal infection with all its associated risks and can be
treated as a normal infection. The bone infection, how-
ever, will persist unless specifically treated and next
month it may again lead to the spread of a new infection.
Diagnosis
Modern: Examination (severe)
Radiography (tricky)
CT or MRI Scan (tricky)
Blood Test (tricky)
Biopsy (easy)
Medieval: Bone infection is not normally known,
but if allowed an examination would
be at least severe.
Futuristic: Hightech Scanner (easy)
Blood Test (easy)
Biopsy (easy)
Spell: Healing Vision
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
Bone Infection Surgical Results
Weeks Disfigurement Impairment
Spell: Purify IV 0-2 Scarring - (-1D)
3-5 Some - (-2D)
Untreated bone infection only gets worse. 6 – 10 Severe -1D (-3D)
11+ Nasty Crippling*
If antibiotics are administered in the first five weeks they * If in a limb means amputation. If location was chest or abdo-
may cure the infection completely. The difficulty to suc- men a patient will only survive with skin grafts and sophistic-
cessfully administer and so cure the bone infection de- ated medical treatment. Large chunks of flesh will have been
pends on the antibiotics. Usually hard for weak antibiot- removed and recovery will take years and even so end up with
ics and tricky for powerful antibiotics. severe disability.

Surgery Amputation of an infected limb is the only way to guar-

antee success.

5 Osteonecrosis
Modern: Debdridement Surgery (see table)
Amputation (easy)
Bone Death, Avascular Necrosis (AVN), Aseptic Necros-
Medieval: Amputation (easy) is, Ischemic Bone Necrosis

Futuristic: Nanobots or engineered biological Osteonecrosis literally means dead bone and occurs when
healers may be able to consume the the bone dies and cannot regenerate itself due to an insuf-
dead tissue and destroy the bacteria. ficient blood supply. The dead bone is worn down and
weakened and eventually collapses.

Most bones have many blood vessels supplying them and

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 in-
fection is, how much is removed and if antibiotics are
also used. Aggressive debridement surgery is easier but
causes greater permanent impairment.
so damage to one usually does not cause a problem. Cer-
tain joints, like the hip and wrist, have only a few blood
vessels and so are vulnerable to osteonecrosis after an in-
jury.
Risks

Debridement Surgery It takes 1D12 months before the bone is worn down
Weeks* Surgery Difficulty enough for the first symptoms to appear. Osteonecrosis
Careful Tricky can therefore appear long after the initial trauma that
0-2 caused it. At this point the bone has been so worn out
Aggressive Easy
Careful Tricky that osteoarthritis develops in the joint. It begins as a –1D
3-5 impairment to actions involving the limb from a painful
Aggressive Tricky
Careful Hard and stiff joint. After that the pain and stiffness only gets
6 – 10 worse increasing the impairment penalty by one every
Aggressive Tricky
Careful Severe three months.
11+
Aggressive Tricky
* since infection Once the penalty reaches -3D there is a risk the bone will
** more removed bone means greater impairment but also collapse completely. Every month roll 1D6 and on a 1
greater chance of success the bone collapses and the joint becomes useless. This
will make an arm useless and if in the hip the character
The table can be used as a difficulty guideline. If antibi- will be unable to stand on the leg.
otics 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 re-

moved. 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
Modern: X-Ray Early Scan (hard)
X-Ray Scan (tricky)
MRI Scan (tricky)
Medieval: Osteonecrosis can likely only be
diagnosed from the impairment
caused. Most medieval societies will
not understand the cause.
Futuristic: Hightech Scanner (easy)
Spell: Healing Vision
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 diffi-
culty 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 bet-
ter 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: Restoration Surgery, Drill (tricky)
Restoration Surgery, Graft (hard)
Medieval: Probably no treatment available.
Futuristic: Hightech Surgery (easy)
Spell: Regrow IV
If detected early, before symptoms, then surgery to re-
store 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 sup-
ply.
The first method drills a hole in the bone to relieve pres-
sure and in the hope of restoring blood supply. It the sur-
gery 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 op-
erations to graft healthy bone from another location, but
it will usually heal the osteonecrosis. If in the hip
crutches must be used for six months or the blood supply
will not be restored.
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 treat-
ment for hip fracture [505B].
6– Burns
Any tissue damage caused by heat, flame, radiation, boil-
ing 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 temper-
ature, voltage or corrosiveness the deeper it goes. The
depth of the burn is grouped into four categories and de-
termined 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 di-
mensions of the burn are important this must be decided
by the GM according to the type of burn and how it oc-
curred.
Continuous Burns
Most burns, but especially flames and acids, continue to
cause damage over time. The rate varies, but the end res-
ult 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
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 scar-
ring.
Risks: moderate blood risk, infection, risk to eyes and hy-
pothermia.
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 impair-
ment.
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 hypo-
thermia.
4th Degree – Mortal Burn Wound
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 scar-
ring 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 de-
grees 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. Li-
quids luckily flow to the ground so exposure from
splashes of hot liquids is usually brief. However, if im-
mersed 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, pro-
longing 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 dur-
ation 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
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 di-
vided 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 pre-
vent shock if the blood loss becomes life threatening is to
give a blood transfusion [2C] and administer fluids.
Hypothermia
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 com-
pensate for the heat loss by increasing the metabolism,
which in turn leads to a dramatic increase in calorie ex-
penditure. Thus severe burn victims need to be kept
warm and well fed.
The exact effect should be determined according circum-
stance. 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 loca-
tion 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 sig-

nificant risk of infection and no roll is needed. However, Modern: Flame Burn (tricky)
a more serious burn not only removes the barrier that Chemical Burn (tricky)
skin provides against infection. The dead skin becomes Electricity Burn (tricky)
an excellent growth medium for bacteria. The local blood
Medieval: Flame Burn (tricky)
supply is also reduced. Leaving inadequate defence Chemical Burn (tricky)
mechanisms to fight a persistent infection. Treat the risk Electricity Burn (tricky)
of infection for a burn as per normal infection [4] rules,
but increase the difficulty of any treatment and the direct Futuristic: Hightech Scan (easy)
infection roll by one. Thus a nasty burn trauma requires a
hard attribute roll to avoid infection, a grievous burn Spell: Healing Vision
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 difficulty of diagnosing the seriousness of a burn de-
pends on the type of burn. Electricity and corrosive
The normal modifiers for wound cleaning, antibiotics chemical burns are tricky to diagnose right, while thermal
and debridement apply, but antibiotics are half as effect- burns and those from a naked flame are tricky.
ive as usual, while debridement is twice as effective as
Treatment
usual. Antibiotics cannot reach the dead tissues but re-
moving it with surgery removes the main source of po-
tential infection. Modern: Debdridement Surgery (tricky)
Skin Grafting (tricky)
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 Medieval: Debridement surgery is possible, but
by one level. On the other hand, if the burn has been skin grafting is usually not.
poorly kept, or exposed to wet or dirty environments, the
difficulty should be increased by one level. Futuristic: Nanobots or engineered biological
healers may be able to consume the
burnt tissue and destroy any bacteria.
Risk to Eyes
Skin can easily be regrown, even for
4th degree burns.
The eyes are especially vulnerable, especially to acid and
naked flames. If the location is the head, then the type Spell: Regrow I (1st degree), Regrow II (2nd
and extent of the burn should indicate if the eyes are degree), Regrow III (3rd degree),
likely to be at risk. If so, then the risk that the eye is Regrow IV (4th degree)
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 The first step is always to stop any fire and wash away
burn. Roll once for each eye. corrosive chemicals. Cold water can be applied, except
when burn is so severe that hypothermia may be a risk.
Disability
Burn care concerns itself with preventing shock, infec-
If the burn does not prove fatal it may still be disabling. tion and hypothermia. It is also important to relieve pain
For 2nd degree burns this is usually not an issue, although and salvage as much viable burned tissue as possible.
some scarring may occur. A 3rd degree burn will cause Blood transfusions [2C], fluid administration, antibiotics,
heavy scarring, and will reduce appearance if in the face. surgical removal of dead tissue (debridement) and skin
grafts may all be needed. Once the immediate risks are
A 4th degree burn is the worst, with a permanent impair- avoided cosmetic surgery with skin grafts may be needed
ment of -1D unless treated with skin grafts. If this is a leg to reduce scarring and avoid impairment from loss of
it will cause a limp and reduce movement speed. functionality. See the various risks above for necessary
treatments.

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 communica-
tion 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 ver-
tebrae, 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.
Risks
The main risk with a spine injury is the danger of dam-
aging the spinal cord. The specific risks are defined for
each type of injury below.
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 be-
cause 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 par-
tial 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 GM’s
discretion, possibly requiring a patient care roll with dif-
ficulty 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 spe-
cified for each type of spinal damage.
7A –Vertebrae Fracture
One of the 33 vertebrae segments of the spine is frac-
tured and collapses bending the backbone and stretching
the spinal cord.
Symptoms
Severe pain, swelling, reduced ability to move.
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 com-
plete [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
 Spinal Cord Damage 7B –Vertebrae Dislocation
Trauma Complete [7D] Partial [7E]
Superficial - 1 A vertebrae dislocation is very serious because it has a
Nasty 1 2 high probability of damaging the spinal cord. It is also
Grievous 1 2-3 unstable which means further injury from movement is
Grim 1-3 4-6 likely.
Mortal 1-6 7-9
Symptoms
Diagnosis
Severe pain, swelling, reduced ability to move.
Modern: X-Ray (tricky) Risks

Medieval: Physical Examination (severe) The immediate risk of spinal cord damage depends on
the amount of trauma that was inflicted. Roll 1D10 on
Futuristic: Hightech Scanner (easy)
the table below and if the number matches with a com-
Spell: Healing Vision plete [7D] or partial [7E] spinal cord damage for the
wound severity the spinal cord is damaged.
Treatment and Surgery The risk when moving the patient is half of this initial
risk, rounding down and so potentially eliminating the
risk for less severe trauma.
Modern: Non-Surgical Treatment (special)
Surgical Correction (special)
Spinal Cord Damage
Medieval: Non-Surgical Treatment (special) Trauma Complete [7D] Partial [7E]
Surgical Correction may be available Superficial - 1
in very advanced societies. Nasty 1 2
Grievous 1-3 4 -5
Grim 1-4 4-7
Futuristic: Non-Surgical Treatment (special) Mortal 1-8 9 - 10
Hightech surgery likely has a
difficulty two levels lower than the Treatment
severity indicates.
See vertebrae fracture (7A).
Spell: Regrow III

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.
7C – Ruptured Ligaments
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.

On a 1D10 roll of 6-10 it will heal without surgery. Oth- Symptoms

erwise it will only heal partially.
Pain in the neck, arms, legs or back along with reduced
If the spine does not heal on its own it requires surgery, ability to move.
although there is a small chance that non-surgical treat-
ment by a skilled doctor is possible instead of surgery. Risks

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 moun-
ted to the spine for stability.
Non-surgical treatment will be one difficulty higher.
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 Risks
damage can happen again and again.
The immediate risk is from going into shock. Make this
Diagnosis an easy shock roll for paraplegia and hard for quadriple-
gia.

Modern: Physical Examination (hard) If the result is quadriplegia the injured will eventually
die. However, with careful care and life support life may
Medieval: Physical Examination (hard) be extended more or less indefinitely.
Futuristic: Hightech Scanner (tricky)
Injury to the spinal cord stops the bladder working. If the
Spell: Healing Vision nerves are intact below the injury the bladder will empty
itself on reflex whenever it is full. If this does not hap-
pen, however, the bladder will need to be emptied regu-
Can be difficult to diagnose as does not show up on x- larly with a catheter.
rays.
Treatment
Treatment and Surgery

Modern: Care can extend life but not heal it.

Modern: Surgical treatment (tricky)
Immobilisation (special) Medieval: Abandon all hope.

Medieval: Immobilisation (special) Futuristic: May be biological grafts or methods

Surgical treatment may be available in to trigger the cord to regrow.
very advanced societies. Nanosurgery (tricky)

Futuristic: Immobilisation (special) Spell: Regrow IV

Hightech surgery likely makes this
easy.
Nanosurgery (easy) The spinal cord does not heal and cannot be treated. Fu-
ture medicine may have a chance of healing cord dam-
Spell: Regrow II age.

7E – Partial Cord Damage

Usually requires surgical treatment, although immobil-
isation of the spinal column for a few weeks or months
has a 25% chance to be sufficient to allow spontaneous
healing.
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
Paralysis, loss of feeling and function in affected regions.
Loss of bowel and bladder control. Erectile dysfunction.
Partial cord damage is very similar to complete cord
damage. The major difference is that the cord is not com-
pletely 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
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
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
Modern: No treatment aside from care.
Medieval: Luckily it may mostly heal.
Futuristic: May be biological grafts or methods
to trigger the cord to regrow.
Nanosurgery (easy)
Spell: Regrow III
Rarely the spinal cord will heal itself over time and al-
though some disability will usually remain the condition
may improve enough that the impairment penalty no
longer applies.
8 – Pain
Pain is an unpleasant and hurtful sensation triggered by
the excessive stimulation of nerve endings due to inflic-
ted 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 treat-
ment. 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
Modern: Drugs is the most common way of
relieving pain.
Medieval: Alcohol and potentially potions or
herbs acting as drugs may lessen the
pain.
Futuristic: Pain can likely be turned on or off
with hightech solutions or drugs.
Spell: Soothe I (relieve pain while
concentrating), Soothe IV (remove all
pain, even from surgery, while patient
is calm and still)
Pain can be reduced through the use of sedatives, drugs
and narcotics. The pain can also be eliminated by sever-
ing 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 care-
lessness and increases the risk of injury and further dam-
age after the initial trauma.
Even worse is long term or permanent loss of pain sig-
nals due to continuous use of drugs, cybernetics or ex-
tensive surgery. Pain is a critical part of the body's de-
fence 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 re-
flexes, 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 char-
acter 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.
9 – Inflammation
Inflammation is a protective reaction of tissue to injury
or infection. The symptoms are pain, redness and swell-
ing.
Sometimes inflammation itself can become the problem.
Excessive inflammation can leave joints stiff and a run-
away inflammation usually results in death. Sepsis [4E],
peritonitis [300A] and dysentery [300C] are all examples
of the body’s 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 cough-
ing and reaction to pain and other sensations are absent.
The most likely reason for a coma is brain damage.
Risks
Because the normal reflexes are not working there is a
significant risk of choking on vomit or even saliva. Be-
cause 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. Even-
tually the brain will stop functioning completely and res-
ult in death.
Treatment
Modern: Care (tricky)
Medieval: Care (hard)
Futuristic: Care (easy)
Drugs to Arouse (easy – hard)
Spell: 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 air-
way.
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 dura-
tion.
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 abilit-
ies. Even basic tasks like talking and dressing. This de-
pends on the underlying reason for the coma and what
treatment was possible for the brain damage.
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 epi-
leptic attacks are called seizures. There are many differ-
ent 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.
Risks
Unless taking anti epileptic drugs on a regular basis any-
one prone to seizures may have an attack. Certain factors
increase the likelihood of an attack. These are; tiredness,
alcohol, high temperatures, dehydration, fever and phys-
ical or emotional stress.
Whenever any of these factors affect the epileptic charac-
ter 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 oc-
cur 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 de-
teriorate for the character re-roll with 1D10 and the pres-
ence of trigger factors may of course bring on a seizure at
any time.
Treatment
Modern: Medication exists to significantly
lower the risk and severity of seizures.
Medieval: No treatment available, but certain
herbs may relieve or reduce seizures.
Futuristic: 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.
Spell: Purify II (stop a seizure)
Purify IV (cure epilepsy)
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 involun-
tary 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.
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.
11C - Tonic-Clonic Seizure
Known as a grand mal attack, these dramatic seizures are
sometimes preceded by a brief warning. A sinking feel-
ing 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 of-
ten follows and a desire to sleep for an hour or two.
Headache and sore muscles are common after an attack.
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
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.
12B - Severe Fever
Spell: Soothe III
Sweating, or suffering from chills and shivering, some-
times alternating periodically between the two. Very high
temperatures, extreme fatigue and often a feeling of im-
pending doom. Chronic fatigue of exhausted lasts as long
as the fever resulting in a minimum of a -1D fatigue pen-
alty. 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
Constantly drained and delirious with a very high tem-
perature, 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
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 monox-
ide. If sleeping there may be no symptoms.
Risks
The outcome depends on the carbon monoxide concen-
tration 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
14 – Dehydration
Effect
in Blood (%) Dehydration means that the body does not have enough
1-10 None. fluids. It can arise from not drinking enough water or
Tension in forehead and dilation from losing too much fluid.
11-20
of blood vessels.
21-30 Headache and pulsating temples. Symptoms
Severe headache, weariness,
31-40 dizziness, weakened sight, naus- Early signs are dry mouth, sunken eyes and skin that
ea and vomiting. does not bounce back quickly when pinched. As it gets
As above plus increased breath- worse pulse increases, hands and feet turn cold, the lips
41-50 ing and pulse. Collapses, uncon- blue and the dehydrated becomes confused and lethargic.
scious by time reaches 50%.
Convulsions start, leading to Risks
51-60 coma and minor brain damage
by the time 55% is reached. A man can only live a few days without water. This can
Deeper coma and major brain be significantly shortened due to a fever or heat. Severe
61-70 vomiting and diarrhoea can cause lethal dehydration in a
damage.
Deeper coma and massive brain day. Dehydration leads to confusion, unconsciousness,
71-80 damage. Slowing of breathing brain damage and eventually death.
and death within hours.
Treatment
Coma and death in less than one
81-90
hour.
The cause of the dehydration, fever, vomiting, diarrhoea
Coma and irreversible death must first be treated while water, and possibly salts, to
91-100
within a few minutes. rehydrate the body.
Smoke from a badly ventilated fireplace will only in-
crease the concentration by five percent every one or two 15 – Hypothermia
hours. In contrast a smoke filled room in a burning house
may increase the percentage level by five percent every The table below shows the symptoms and treatment for
ten seconds. If the smoke is seeping in from a fire behind abnormally low body temperatures in Celsius. If the
a closed door, or up a stairway, it is more likely to in- warming is too rapid it may result in heart attack [202C].
crease the concentration in the bloodstream by something
like five percent every five minutes. Hypothermia
Body
Obviously there are many other rates at which carbon Symptoms Treatment
Temp
monoxide may accumulate and each situation must be 36 Feel cold Dry shelter and clothes,
determined by the GM. warmth, light exercise,
35 Shivering
warm drinks and food.
Once out in fresh air again the percentage will slowly Avoid rapid warming,
drop. Clumsy, Irra-
34 rest, warm food, drink
tional, Confused
and breathe warm air.
Treatment
As above, lie down with
33 Muscle stiffness
feet raised.
Spell: Cleanse I (1-25), Cleanse II (26-50), Stops shivering
32 As above, but nothing
Cleanse III (51-75), Cleanse IV (76-100) and collapses
by mouth and keep air-
31 Semi conscious
ways open.
30 Unconscious
Fresh air or pure oxygen for more severe poisonings. A Slow pulse and Mouth-to-mouth breath-
29
ventilator may be needed to save someone who has breathing ing at slow pace.
suffered prolonged exposure. 28 Heart Attack Heart compression (CPR)
CPR, mouth-to-mouth
and slow warming may
Below
No vital signs work. Should not be
28
and cold 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
Body Temp Symptoms
38 Sweating
Severe sweating, red, breathless and
39
exhausted.
Profuse sweating, weak, dehydra-
40
tion, headache and dizzy.
Vomits, severe headache, dizzy, con-
40.5
fused and may hallucinate.
41 As above and delirious, drowsy.
Turns Pale, abnormal blood pres-
42 sure, fast heart rate, convulsions and
faints.
Minor brain damage and shock as if
43
suffocating due to heart failure.
Major brain damage and shock as if
44
suffocating due to heart failure.
Massive brain damage and shock as
47
if suffocating due to heart failure.
50 Muscle rigidity, immediate death.
Treatment
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.
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 hor-
mone 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
body’s 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.
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 pan-
creas but more commonly from an autoimmune disease
in which the body’s immune system mistakenly launches
an attack on the insulin-producing cells of the pancreas.
Symptoms
Symptoms start mild but rapidly get worse. If the dia-
betes 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:
● Poorly healing skin rashes which may affect ap-
pearance.
● 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.
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 de-
hydration [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 per-
ception 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 seri-
56
 ous risk. Each week roll 1D10 and on a 10 a fes-
tering infection [4A] develops. Careful foot care
may eliminate this risk.
After the period of severe symptoms the character’s
health will deteriorate quickly and the symptoms become
life-threatening.
Risks
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 character’s 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 in-
creased 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 supply-
ing insulin, will lead to death in another 1D10 days.
Diagnosis
Modern: Blood Test (easy)
Medieval: 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.
Futuristic: Blood Test (easy)
Spell: Healing Vision
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
Modern: Regular insulin injections, carefully
planned diet and monitoring.
Medieval: Probably no treatment available.
Futuristic: Insulin producing device installed.
Nanotechnology would allow
nanobots to repair a damaged
pancreas to restore insulin production.
Spell: Purify IV (cure diabetes)
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 charac-
ter 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 man-
agement 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
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 life-
threatening just as for diabetes I.
Risks
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 character’s life by
decades, probably allowing him to live until old age.
57
 Stroke Damage
19 – Blood Clot 1D10 Damage
1-3 Minor Brain Damage [105A]
Thrombosis 4-6 Major Brain Damage [105B]
7-8 Massive Brain Damage [105C]
A potentially fatal obstruction of an artery or vein by a 9 - 10 Death
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

There may be pain and swelling where the clot lodges.

Risks

If a blood clot forms roll 1D10.

Blood Clot
1D10 Result
1 Gangrene in left arm
2 Gangrene in right arm
3-4 Gangrene in left leg
5-6 Gangrene in right leg
7-8 Heart Attack
9-10 Stroke

Treatment

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 im-

paired 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)
Anatomy
Here the head includes the throat and upper neck.
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.
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.
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 sys-
tem. Different parts of the brain control different func-
tions and so is usually divided into regions called lobes.
Everything from basic reflexes and breathing to intelli-
gence 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 in-
formation 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.
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.
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 in-
ternal bleeding as it may cause additional damage to the
brain.
Symptoms
The accumulated blood presses against brain tissue caus-
ing 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 con-
sciousness.
Risks
The greatest risk is that the bleeding is not stopped, or re-
lieved. 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, typic-
ally Spirit. On a failed roll death follows after another in-
terval 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 1-
2 the clot is not significant and the character regains con-
sciousness in 1D12 hours. On a result of 3-4 the charac-
ter regains consciousness in 1D12 hours too, but will ex-
perience 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 uncon-
scious 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 pres-
sure as normal.
Diagnosis
Modern: CT or MRI Scan (tricky)
Medieval: May be guessed from observing
symptoms (hard)
Futuristic: Hightech Scan (easy)
Spell: Healing Vision
Diagnosis is difficult and so a doctor should presume that
progressive loss of consciousness after a head injury in-
dicates an intracranial bleeding until proved otherwise.
CT and MRI scans are best used and can determine the
position and size of the bleeding.
Surgery
Modern: Drilling the skull (hard)
Scan and drilling the skull (tricky)
Clot Removal (varies)
Medieval: Drilling the skull (hard)
Clot Removal (varies)
Futuristic: Hightech Surgery (easy)
Spell: Bloodmagic I (some), Bloodmagic II
(moderate), Bloodmagic III (heavy),
Bloodmagic IV (massive)
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 bleed-
ing. 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.
100B – Suffocation
Suffocation means that the brain is starved from oxygen
(ischemia) which causes brain cells to die causing irre-
versible 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 Effect
4 Minor Brain Damage [105B]
6 Major Brain Damage [105C]
7 Massive Brain Damage [105D]
10 Unlikely to be revived
60
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 sever-
ity or multiply the minutes by the result of a 1D10 roll
where 7+ means the character is not dying, only strug-
gling 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
Modern: Scalpel Tracheostomy (easy)
Knife Tracheostomy (tricky)
Medieval: Scalpel Tracheostomy (easy)
Knife Tracheostomy (tricky)
Futuristic: Hightech Tracheostomy (easy)
Spell: Cleanse (level would depend on the
blocking object I-IV)
Treatment depends on the damage, but if the air way is
just blocked may only need to use instruments to dis-
lodge 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.
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 intro-
duced through trauma or surgery, which penetrated the
skull, or from a nearby infection in the head, throat or
chest. After a couple of weeks the infection is encapsu-
lated. 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 of-
ten 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 symp-
tom 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
Without treatment it is fatal in the majority of cases, of-
ten 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 mat-
ter 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 cap-
sule 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.
61
 ● Formation Stage: 1D6 not known a wide spectrum antibiotic must be used. If
● Capsule Stage: 1D8 the bacteria is known the pharmacy difficulty is tricky,
● Capsule Stage with Multiple Abscesses: 1D12 otherwise it is hard. Modified by what is available of an-
● End of Capsule Stage or Rupture: 1D12 tibiotics of course. Unless the antibiotic treatment is an
exceptional success surgery is also needed.
Brain Infection Brain Damage
Roll Damage Surgery
1-3 No Brain Damage
4-6 Minor Brain Damage [105B]
7-9 Major Brain Damage [105C] Modern: Drain Abscess (tricky-severe)
10 - 12 Massive Brain Damage [105D] Surgical Debridement (severe
or worse)
Diagnosis
Medieval: No treatment normally possible.

Modern: MRI Scan (easy) Futuristic: Hightech Surgery (easy-tricky)

X-Ray (tricky)
Surgery (varies)
From Symptoms (insane) If there are multiple abscesses increase all surgery diffi-
culties by one.
Medieval: Surgery (varies)
From Symptoms (insane) In addition to antibiotics surgery is nearly always neces-
sary to drain the abscess. If scanners and surgical needles
Futuristic: Hightech Scan (easy) are available for the job this is of tricky difficulty. Other-
wise it will be severe or worse, depending on the equip-
Spell: Healing Vision ment available. Any failure might cause brain damage as
described in the section on the brain [105] for treatment.

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 ima-
ging devices and scanners. A MRI scanner makes it easy
while it is tricky to diagnose with the use of a x-ray ma-
chine. 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 de-
pending on where the infection is located.
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 suc-
cess. Alternatively if one has a normal success then only
one other method needs to be employed at normal or bet-
ter 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

Modern: Special Antibiotics (tricky-hard)
Medieval: No treatment likely exists
Futuristic: Powerful antibiotics, and possibly
nanobots or friendly bacteria will
exist to cleanse the infection.
Spell: Purify II
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
this stage. The decision to use or leave out each tech-
nique must be decided with no knowledge of the level of
success of the other techniques.
How many attempts can be made depends on the dia-
gnostic capability available and the duration of the infec-
tion. With MRI or other sophisticated scanners an at-
tempt 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 an-
other infection.

62

101 - Ear
The ear is not only responsible for hearing but also bal-
ance. 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.
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 negli-
gible in most cases, although may become an issue if
both ears are severed.
Risks
If the trauma that caused the severe ear trauma also
caused internal bleeding, it can be assumed to be intra-
cranial [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 dam-
aged. If this is the case roll 1D100. The result is the per-
centage of hearing remaining on the ear. Anything under
20% is effectively deaf.

Surgery

Modern: Sew ear back on (hard)

Microsurgery (easy)
Prosthesis (varies)

Medieval: Sew ear back on (hard)

Futuristic: Sew ear back on (hard)

Hightech Microsurgery (easy)
Nanosurgery (easy)

Spell: Regrow II (fuses ear back on)

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 diffi-
culty 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 tem-
porary and permanent debilitation.
Symptoms
The symptoms of damage to the inner ear can be bleed-
ing from the ear canal, vertigo, tinnitus and reduced hear-
ing depending on what has been damaged as outlined un-
der 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 ac-
tions 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 char-
acter 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 ac-
tions, 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 bal-
ance 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] be-
ing damaged. Severity moderate.
Surgery
Modern: Surgical Repair (severe)
Medieval: No repair possible
Futuristic: Hightech Surgery (tricky)
Nanosurgery (easy)
Spell: Regrow III
Except for emergency surgery to stop any severe intra-
cranial 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 infec-
tion [100D] but also runs the risk of causing brain herni-
ation 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 tem-
poral bone, forming the side and base of the skull, is frac-
tured. 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 in-
ternal bleeding.
Symptoms
The symptoms of damage to the inner ear can be bleed-
ing from the ear canal, leaking fluid, vertigo, tinnitus and
reduced hearing depending on what has been damaged as
outlined under risks below.
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 leak-
age 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 in-
fection [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 mat-
ter 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.
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 spin-
ning 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 erro-
neous signals from the ear. There is, however, a 30%
chance that the character will be plagued with vertigo at-
tacks 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 at-
tack starts right after the offending head movement and
lasts for roughly 30 seconds. In that period of time all ac-
tions 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
Modern: Surgical Repair (severe)
Medieval: No repair possible
Futuristic: Hightech Surgery (tricky)
Nanosurgery (easy)
Spell: Regrow IV
Except for emergency surgery to stop any severe intra-
cranial 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 infec-
tion [100D] but also runs the risk of causing brain herni-
ation 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 explor-
atory surgery.
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
socket itself is larger than the eye-ball, but filled with
loose fat to allow the eye movement. The eye moves us-
ing six small muscles. The eye is also a relatively unpro-
tected 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 re-
duction 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.
The percentage will usually be converted to an impair-
ment 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 hand-
guns. 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 im-
possible without glasses or other vision aids.
65
 The left eye is fine but the right eye has a 60% Futuristic: Hightech Surgery (hard)
vision reduction. This gives a total vision reduction Hightech Microsurgery (tricky)
Hightech Microsurgery to restore
of 30% or –1D impairment.
nerve (tricky)
Nanosurgery (easy)
Then the left eye sustains trauma which reduces its
sight by 75%. This gives a total vision reduction of Spell: Cleanse II (remove fluids), Regrow III
75% + 60% divided by two. Or 135 / 2% which is (repair damaged nerve)
67.5% or –2D impairment.

Surgical removal of the blood and fluid causing damage

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.
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 scan-
ner, the difficulty is increased to at least severe.

Symptoms
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 accumu-
lated on the eye each day. After five days it reaches
100% and vision is permanently lost on the eye.
Diagnosis
Normal failure will sever the optic nerve causing per-
manent 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.
102B – Eye Laceration
The cornea is cut, punctured or ruptured permanently
damaging vision.
Risks

Modern: MRI Scan (tricky) There is a 50% chance of complete and permanent blind-
ness. Otherwise perception on the eye is reduced to
Medieval: Not possible 1D100 percent of what it was. Round down as usual.

Futuristic: Hightech Scan (easy) The secondary risk is an infection, which is determined
as per normal for any trauma. An infected eye however,
Spell: Healing Vision will lose all vision it has left and there is of course the
small but deadly risk of a brain infection [100D].
Surgical treatment before vision is lost may be possible if Surgery
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 Modern: Microsurgery (hard)
eye.
Medieval: No repair possible
Surgery
Futuristic: Hightech Microsurgery (tricky)
Nanosurgery (easy)
Modern: Surgery (severe)
Microsurgery (tricky) Spell: Regrow III

Medieval: No repair possible

66
Repairing a lacerated eye is usually not possible. How- 100% Orbital Rim Fracture
ever, with advanced medical equipment such as lasers, 70% Retinal Detachment
microsurgery might be able to restore some vision.
40% Severe Hyphema
Grievous
The percentage of lost vision recovered depends on the 20% Dislocated Lens
success. Marginal success 30%, normal success 60%. 10% Blowout Fracture
Only an exceptional success will restore vision one hun- 5% Nerve Damage
dred percent. Normal or worse failure will cause further
100% Orbital Rim Fracture
damage to the eye and the loss of all vision if that is not
80% Retinal Detachment
already the case.
70% Severe Hyphema
Grim 50% Dislocated Lens
102C – Blunt Eye Trauma
40% Blowout Fracture
A heavy blow to the eye can seriously damage the eye 30% Nerve Damage
and its surrounding structure of bone, ligaments, Mortal 100% Destroyed Eye
muscles, blood vessels and nerves.
As with eye laceration any infection will most likely
Symptoms leave the eye blind and pose a risk of brain infection
[100D] as for any infection in the head.
Symptoms will depend on the damage done but it is safe
to say that the eye will be painful, bruised, swollen and Blowout
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 frac- Modern: Surgical Trapped Muscle Repair (see
ture. Such deformity may be permanent and will reduce treatment)
appearance.
Medieval: Lowtech Surgical Repair (tricky)
Risks
Futuristic: Hightech Surgical Repair (easy)
The risk and extent of damage of a blunt eye trauma de-
Spell: Regrow II
pends on the force, angle and shape of the impacting ob-
ject. Thus the risks are divided in the table below de-
pending on the severity of the trauma inflicted.
The eye is pushed back and the thin bone at the bottom
of the eye socket is fractured, or in other words blown
Roll 1D100 only once. All types of damage to the eye
out by the pressure. In addition to great pain it causes
that have a percentage chance higher or equal to the res-
double vision that lasts for 1D10 days. There is a 10%
ult apply. So that a low roll can result in several types of
chance that the eye muscles become trapped by the bony
damage at once. If the result is greater than all the pos-
fragments of the fracture. If that is the case surgery is ne-
sible types of damage the result is only a severely black,
cessary to cure the double vision. Double vision effect-
swollen and painful eye that will have a somewhat
ively reduces eyesight on the eye by 50%.
blurred vision for a few days.
Retinal Detachment
Blunt Eye Trauma Risks
Trauma 1D100 Damage to Eye
50% Blowout Fracture Modern: Surgical Retinal Attachment (see
Superfi- 15% Retinal Detachment treatment)
cial 10% Hyphema
Medieval: No treatment
5% Dislocated Lens
70% Blowout Fracture Futuristic: Hightech Surgery (easy)
30% Retinal Detachment
Spell: Regrow II
Nasty 20% Hyphema
10% Dislocated Lens
5% Orbital Rim Fracture 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

Modern: Severe Hyphema Surgical Repair (see by 20%. The head must be moved to see to the sides, up
treatment) or down.
Medieval: No treatment
As the eye socket fractures it may puncture the eye caus-
Futuristic: Hightech Surgery (tricky) ing further damage. There is a 20% risk of such an eye
laceration [102B].
Spell: Cleanse II
The swelling and discolouration usually lasts about 10
days before it starts to go away. However, appearance
The blood vessels around the iris burst bleeding into the may be reduced from bone deformities in the forehead or
eye. The inside of the eye is a clear fluid but when hy- cheek.
phema occurs sight on the eye turns pinkish and foggy.
Nerve Damage
For normal hyphema eyesight is temporarily reduced by
about 50% percent. This lasts 1D10 days before it clears
Modern: No treatment
up.
Medieval: No treatment
For severe hyphema all vision is lost on the eye, often
permanently. Without surgery there is a 50% chance that Futuristic: Hightech Microsurgery (tricky)
1D100 percent of vision will be recovered. With surgery Nanosurgery (easy)
it depends on the success of the operation.
Spell: Regrow III

Dislocated Lens The optic nerve [107B] from the eye to the brain is dam-
aged effectively blinding the eye.

Modern: Surgical Correction (see treatment) Treatment

Medieval: No treatment Attaching a detached retina is only possible with special-

ised advanced medical equipment. The difficulty depends
Futuristic: Hightech Surgery (easy)
on how soon after detachment the operation is performed
Spell: Regrow II
and the equipment and method used. For every day after
the fourth since the retina detached completely, increase
The lens is detached from the eye and left floating free. difficulty by one level. Assume tricky difficulty with
This causes blurred vision with a 25% reduction in eye- good equipment.
sight.
Only severe hyphema needs surgery but it is tricky even
Eyesocket Fracture with the right equipment to improve on recovery. Any
normal or worse failure damages the eyes as for surgical
treatment of fractures detailed below.
Modern: Surgical Repair (see treatment)
A dislocated lens is often best left untreated. Difficulty
Medieval: No treatment will be tricky even with the right equipment. Normal fail-
ure will cause a retinal detachment and significant or
Futuristic: Hightech Surgical Repair (easy)
worse will damage the eye (vitreous loss) causing blind-
Spell: Regrow II ness.

Surgical treatment to repair a blowout or orbital fracture

The bony cup called the eye socket that surrounds and is going to be tricky even with the right equipment. Even
protects the eye is fractured. The fracture of the eye sock- normal failure will mean puncturing of the eyeball
68
[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 appear-
ance.
Nerve damage is usually not treatable.
102D – Destroyed Eye
The eye is completely destroyed beyond any hope of
even surgical repair.
Risks
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: Dead tissue Surgical Removal (easy)
Medieval: Dead tissue Surgical Removal (easy)
Futuristic: Dead tissue Surgical Removal (easy)
Install Cybernetic Eye
Spell: Cleanse II (remove dead tissue),
Regrow IV (new eye)
Removal of dead tissue and administrating antibiotics to
prevent infection.
103 – Mouth
The mouth is surrounded by muscles essential in eating,
swallowing and to articulate speech.
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
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.
103C – Severed Tongue
The tongue can cause breathing problems and death by
blocking the airway if loosened by damage.
104 - Nose
Supported by the nasal bone, which is in fact cartilage,
the nose is the normal organ for breathing. It is also re-
sponsible for smell.
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 abil-
ity 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 de-
pends 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
Modern: Diagnosis, Examination (easy)
Splintering (easy)
Medieval: Diagnosis, Examination (easy)
Splintering (easy)
Futuristic: Diagnosis, Examination (easy)
Splintering (easy)
Spell: Regrow I
The nose can remain swollen for several days, but once it
goes down the bone can usually be set or splinted to en-
sure 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.
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
The nose is split open and the bones can be shattered into
more than twenty pieces.
Risks
The character will be less attractive, unless the nose is re-
constructed.
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%.
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 de-
pends 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: Diagnosis, Examination (easy)
Nose Reconstruction (hard)
Medieval: Diagnosis, Examination (easy)
Nose Reconstruction (severe)
Futuristic: Diagnosis, Examination (easy)
Hightech Reconstruction (tricky)
Nanosurgery (tricky), the high
difficulty is because the shattered
pieces may not be aligned properly
and require a surgeon’s assistance to
align them.
Spell: Regrow II
Surgery is the only way to repair the nose and will in-
volve 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 char-
acter's appearance.
104C – Severed Nose
The nose is severed or severely mutilated.
Symptoms
The nose is cut off from the face or otherwise destroyed.
70
Risks entirely severed from its original position in order to
keep it alive. The site of the nose is cut and the skin flap
A severed nose has a dramatic impact on appearance and twisted around and attached. The patient must usually lie
the character is likely to be met with shock and even re- still for about a week and the skin may need to remain
pulsion. connected to its original position for as much as 20 days.
After about ten days cloth or something similar needs to
Any infection in a nose wound will have a greater chance be inserted into the nostrils to make sure they remain
of causing a brain infection [100D] than normal even open. Once the skin is severed from its original position
though the skull is not penetrated. For minor infections some final cutting of the nose is usually performed to im-
the risk is 10%, while for major infections the risk is prove its shape.
40%.
The operation is usually hard but the new nose can look
The ability to smell is lost and breathing difficulties almost natural. If only a marginal success the face will
halves stamina during physical activity. still be hideously disfigured. A normal success means the
character will look more normal even if the nose does not
There is also a small but serious risk that any bleeding look entirely natural. If the success is exceptional the
from the arteries at the back of the nose may cause nose is almost perfectly restored.
breathing difficulties. If this occurs the times before
shock occurs from the bleeding are halved. The risk de-
pends on the bleeding caused by the trauma that broke 105 - Brain
the nose. It is 5% for moderate bleeding, 15% for heavy
bleeding and 25% for massive bleeding. The brain is without doubt the most important organ of
the body.
Treatment
Reflexes, blood circulation, breathing and other similar
functions are generally located in the lower part of the
Modern: Diagnosis, Examination (easy) hindbrain near the spinal cord. While the forebrain, fur-
Reattachment (hard) ther out, is the primary centre for intelligence and higher
Reconstruction (hard) thought. This is a simplified view, however, as the brain
Microsurgery Reattachment (tricky)
works as one integrated unit.
Medieval: Diagnosis, Examination (easy)
Reattachment (hard) Certain parts of the brain deals primarily with certain
Reconstruction (severe) functions and so it is divided into regions called lobes.
The brain needs a constant supply of oxygen and glucose
Futuristic: Diagnosis, Examination (easy) at all times. If this is interrupted the brain immediately
Reattachment (tricky) stops working and irreparable damage is done in minutes,
Reconstruction (tricky) see suffocation [100B].
Hightech Microsurgery Reat. (easy)
Nanosurgery (easy) Because the cerebral cortex controls most of the func-
tions of the human body, apart from the very basics, such
Spell: Regrow III (fuse nose), Regrow IV
(grow new nose) as breathing, damage to it can affect almost any part of
the body.

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 an-
other 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
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. Usu-
ally 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 Risk
Concussion 1%
Minor 5%
Major 10%
Massive 20%
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 dis-
order 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 con-
sulting the table below or comparing to the numbers in
brackets for each region.
Brain Disorder Regions
1D10 Region
1-2 Frontal Lobe
3-4 Parietal Lobe
5-6 Occipital Lobes
7-8 Temporal Lobes
9 Brain Stem
10 Cerebellum
Frontal Lobe (1 - 2)
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 Effect
Paralysis. Left or right side of body is com-
1
pletely paralysed.
Loss of spontaneity. Will follow leads,
commands, plans and react in a predictable
2 and previously learned manner. Will never
say, think or do anything impulsive or unex-
pected.
Inability to express language. Will under-
stand others and can even learn new lan-
3 guages but is completely unable to pro-
nounce words. Is still able to shriek, grunt
and “speak” utter nonsense.
Single mindedness. Becomes obsessed with
a single thought and is unable to stop think-
ing about it. Will constantly talk about it,
4 compare it with current activities and in-
volve 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 concen-
tration for more than a few seconds. Reduce
this to -1D if someone is helping the charac-
ter to keep focused or is in a minimal envir-
5 onment 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, typ-
ically +1XP. Action skills, such as combat
skills and athletics, may be exempt.
72
 Emotionally unstable. Short tempered,
prone to crying and anxious. May switch
suddenly from anger to sadness or from hap-
piness to depression and so on. Usually
brought on by stress, physical exhaustion or
6 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 loud-
mouth. The outspoken leader may become
an introverted recluse. The new personality
7 still known and recognised, it is difficult to
will often be more prone to disruptive, inap-
propriate 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 uncon-
trollable twitches. May come at any time but
more frequently during physical or emotion-
al stress. Although causes no physical handi-
cap will have a negative impact on social in-
teractions. Roll 1D10 to make a check.
8 reading but makes writing very slow, awk-
When calm twitches only appear on a result
of 8 or more. Mild and moderate stress re-
duces 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.
9 This is reflected with a permanent -1 reduc-
tion of the primary mental attribute, typic-
ally Cunning.
Seriously impaired mental function. All
10 mental attributes, such as Cunning and Wis-
dom, 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 per-
ception, 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
1 book is completely unable to notice anything
or anyone else. The world can be falling
down around him and he will not notice un-
less directly struck.
Impaired word recall. Although objects are
remember their names. People, places and
things can often be described but the word is
out of reach. There is no problem repeating
2
the word if it is provided but it may be for-
gotten again in the future. This should be ro-
leplayed 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
3
ward and often impossible.
Reading impairment. While still able to
write cannot recognise written words and
has difficulty recognising letters. Can recog-
4 nise 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
5
be crude and often unrecognisable.
6 Unable to distinguish left from right.
Mathematically impaired. Simple addi-
tions and subtractions that used to be easy
7 become severe to solve. Easy becomes ex-
treme and tricky becomes insane. Anything
harder is impossible.
Reduced eye and hand coordination. Any
task that requires eye-hand coordination re-
8
ceives a –1D permanent penalty. This obvi-
ously 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
9
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 self-
10
care and generally be unresponsive to sur-
roundings unless directly targeted.
73
Occipital Lobes (5 -6)
At the back of the head, the occipital lobes are the centre
of the visual perception system.
Occipital Lobes: Back
1D10 Effect
Reduced field of vision. The vision field is
1-2
cut. -1D to defensive actions and Perception.
3 Colour blindness.
Hallucinations. Colours, stars, spots, balls
of fire and flashes of light may suddenly ap-
pear. Especially in times of stress, tiredness
or physical strain. Even colourful, vivid,
4 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 suf-
5
fers 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 re-
cognise words, making reading impossible.
6 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
7-8
other peoples' movements, such as attacks,
much slower. –1D penalty to initiative and
reflex rolls, close combat and any ranged at-
tacks against a moving target.
Read/Write impairment. While able to
read and write, will make many errors, miss
9-10 words and have a much harder time compre-
hending words and letters making the whole
process very slow.
Temporal Lobes (7 - 8)
Located above the ears on each side the temporal lobes.
Temporal Lobes: Side Above Ears
1D10 Effect
Face blindness. Unable to recognize faces
as the part of the brain which usually does
this no longer functions. People are not eas-
ily recognised and voice, clothing, hair and
general features are more important than the
1-2 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
3 everything on his mind, and even if per-
suaded or threatened into stopping this beha-
viour will resume talking again soon after as
is simply unable to help himself.
Short term memory impairment. A seri-
ous disability that makes it impossible to re-
member anything for more than a second or
two. Will need constant help or depend on
routines to get through a day. It will not im-
pair skill or ability and new ones can be
learned, although the cost for both study and
4-5 experience points are doubled. Thus a
memory impaired fighter will have no prob-
lem 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 dif-
ficult to remember even simple things and
much harder to learn new things. Wisdom
6
attribute is permanently reduced by one.
Double experience point costs for learning
any skill that relies on wisdom.
7 Increased interest in sexual behaviour.
Increased aggressive behaviour. Becomes
8
aggressive and violent.
Inability to understand spoken or written
language. Although able to speak, it makes
9-10
no sense. Can still understand a few indi-
vidual words.
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 protru-
sions it is vulnerable to damage from trauma.
Brain Stem: Deep Within the Brain
1D10 Effect
Decreased vital capacity in breathing.
1-2
Voice almost a whisper and unable to shout.
Difficulties in swallowing food and water.
Eating and drinking enough becomes a prob-
lem. Will easily get things in windpipe and
3-4
is unable to cough such things clear. Will
suffer from malnourishment and loss of
weight over time.
Perception impairment. Problems perceiv-
ing and organizing what is seen. Able to see
things when pointed out and able to focus on
an object or person. However, unable to
5
keep track of everything in the field of vis-
ion. 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
6-7
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
8
present. Running or any tasks involving bal-
ance receive a –1D impairment penalty and
may cause nausea.
Insomnia. Inability to sleep during night
causes sleepiness during the day and so re-
duced concentration. Depression, irritability,
9-10
memory problems and falling asleep during
the day will occur frequently. Increase the
difficulty for tasks needing concentration.
Cerebellum (10)
Located at the base of the skull. The cerebellum is in-
volved 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
1D10 Effect
Clumsy. Will sway and stagger when walk-
ing. Constantly knocks things over and has
1
great difficulty with fine movements. –1D
penalty to delicate tasks.
Unable to walk. Can only stagger a few
2
steps without falling. Still able to stand.
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
3
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
4-5 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
6 which may vary in severity but always
present. Running or tasks involving balance
receive –1D and may cause nausea.
7-8 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 in-
stead hesitate and require concentration to
9-10
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
Modern: Diagnostic Scan (tricky)
Minor Surgery (severe)
Major Surgery (extreme)
Massive Surgery (insane)
Relieve Brain Swell (tricky)
Medieval: Relieve Brain Swell (tricky)
No other treatment available
Futuristic: 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.
Spell: Healing Vision
Soothe II (stop brain swelling),
Regrow III (minor brain damage),
Regrow IV (major brain damage)
Generally there is no treatment for brain damage. How-
ever a skilled brain surgeon may be able to remove dam-
aged parts and perform simple repairs.
Such an operation would be severe for minor brain dam-
age, extreme for major brain damage and insane for
75
massive brain damage. Assuming of course that the sur-
geon has the right surgical tools for the job.
Any failure, except marginal, would cause further brain
damage. Normal failure minor brain damage and excep-
tional major brain damage or death.
A marginal success might reduce or stop epileptic at-
tacks, while a normal success could improve the condi-
tion. An exceptional success may almost restore the pa-
tient 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.
105A – Concussion
Treatment
Rest is usually the only needed treatment. A concussion
will usually wear of in a day or so but a more severe con-
cussion 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
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.

Concussion shows itself in confusion and amnesia often
after a loss of consciousness.
Symptoms
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
The main risk is the brain disorders caused by the dam-
age to the brain. Roll two different brain disorders as ex-
plained under brain [105] above.
Another danger is intracranial pressure from brain swell-
ing. See fatal brain swelling under brain [105] above.
There is also a small risk of epilepsy. Roll 1D10 and
check the table below.

Risks Epilepsy Risk

1D10 Epilepsy
The main risk of a concussion is amnesia. Roll 1D100 1-7 No epilepsy
and consult the table below. 8 Simple Partial Epilepsy (15A)
9 Complex Partial Epilepsy (15B)
Concussion – Amnesia 10 Tonic-Conic Epilepsy (15C)
1D100 Memories Lost
1-30 None Finally roll 1D10 and on a 8 or greater the brain damage
Last few minutes before will have caused a coma [10]. Even if this is not the case
31-50 brain damage always causes unconsciousness and this
the concussion.
Last few hours before the will generally last until the head injury has been treated
51-70 or started to heal.
concussion.
Everything since that
71-80 Treatment
morning.
Everything for the last
81-90 See treatment under brain [105] above.
1D10 days.
Loss of identity and all per-
sonal memories. Does not 105C – Major Brain Damage
91-100
affect skills, language or
general knowledge. Major brain damage is very serious and invariably leads
to serious handicaps and disabilities.
Memories will usually return gradually with time, but for
a more severe amnesia it may take months or even years, Symptoms
and even then some things may not come back. They
may never come back or they may return with some trig- Epilepsy, memory problems, poor judgement, reduced
ger that suddenly opens up access to the lost memories. abstract reasoning, emotional difficulties, depression,
Another danger is intracranial pressure from brain swell- personality changes and a short temper are just some of
ing. See fatal brain swelling under brain [105] above. the possible symptoms of brain damage.

76
Risks 105E – Breathing Stop
The main risk is the brain disorders caused by the dam- Apnea
age to the brain. Roll four different brain disorders as ex-
plained under brain [105] above. As a result of massive internal bleeding inside the skull
or severe head injuries breathing stops. Since the heart
Another danger is intracranial pressure from brain swell- still continues pumping the pressure increases in the skull
ing. See fatal brain swelling under brain [105] above. until the brain tissue herniates down through the bony
ring, tentorial opening, on which it rests. The brain stem
There is also a significant risk of epilepsy. Roll 1D10 and is dislocated and pushed downwards and irreversible
check the table below. damage is caused by the squeezing of the brain on each
side as it is pushed down. The end result is either
Epilepsy Risk massive brain damage [105D] or death.
1D10 Epilepsy
1-4 No epilepsy
5-7 Simple Partial Epilepsy (15A)
8-9 Complex Partial Epilepsy (15B)
10 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 self-
care and neither will he be able to act purposefully in re-
sponse 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.
106A – Carotid Severed in Neck
Even if only partially severed can cause oxygen starva-
tion to the brain and thereby brain damage or death.
Risks
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 dam-
age occurs much faster. For one severed carotid treat as
suffocation [100B], but if both are severed then uncon-
scious 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 ar-
teries, 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 com-
pletely 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.
Surgery
Modern: Diagnosing (easy)
Severed Carotid (extreme)
Partially Severed Carotid (severe)
Medieval: Diagnosing (easy)
Severed Carotid (extreme)
Partially Severed Carotid (severe)
Futuristic: Diagnosing (easy)
Hightech Severed Carotid (tricky)
Hightech Partially Severed (easy)
Spell: Bloodmagic III (heavy),
Bloodmagic IV (massive)
Treatment consist of restoring blood circulation to the
brain, this must be done very rapidly to avoid brain dam-
age. Pressure may stop the bleeding but will not help re-
store 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.
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.
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 loc-
ated in the upper part of the nasal cavity. The olfactory
nerves are the only nerves that regenerate and some dam-
age may therefore heal over time.
Most injuries to the nose [104] holds some risk of dam-
aging 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 vis- One side of face droops
ion of both eyes overlap. severely affecting appearance.
Severe Slurred speech and unable to
See pressure blindness [102A] and blunt eye trauma close eye on the damaged side
[102C] for examples of damage to the optic nerve. completely.
One side of face droops
107C - Oculomotor, Trachlear and severely and is partially para-
Abducens Nerve Very Severe lysed causing slurred speech
and affecting appearance. In-
Nerves responsible for eye movement. ability to close eye.
As above, but completely para-
107D - Trigemenial Nerve lysed. Speech is very unclear
Total and eye cannot be closed or
kept shut without manual ma-
Sensations from face and scalp as well as controlling the
nipulation with hands.
movement of the jaw. It emerges from the root of the
brain and follows the floor of the skull to the inner ear. Treatment and Surgery
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 Modern: Surgery (severe)
the mandibular nerve controlling the jaw. Microsurgery (tricky)

Damage to this nerve can cause severe stabbing pains in Medieval: Lowtech Surgery (extreme)
the face, jaw, tongue, ears and lips. Usually associated
Futuristic: Hightech Surgery (hard)
with movement of the jaw, making it very painful to talk, Hightech Microsurgery (tricky)
eat or even swallow. Nanosurgery (easy)

107E - Facial Nerve Spell: Regrow III

Controls movements of the face as it branches out to all

the muscles of facial expressions. The facial nerve is robust and has an excellent ability to
recover from any but the most severe damage. Normally
Symptoms it will heal for superficial, nasty and grievous wounds,
but not for grim and mortal. However, if infected the fa-
Damage to the facial nerve can be seen from one side of cial nerve will never heal for any wound severity unless
the face drooping as the muscles on the side of the dam- treated immediately.
aged nerve hang loosely.
Surgery may be attempted if the nerve does not heal, but
Risks is tricky using microsurgery and at least severe other-
wise. Even with very good surgical tools.
The facial nerve is usually damaged when the temporal
bone is fractured. The severity should be specified with 107F - Auditory Nerve
the trauma. If it is not it should be determined by the
severity of the trauma or a random roll. Also known as the acoustic nerve. Made up of the coch-
lear nerve for hearing and the vestibular nerve for bal-
Facial Nerve Damage ance. See moderate ear trauma [101B] and severe ear
Severity Effect trauma [101C] for some of the associated risks.
Barely noticeable involuntary
contractions of facial muscles 107G - Glossopharyngeal Nerve
Mild
and a slight sag of face and
mouth on damaged side. Sensations in the back of the mouth.
One side of face and mouth
sags somewhat and there are 107H - Vagus Nerve
Moderate noticeable involuntary contrac-
tions of facial muscles. Ap- Extends from the brain, down into the neck all the way to
pearance is affected. 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
it controls many muscles and is important for speech, live with the condition. A -1D impairment is permanent
breathing and even plays a role in memory. unless the condition is treated or heals completely.

Symptoms Treatment

Damage to the vagus nerve often shows itself as hoarse-

ness and problems with swallowing. Modern: Surgery (hard)
Microsurgery (tricky)
Risks
Medieval: Lowtech Surgery (severe)
Damage to the vagus nerve can have a wide range of ef-
fects depending on the location and severity of the dam- Futuristic: Hightech Surgery (tricky)
age. Chronic fatigue, inability to cough, problems swal- Hightech Microsurgery (easy)
lowing, hoarse voice and much more. Nanosurgery (easy)

Treatment Spell: Regrow III

Modern: Surgery (hard) The nerve will usually heal, but often surgery is required
Microsurgery (tricky) to repair the damage and remove clotted blood, bone
fragments or otherwise relieve the nerve of unwanted
Medieval: Lowtech Surgery (severe) pressure.
Futuristic: Hightech Surgery (tricky) If no surgery is attempted roll 1D10. On a 1-4 the nerve
Hightech Microsurgery (easy) will not heal and the damage becomes permanent. Other-
Nanosurgery (easy) wise it heals as normal and the character makes a full re-
Spell: Regrow III
covery.

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. Other-
wise it heals as normal and the character makes a full re-
covery.
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 accessory nerve can lead to a crooked po-
sition of the head where it is twisted to one side. The
awkward position is both a handicap and a social prob-
lem as might make the character seem weird and re-
tarded.
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
The twelfth cranial nerve, the hypoglossal nerve, is the
motor nerve of the tongue.
Symptoms
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 di-
minishes in size as unused muscles waste away (at-
rophies).
Risks
The immediate problem of damage to the nerve is its im-
pact 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.

80
Treatment quired. Future dislocations are however more likely since
ligaments will have been stretched and shouting or any
Modern: No treatment other activity which causes the mouth to open wide is not
recommended for the first couple of months.
Medieval: No treatment

Futuristic: Hightech Surgery (hard) 108B – Fractured Jaw

Hightech Microsurgery (tricky)
Nanosurgery (easy) The jawbone is fractured. This requires great force and
so there are usually other complications as well and teeth
Spell: Regrow III are usually lost.

Surgical treatment is not normally possible. Only very
advanced technology may be able to repair the damage.
Symptoms
In addition to pain and tenderness the character will usu-
ally 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 im-

mediate concern as detailed under suffocation [100B].

A minor jaw fracture may heal with simple limitation of

108 – Jaw 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
Mandible
heal properly. Failure to do so may leave the character’s
face deformed and with an incorrect bite that may inter-
The lower jaw is a single bone loosely jointed with the
fere with talking and eating.
skull.
Surgery
108A – Dislocated Jaw
Although anchored by strong chewing muscles, the jaw Modern: Surgery (tricky)
is unstable in comparison with other bones and can thus
be dislocated from the joints attaching it to the skull. Medieval: Lowtech Surgery (hard)

Symptoms Futuristic: Hightech Surgery (tricky)

The mouth cannot be closed and the jaw might be twisted Spell: Regrow III
to one side.

Risks Repairing a fractured jaw is a long and complicated pro-

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 manoeuv-
ring it back into place is not difficult. An easy treatment
roll pushes the jaw back into place and is all that is re-
cess. The jaw must be surgically immobilised and prop-
erly 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 op-
eration.

81
108C – Shattered Jaw
The jaw is fractured into dozens or even hundreds of
pieces making recovery unlikely.
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
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 frag-
ments of the jaw, teeth or the tongue blocking the airway.
Bleeding is also certain to be dramatic and the risk of in-
fection is great.
Surgery
Modern: Repair (Extreme)
Artificial Replacement (Severe)
Medieval: Lowtech Surgery (Insane)
Futuristic: Hightech Surgery (tricky)
Artificial Replacement (easy)
Spell: Regrow IV
A shattered jaw cannot heal and without it the patient is
not only deformed but also unable to eat or talk. Breath-
ing will usually also be difficult and constant pain is al-
most 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.
109 – Skull
The skull is made up of more than twenty bones, with the
main features being the cranium (brain-box) and the face.
109A – Cranial Fracture
A cranial fracture is a fracture of the skull. It can be de-
pressed or non-depressed.
Symptoms
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
Superficial and nasty wounds cause non-depressed frac-
tures, while more severe traumas cause depressed frac-
tures.
If non-depressed there are no further risks from the frac-
ture, 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 dam-
age. Roll 1D10 once with a 1 major brain damage [105C]
and 2 or 3 minor brain damage [105B].
82
A depressed fracture will usually leave the character un-
conscious until the pressure from the displaced fragment
is relieved.
Surgery
Modern: Surgical Repair (tricky)
Medieval: Lowtech Surgery (hard)
Futuristic: Hightech Surgery (tricky)
Spell: Regrow III
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 ma-
jor brain damage [105C].
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).
Risks
Those who suffer facial fractures are usually knocked un-
conscious 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 pen-
alty to all visual tasks.
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
Swelling, pain and possibly bleeding from the nose or
mouth. There may be bruising around the eyes.
Treatment and Surgery
Modern: Major Fracture Surgery (hard)
Medieval: Lowtech Surgery (severe)
Futuristic: Hightech Surgery (tricky)
Spell: Regrow II
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.
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
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
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 Surgery
directly lethal.

If the trauma is grievous or worse the casualty will be Modern: Laser Surgery (tricky)
choking as detailed under suffocation [100B]. Transplant (tricky)

Treatment Medieval: No treatment possible

Futuristic: Hightech Surgery (tricky)

Modern: Breathing Tube (tricky) Hightech Replacement (tricky)
Scalpel Tracheostomy (easy)
Spell: Regrow II (superficial or nasty),
Regrow III (grievous or worse)
Medieval: Tracheostomy (easy)

Futuristic: Hightech Breathing Tube (easy)
Hightech Tracheostomy (easy)
Spell: Regrow II
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 suf-
focation treatment [100B] can be used to establish an air-
way.
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 pro-
cedures are probably going to be at least tricky.
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
If the esophagus is injured then the windpipe [110A] and
The vocal cord is damaged causing hoarseness or com-
spine [7] are also likely to have been damaged.
plete loss of voice.

Symptoms
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.
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 re-
paired then starvation and infection will eventually lead
to death.
Diagnosis
Modern: Physical Exam. (tricky or worse)
Scan (tricky)
Medieval: Physical Exam. (tricky or worse)

Futuristic: Physical Exam. (tricky or worse)

Hightech Scan (easy)

Spell: Healing Vision

84
Diagnosis can be tricky or even severe if the damage res-
ulted from a blunt trauma. There may be no outwards
signs, but unless the esophagus is repaired with surgery
the casualty will die.

Surgery

Modern: Repair (tricky)

Medieval: Lowtech Surgery (tricky)

Futuristic: Hightech Surgery (easy)

Spell: 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 dia-
gnosis is delayed. Even with prompt diagnosis and treat-
ment the mortality rate is high from the following infec-
tion. 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 prob-
lem; cool the entire body, reduce oxygen requirements,
interrupt the circulation and open the heart"
- Bigelow (20th Century)
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.
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.
Great Vessels
The pulmonary arteries and veins carry blood between
the lungs and the heart.
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 sup-
ply 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 pu-
berty 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.
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.
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].
86
Finally there is the risk of pneumonia [200E]. Pneumonia In the unlikely event that the character does not recover
is usually caught from an infected person or animal as it or die after 80 hours the shock difficulty will stay at in-
can be quite contagious, but may also result from infec- sane and the recovery at tricky until recovery or death
ted drinking water or penetrating trauma. from shock.

200A – Chest Infection Chest Infection Progression

Hours Shock Recovery
Mediastinitis, pleurisy, sepsis 10 Easy Insane
20 Easy Insane
Any trauma or surgery that penetrates the chest will have 30 Tricky Extreme
a high risk of causing infection and sepsis. Infection in 40 Tricky Extreme
the chest spreads easily and is often fatal. 50 Hard Severe
60 Severe Severe
Symptoms 70 Extreme Tricky
80 Insane Tricky
Fever, chills, chest pain, shortness of breath and exhaus- Every +10 Insane Tricky
tion.
The onset of sepsis will of course accelerate the risk of
Risks shock greatly which makes recovery very unlikely. See
sepsis [4E].
Unlike infection in most other places in the body, the
chest is an excellent and spacious breeding ground for Diagnosis
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 Modern: Scan (tricky)
after the onset of symptoms make a shock roll, starting at Exploratory Surgery (tricky)
easy, but increasing by one level each time. As the symp- Diagnose Symptoms (special)
toms get worse and the difficulty higher this reflects the
Medieval: Diagnose Symptoms (special)
infection spreading to surrounding structures like the
heart, great vessels, lungs and even bones. Futuristic: Hightech Scan (easy)
Diagnose Symptoms (special)
In addition to shock also roll 1D100 for other complica-
tions each time shock is rolled. If the result is within one Spell: Healing Vision
of the ranges below that complication occurs.

For the first 40 hours. Early diagnosis before the symptoms appear is only pos-
sibly with exploratory surgery or some very advanced
● 1 : Bone Infection [4G] equipment. Once symptoms start appearing the difficulty
● 2 - 3 : Blood Poisoning [4F] starts at hard and drops by one level after every ten hours
● 4 - 7 : Sepsis [4E] of observation.
● 8 - 10 : Pneumonia [200E]
Treatment and Surgery
After the first 40 hours the risks increase.
Modern: Antibiotics
Chest Surgery (tricky)
● 1 - 2 : Bone Infection [4G]
● 3 - 7 : Blood Poisoning [4F] Medieval: Chest Surgery not possible in a
● 8 - 15 : Sepsis [4E] lowtech society.
● 16 - 20 : Pneumonia [200E]
Futuristic: Powerful antibiotics, ointments and
As the danger of shock increases with time so does the possibly nanobots or friendly bacteria
chance that the body will be able to defeat the infection. will exist to cleanse the infection.
After every shock roll also make a recovery roll. Make it
the same way as a shock roll with the appropriate attrib- Spell: Purify II
ute, typically Spirit, but the difficulty starts at insane and
only decreases one level every twenty hours. Also, it can
never decrease below tricky. 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 tis-
sues.
The treatment will slow the progression of shock. De-
pending 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 char-
acter of course.
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 nor-
mal 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.
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.
200E - Pneumonia
Pneumonia can be caught from an infected person or an-
imal. 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 pneumo-
nia. 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
After the onset of symptoms pneumonia can last any-
where 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 in-
creases 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 re-
duce the ability to breathe to the point of oxygen starva-
tion. 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
If put on life support treat that condition as ARDS [212]
as well as the pneumonia continuing to develop.
201 - Great Vessels
The secondary risks of blood poisoning [4F] and sepsis The aorta is the main artery from the heart accompanied
[4E] are resolved by rolling 1D100 each week. If the res- by the vena cava and azygos veins.
ult is a 1 blood poisoning occurs and on 2 or 3 sepsis.
The aorta originates at the heart pointing upwards but im-
Diagnosis mediately bends down in an arch into the abdomen (see
Abdominal Aorta). It also branches out into several arter-
ies supplying the head (carotid artery) and arms (sub-
Modern: Physical Examination (see below) clavian artery) as well as to organs and muscles.
Blood Test (tricky)
X-Ray (tricky) The subclavian arteries are two very large arteries on
each side under the collarbone providing blood to the
Medieval: Physical Examination (see below) arms and to the carotid arteries for the head.
Futuristic: Physical Examination (see below)
Hightech Blood Test (easy) 201A – Great Vessel Tear
Advanced Scan (easy)
An incomplete tear of the aorta or any great vessel is sur-
Spell: Healing Vision vivable with prompt surgical repair but untreated eventu-
ally leads to the same death as for a rupture [201B].

Diagnosis is usually based on symptoms and physical ex- Symptoms and Risk
amination. Diagnosing pneumonia during the incubation
period is usually impossible. Once symptoms start the In about half of all cases the lower part of the chest turns
difficulty starts at tricky but by the time the character is pale and cold, or clammy. For the rest there are no obvi-
coughing phlegm it is easy. Stethoscope, x-ray and ous signs. As the bleeding is usually heavy or massive
shock soon follows.
Treatment
Surgery
Treatment of bacterial pneumonia is done with antibiot-
ics. With antibiotics pneumonia is usually cured in a
week. Viral infections cannot be treated with antibiotics Modern: Close Artery (tricky)
but if available, antiviral drugs may help if the infection Replace Artery (tricky)
is caught early. Medieval: Close Artery (hard)
Replace Artery (hard)
Pneumonias resulting from chest infections are always
bacterial. If the type and cause is unknown it will be a Futuristic: Welding beam or self guided
bacterial infection 60% of the time. instruments might make this easy.

Spell: Bloodmagic III (heavy), Bloodmagic

Respiratory failure can be treated with concentrated oxy- IV (massive)
gen and as a last effort a mechanical ventilator.

Surgery
Surgery is necessary to close the artery or replace dam-
aged parts with artificial tubes. Difficulty depends on
Modern: Drainage (tricky)
severity, but is at the very least tricky and often hard or
worse depending on the damage and equipment avail-
Medieval: Not usually possible able.

Futuristic: Hightech Drainage (tricky) 201B – Great Vessel Rupture

Spell: Purify II 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
Drainage of pus and fluids in the lungs can be done which pumps blood directly from the heart. Shock
through surgery to reduce the risk or prevent respiratory quickly sets in.
failure.

89
Surgery 202A – Myocardial contusion
Bruising of the heart causes accumulation of blood and
Modern: Close Artery (severe)
Replace Artery (severe)
inflammation in the heart muscle which can lead to ab-
normal heart movement and stunning of the heart muscle
Medieval: Close Artery (extreme) (cardiac dysrhythmia).
Replace Artery (extreme)
Symptoms
Futuristic: Some sort of welding beam or self
guided instruments might make this Uneven or rapid heartbeat.
tricky.
Risks
Spell: Bloodmagic IV
Abnormal heart movement will usually resolve on its
own but there is always a risk of complication. Roll
There is rarely time for treatment but if surgery is avail- 1D100; 1-5 fibrillation, 6-12 cardiac tamponade [202D].
able immediately there is always a tiny chance that a bril-
liant surgeon can save the day. 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
202 - Heart heart is no longer able to pump blood. Fibrillation leads
to a heart attack [202C] in under a minute.
The heart is a vital muscle pumping blood through the
body. It is around 12 cm long, 8 cm wide and 6 cm thick, Treatment
weighing from 230 grams in females up to 340 grams in
males. Will resolve on its own but any tamponade or heart at-
tack will need treatment.
The heart is made up of four chambers. The two upper
chambers where blood enters the heart are called atriums. 202B - Cardiac Penetration
The atriums collect the blood and then force it into a
ventricle, from where it is pumped back into the body. Penetration of the heart is usually fatal, but rapid treat-
ment may save the character’s life.
Oxygenated blood returns to the right side of the heart
from the lungs through the pulmonary veins. It enters the Symptoms
right atrium from where it is forced into the right vent-
ricle chamber and forced into the aorta artery. The aorta Unconsciousness, weak pulse and uneven heartbeat.
artery transports the oxygenated blood into the body. The
blood returns from the body on the left side. It enters the Risks
left atrium through the large inferior vena cava vein and
The damage to the heart always causes life-threatening
from the head through the superior vena cava vein. The
bleeding and in most cases the heart will stop pumping
left atrium then forces the blood into the left ventricle. It
without treatment.
in turn contracts to force the blood into the pulmonary
artery. The pulmonary artery takes the blood to the lungs
All four heart chambers may be damaged but the vent-
where it is oxygenated. It then returns to the heart
ricles are the most vulnerable and the right side of the
through the pulmonary vein and the cycle starts over
heart more likely to be hit.
again.
A normal heart rate is around 70 beats per minute. A rise
Penetrating trauma rarely cause a tamponade [202D] but
in physical or emotional demands increases the heart rate
there is a 5% risk.
up to a maximum of about 140 beats per minute. The
heart will continue to beat even after being removed from
Make an attribute roll, typically Spirit, soon after the car-
the body and despite being cut into pieces.
diac penetration and then again every hour. The difficulty
starts at easy but increases by one level every four hours.
Heart injuries are frequently fatal as they cause massive
If the roll fails the heart gives up and goes into heart at-
internal bleeding which starves the brain and other or-
tack [202C].
gans from oxygen. Heart injuries nearly always lead to
shock and death.
The character will always lose consciousness but may
awaken again. However, he will be too weak to do any-
thing and usually mentally confused.
90

Treatment and Surgery
Modern: Heart Surgery (hard)
Medieval: Hearth surgery will not usually be
possible, but if allowed at least severe.
Futuristic: Hightech Heart Surgery (tricky)
Spell: Regrow III, Bloodmagic III (heavy),
Bloodmagic IV (massive)
Treatment before the heart stops is more likely to be suc-
cessful. 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 hos-
pital 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.
202C – Heart Attack
Cardiac Arrest
The heart stops pumping which leads to oxygen starva-
tion 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 suffoc-
ates. 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.
Heart Attack
Minutes Effect
4 Minor Brain Damage [105B]
6 Major Brain Damage [105C]
7 Massive Brain Damage [105D]
10 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
Modern: Electrical Defibrillation (see below)
CPR (see below)
Medieval: If understood CPR is the only
treatment normally possible.
Futuristic: Hightech Defibrillation reduces
difficulty by one or more levels.
Spell: Arouse II
Cardiopulmonary resuscitation (CPR) is meant to pro-
long 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 compres-
sion and may also include mouth-to-mouth ventilation.
CPR is usually not known in a medieval or fantasy set-
ting, 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 suc-
cess 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 at-
tempt 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 in-
travenous medication. If the heart is damaged it may
need emergency surgery, such as for a cardiac penetra-
tion [202B], before it can be restarted. If under pressure
and constricted by fluids, such as in a cardiac tamponade
91
[202D], drainage or pumps must first clear the pericardial The effects and treatment is the same as for a cardiac
sac before the heart can be restarted. tamponade [202D].

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.
202F- Commotio Cordis
A very unlucky hit of the heart during the most vulner-
able period of its cycle. Immediate collapse is the norm,
although some have a brief period of consciousness be-
fore collapse. Survival is very rare despite immediate re-
suscitative efforts.
Treat as a heart attack [202C] but any attempts at CPR or
other treatment should have its difficulty increased.

202D – Cardiac Tamponade Symptoms

Blood fills the pericardial sac that surrounds the heart. Sudden Death
This compresses the heart and eventually renders the
heart unable to beat. 202G – Shattered Heart
Symptoms
Ruptured Ventricle
Diminished heart sound, distended jugular veins and fast
heart rate. If one or both the ventricle chambers are ruptured or oth-
erwise destroyed death is usually rapid with shock start-
Risks ing almost at once. Treat as a heart attack [202C] but first
aid or any other treatment will not have an effect on the
Unless relieved with surgery leads to shock as the blood condition. Only surgery may save the character, but only
fills the pericardial sac. Halve the time for shock to set in an immediate heart transplant is likely to have any
given in the blood loss table under bleeding [2]. If the chance of success.
bleeding stops before shock occurs the heart will be able
Treatment and Surgery
to keep working for another 1D6 days before it tires and
gives in.
Modern: Heart Surgery (extreme)
Surgery
Heart Transplant (hard)

Medieval: No treatment possible

Modern: Puncture Pericardial Cavity (tricky)

Medieval: Hearth surgery will not usually be Futuristic: Hightech Heart Surgery (tricky)
possible, but if allowed at least hard. Hightech Heart Transplant (tricky)

Futuristic: Hightech Surgery (easy) Spell: Regrow IV

Spell: Bloodmagic I (some), Bloodmagic II

(moderate), Bloodmagic III (heavy),
Bloodmagic IV (massive), Cleanse II
(remove clotted blood) 203 – Digestive Tract
Esophagus
Oxygen and intravenous can prolong life, but surgical
puncture of the pericardial cavity is required and is tricky Carrying food from the mouth down into the stomach,
even with appropriate surgical tools. An untreated tam- the esophagus passes behind the heart, but in front of the
ponade is always fatal. aorta.

202E- Pneumopericardium 203A – Damaged Esophagus

Air enters the pericardial cavity through a penetrating Blunt trauma rarely damages the esophagus in the chest
wound but is unable to leave. as it is well protected. When it is damaged other organs
92
are usually also damaged and the spilling of gastrointest-
inal 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
Shortness of breath, coughing of blood, small bubbles in
The two lungs fill a lot of the chest cavity and are com- the bleeding from the wound and of course the tell tale
pletely protected by the ribs. The right lung has three sucking sound. Eventually turns blue and falls uncon-
lobes while the left lung has only two lobes to make scious.
room for the heart.
Risks
Each lung is enclosed in a thin membrane called the
pleura. The pressure within the pleura is below atmo- The most immediate danger is the threat of shock from
spheric pressure allowing the lungs to stay expanded. If the lack of oxygen. There is also a small risk of a hemo-
the pleura is penetrated the pressure will increase until it thorax developing in the next 24 hours as well as a risk
reaches atmospheric pressure collapsing the lung. This is of chest infection. Any wound infection is a chest infec-
called an open pneumothorax [204A]. Any surgery inside tion. A hemothorax develops if there is moderate, heavy
the pleura therefore requires a lung machine to keep the or massive bleeding.
lung from collapsing.
Sucking Chest Wound Risks
The lungs most import function is to retrieve carbon di- Trauma Recovery
oxide from the blood and replace it with oxygen (respira- Superficial sucking chest wound. Lack of
tion). It is possible to live with a part of a lung missing or oxygen means small risk of shock until
even with only one lung but this will reduce stamina. healed. Roll for shock if any strenuous
activity is performed. Difficulty should
Superfi-
depend on how exerting and prolonged
cial
the activity is. Short, slow walk (easy),
jog (easy), heavy lift (tricky), etc.
Infection [200A]
Complications
Hemothorax [204C]
As above.
Nasty Infection [200A]
Complications
Hemothorax [204C]
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
Grievous 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
204A – Sucking Chest Wound Grim every fifteen minutes.
Infection [200A]
Open pneumothorax Complications
Hemothorax [204D]
The famous sucking chest wound. It occurs when the Massive sucking chest wound. Shock risk
chest is penetrated and air is sucked in and out of that as above but roll and increase difficulty
Mortal every five minutes.
hole instead of through the windpipe. Breathing becomes
difficult and the affected lung collapses, if it hasn’t Infection [200A]
Complications
already been punctured, as air collects in the chest cavity. Hemothorax [204C]

93
Diagnosis
Modern: Examination (easy)
Medieval: Examination (easy)
Futuristic: Examination (easy)
Spell: Healing Vision
Treatment and Surgery
Modern: Grievous Wound Stitching (easy)
Grim Wound Surgery (tricky)
Mortal Wound Surgery (hard)
Medieval: Grievous Wound Surgery (easy)
Grim Wound Surgery (tricky)
Mortal Wound Surgery (extreme)
Futuristic: Hightech surgery will usually be one
degree lower difficulty.
Spell: Regrow I (superficial and nasty),
Regrow II (grievous), Regrow III
(grim), Regrow IV (mortal)
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 dif-
ficulty starts at easy for a superficial wound and in-
creases 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 evacu-
ated 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 re-
quires 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 [204B] as the lung is probably
leaking air. The percentage risk depends on the surgery.
Marginal success 60%, normal success 30% and excep-
tional 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] be-
low for how the surgery results may affect constitution.
Special Considerations
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.
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 to-
wards the healthy side. The pressure may cause compres-
sion of the healthy lung and restricts the heart’s ability to
function by distorting the superior vena cava, and so de-
creasing the blood return to the heart.
Tension pneumothorax is a critical condition which leads
to shock and death from lack of oxygen.
Symptoms
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 hemo- Modern: Grievous Punctured Lung (tricky)
thorax developing in the next 24 hours as well as a risk Grim Punctured Lung (hard)
of chest infection. Any wound infection is a chest infec- Mortal Punctured Lung (severe)
tion. A hemothorax develops if there is moderate, heavy
Medieval: A suction tube will not normally be
or massive bleeding. available, but surgery to convert the
trauma to an open pneumothorax is
Punctured Lung Risks possible same as for modern surgery.
Trauma Recovery
Simple pneumothorax, no further risks. Futuristic: Hightech surgery will usually be one
Super- degree lower difficulty.
ficial Infection [200A]
Complications
Hemothorax [204C] Spell: Regrow I (superficial and nasty),
Simple pneumothorax. Lack of oxygen Regrow II (grievous), Regrow III
(grim), Regrow IV (mortal)
means small risk of shock until healed.
Roll for shock if any strenous activity is
performed. Difficulty should depend on
A large syringe can be used to extract air, easing breath-
Nasty how exerting and prolonged the activity is.
ing and preventing shock as long as air is evacuated peri-
Short, slow walk (easy), jog (easy), heavy
odically. Pain relief can also help ease breathing and
lift (tricky), etc.
therefore delay shock.
Infection [200A]
Complications
Hemothorax [204C] A superficial or nasty punctured lung wound will heal
Tension pneumothorax. Pressure builds with rest with no further treatment. A grievous or worse
quickly leading to shock. Every fifteen punctured lung requires surgery or pressure will quickly
minutes roll shock with difficulty starting kill the character. A chest tube can be inserted to suck
Griev- at easy but increasing by one degree every out the air and keep the pressure negative, surgery
ous time. Any straining physical exertion (tricky). Without such a tube there is little a surgeon can
means an extra shock roll. do except to convert it to an open pneumothorax [204A]
and treat that.
Infection [200A]
Complications
Hemothorax [204C]
There is a risk that damaged or scarred lung tissue need
Severe tension pneumothorax. Shock risk to be removed to allow the pneumothorax to heal. Lesser
as above but roll and increase difficulty traumas do not have this risk but the risk is 10% for
Grim every ten minutes. grievous trauma, 20% grim trauma and 30% for mortal
Infection [200A] trauma. The result of the surgical removal of lung tissue
Complications
Hemothorax [204D] will determine how badly the patient’s stamina is af-
Massive tension pneumothorax. Shock risk fected.
as above but roll and increase difficulty
Mortal every five minutes. If the operation fails it must be attempted again to heal
the pneumothorax. Every time the surgeon fails the char-
Infection [200A] acter’s constitution suffers and may become chronically
Complications
Hemothorax [204C] winded or even exhausted in extreme cases. For excep-
tional failures the character will most likely die unless
Diagnosis
another surgeon is on hand to make an heroic save and
even so the lung will be lost leaving the character chron-
Modern: Examination (easy) ically winded at best.

Medieval: Examination (easy) 204C – Hemothorax

Futuristic: Examination (easy) A hemothorax is a collection of blood between the lung
and chest wall that makes breathing harder. It is similar
Spell: Healing Vision
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 lung developing is the same as for the empyema develop-
internal bleeding in the chest. Either directly from an in- ing in the first place.
jured heart or from any of the blood vessels in the chest.
A common source of significant and persistent bleeding Diagnosis
are branches of the internal mammary artery, also known
as the internal thoracic artery. It branches off from the
Modern: Examination (hard)
subclavian artery and travels beneath the ribs in the Scan (tricky)
chest.
Medieval: Examination (hard)
Heart injury produces hemothorax if communication ex-
ists between the pericardium and pleural space.
Futuristic: Examination (hard)
Pulmonary injury may cause hemothorax, but is usually Hightech Scan (easy)
self-limited because the pulmonary vascular pressure is
Spell: Healing Vision
low. It is more likely to develop into a pneumothorax.

Because the chest cavity has room enough for more or

Diagnosing a hemothorax is difficult mostly because the
less all the blood in the body it is possible to bleed dry
associated trauma masks symptoms.
with no external evidence of blood loss. Shock will of
course kill long before this happens and because the Surgery
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 Modern: Intercostal Incision (tricky)
bleeding has stopped. Close Wound (easy)
Reopening for cleaning (tricky)
Symptoms Suction Tube Drainage (tricky)

Symptoms are usually masked by the damage that caused
the hemothorax but shortness of breath and shock can
both indicate a hemothorax.
Risks
Medieval: A suction tube will not normally be
available, but the other forms of
surgery are potentially possible,
although likely more difficult with
primitive tools.

Futuristic: Hightech surgery will usually be one

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 circula-
tion.
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 ex-
pand leading to a reduction in pulmonary function. This
reduces constitution by one. The chance of a trapped
degree lower difficulty.
Spell: Bloodmagic I (some), Bloodmagic II
(moderate), Bloodmagic III (heavy),
Bloodmagic IV (massive), Cleanse II
(remove clotted blood)
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 signific-
ant 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 pneu-
mothorax [204B] with the severity of a trauma of a griev-
ous wound.

96
The second method of closing the wound right away al-
lows 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 infec-
tion (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 fur-
ther 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 un-
likely 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, pro-
tecting 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 specified at the time of injury the main risks are contu-
sion [202A] or penetration [202B] of the heart. Cardiac
tamponade [202D], hemothorax [204C] and punctured
Modern: Examination (hard) lung [204B].
X-Ray (tricky)
Examination, grim (tricky) Diagnosis
X-Ray, grim (tricky)

Medieval: Examination (hard)

Examination, grim (tricky) Modern: Examination (tricky)
X-Ray (tricky)
Futuristic: Examination (hard)
Hightech Scan (tricky) Medieval: Examination (tricky)
Examination, grim (tricky)
Hightech Scan, grim (easy) Futuristic: Examination (tricky)
Hightech Scan (easy)
Spell: Healing Vision
Spell: Healing Vision

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
Splintering can be done by strapping fractured ribs to re-
straightforward and can be treated as a normal closed
lieve pain when breathing. This doubles the risk of pneu-
fracture [1A]. It is splintered by strapping of the chest
monia because it impedes breathing. Which means the
and sternum to hold the fracture still and so ease the pain
lungs are not properly cleaned out.
when breathing.
Any treatment is usually for underlying lung or heart
However, if the wound is grim or worse the breastbone is
damage and to allow adequate oxygenation and drainage
badly displaced and requires surgery to reduce the dis-
of blood or pus. The fracture itself will usually heal on its
placement and fix the ends together. Treat this as a mal-
own.
union that needs resetting as described under closed frac-
ture surgery [1A]. Failure to do so results in a permanent
However, if the wound is grim or worse the breastbone is
impairment of –1D. The longer it is left, counting in
badly displaced and requires surgery to reduce the dis-
months, the more difficult any surgery will be.
placement and fix the ends together. Treat this as a mal-
union that needs resetting as described under closed frac-
206B – Flail Sternum ture surgery [1A]. Failure to do so results in a permanent
impairment of –1D. The longer it is left, counting in
Multiple fractures of the sternum result in a free floating months, the more difficult any surgery will be.
and unstable segment.

Symptoms
207 – Ribs
Pain and tenderness. Breathing pain and shortness of
breath, often with rapid breathing and a high heart rate. Rib pairs run down the length of the chest protecting the
lungs and other underlying organs.
Risks
They easily break but also heal easily. The greatest prob-
A flail sternum takes a long time to heal and requires lem is the danger of internal bleeding and injuries to the
rest. Triple the basic healing time. organs under the ribs. Those are the lungs spleen and liv-
er.
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 asso-
ciated 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

Multiple fractures of the ribs result in a free floating and
unstable segment. Flail chest is the result of a severe
207A – Simple Rib Fracture blow and a common serious injury to the chest.
Single break in one or more ribs. Symptoms

Symptoms
Pain and tenderness. Breathing pain and shortness of
breath, often with rapid breathing and a high heart rate.
Pain when breathing and swelling.
The affected chest segment appears to move in the op-
Risks posite direction of the rest of the chest when breathing.

None. Risks

Treatment
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].
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 ac-
99
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
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 dis-
placement 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 per-
manent impairment of –1D. The longer it is left, counting
in months, the more difficult any surgery will be.
208 – Shoulder Blades
Scapula
Two triangular, flat bones in the upper back forming the
shoulder joint with the humerus of the upper arm.
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
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
failure to heal correctly and chronic pain, deformity and
permanently reduced function of arm.
Diagnosis
Modern: Examination (tricky)
X-Ray (easy)
Medieval: Examination (tricky)
Futuristic: Examination (tricky)
Hightech Scan (easy)
Spell: Healing Vision
Treatment
The scapula will often heal on its own with immobilisa-
tion 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 of-
ten requires the use of plates and screws to hold the scap-
ula together. Treat this as a mal-union that needs reset-
ting 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, deform-
ity and a permanent –1D impairment when using the af-
fected 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
Decreased pulse in arm, loss of sensation and use, as well
as severe pain.
Risks
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 in-
sufficient 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
210 – Bronchial Injury
trauma.
Laceration, tear or other disruption of a major bronchus.
Diagnosis Similar to tracheal injuries and just as deadly.

Symptoms
Modern: Examination (tricky)
X-Ray (easy) See tracheal injuries [110A].

Medieval: Examination (tricky) Treatment

Futuristic: Examination (tricky) Requires surgical repair as for tracheal injuries [110A]
Hightech Scan (easy) but the operation is much more difficult and unlikely to
succeed. Usually severe or worse.
Spell: Healing Vision

211 - Pulmonary Contusion

Surgery
The smallest vessels in the lungs (microvasculature)
burst and blood and other fluids invade the tissue. Can be
Modern: Amputation (easy) caused by any sharp object or by rib lacerations.
Stabilise shoulder (severe)
Symptoms
Medieval: Amputation (easy)
Stabilise shoulder (extreme)
Takes 1D12 hours for symptoms to appear. Then short-
Futuristic: Amputation (easy) ness of breath, often with rapid breathing and a high
Hightech Surgery (tricky) heart rate.

Spell: Regrow III Risks

The greatest risk is the development of ARDS [212]. On

Amputation above elbow may be needed if blood supply day three there is a 50% chance of ARDS developing. In-
to arm is insufficient and gangrene sets in. ternal bleeding is often associated with pulmonary contu-
sion.
If limb remains viable surgery may restore shoulder sta-
Diagnosis
bility 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 Modern: Examination (severe)
motor function in the arm leaves amputation the only Scan (tricky)
solution.
Medieval: Examination (severe)
209 Traumatic Asphyxia Futuristic: Examination (severe)
Hightech Scan (easy)
This rare condition is caused from a severe crushing
blow. The face swells up like a moon due to lack of oxy- Spell: Healing Vision
gen and bleeding.

It is an indication of nasty trauma to the torso or head
that may require surgical intervention.
Symptoms
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.
Diagnosis is difficult and severe from physical examina-
tion alone.
Treatment
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 dysfunc-
tion. It most commonly results from pneumonia, sepsis
and trauma where internal lung damage or infection res-
ults 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
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 cir-
culate enough oxygen. The character loses consciousness
and awakens periodically in a delirious state. The condi-
tion gradually deteriorates and respiration fails com-
pletely in 1D10 hours. Unless the character is placed on
life support (mechanical ventilation) he will suffer the ef-
fects of suffocation [100B].
Other common complications are pneumonia [200E] de-
veloping 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.
Treatment
Modern: Only care and life support.
Medieval: Only general care while the
patient fights for survival
Futuristic: Drugs or nanobots to halt ARDS
Lung Transplant (tricky)
Artificial Lung (tricky)
Spell: Regrow III
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 profession-
al hospital care with good medication. Failure results in
heart attack [202C]. If the character is revived and sur-
vives 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 con-
dition 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 pos-
sible without a lung transplant. Weakness and shortness
of breath means the character is chronically winded with
fatigue.
102
Abdomen
“The abdomen is the reason why man does not easily
take himself for a god”
- Friedrich Wilhelm Nietzsche
Anatomy
Here the abdomen is the area between the chest (thorax)
and down to and including the pelvis. The chest and ab-
domen is separated by a muscle called the diaphragm.
The abdomen is protected in the rear by the spine (back-
bone), 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 pro-
tects the organs by reducing friction.
Injuries or surgery in the abdomen are often fatal because
they cause peritonitis [300A].
Vital Organs
The stomach lies directly under the chest and continues
down into the intestines.
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 skel-
eton 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.
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 penetrat-
ing trauma or surgery. Any damage, even blunt trauma,
that causes leaks from the intestines may also cause peri-
tonitis.
Symptoms
Severe abdominal pain, swollen stomach, nausea, vomit-
ing 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 Modern: Examination (see below)
and the first shock roll must be made against easy. Every
ten hours after that the difficulty is increased by one and Medieval: Examination (see below)
shock must be rolled again.
Futuristic: Examination (see below)
If the source of the infection remains the character cannot Spell: Healing Vision
start to recover. The source may be a perforated internal
organ, such as the stomach or intestines, that keeps dis-
charging bacteria and foods into the abdomen. It may be Peritonitis is usually expected after penetrating trauma to
dead tissue or it may be a foreign object stuck inside the the abdomen, and either watched for or treated with anti-
body. biotics even before symptoms appear. Trying to diagnose
peritonitis in the first 20 hours before symptoms appear
However, if there is no such source, or it is removed, the is insane. Once symptoms appear the difficulty drops to
character may be lucky enough to recover. As the inflam- tricky. Continue lowering the difficulty and allow a new
mation gets worse and the danger of shock increases so attempt every ten hours.
does the chance that the body will be able to defeat the
infection. After each shock roll also make a recovery roll. Treatment and Surgery
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 Modern: Antibiotics
has fought off the infection and starts to gradually recov- Abdominal Surgery (tricky)
er with no further need for shock rolls.
Medieval: Abdominal Surgery not possible in a
lowtech society.
If the character survives more than 90 hours the shock
difficulty will stay at insane and the recovery at tricky Futuristic: Powerful antibiotics, ointments and
until he either recovers or dies from shock. possibly nanobots or friendly bacteria
will exist to cleanse the infection.
Peritonitis Progression
Hours Shock Recovery Spell: Purify II
20 Easy Extreme
30 Easy Extreme
40 Tricky Severe Without treatment peritonitis is nearly always fatal.
50 Tricky Severe Treatment consists of antibiotics for the infection and
60 Hard Hard surgery to repair any damage and possibly remove infec-
70 Severe Hard ted tissue. The latter usually requires a successful CT or
80 Extreme Tricky MRI diagnostic scan of tricky difficulty or equivalent to
90 Insane Tricky locate the infected tissues.
Every +10 Insane Tricky
If there is internal damage, foreign material or dead tis-
In addition there may be other complications. Each time sue which acts as a source for the infection the character
a shock roll is made, regardless of the outcome, also roll can only recover with the help of surgery. The difficulty
1D100 for complications. will of course depend on the surgery required.

Peritonitis Complication Risk The treatment will slow the progression of shock. De-
1D100 Complication pending on the treatment, the interval between each
1 - 90 None shock roll, and increase in difficulty, is increased by a
91 – 95 Sepsis [4E] number of hours. The recovery roll is unaffected which
96 – 99 Blood Poisoning [4F] effectively improves the chance of recovery. The table
100 Bone Infection [4G] below gives some examples.

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.
300B – Bowel Gangrene
Gangrene in the bowels is the most fatal type of gan-
grene. See gangrene [4B] and necrotizing fasciitis [4C]
for details.
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 condi-
tion for dysentery. Because of this dysentery often occurs
among soldiers in wartime. Meats and other hard to di-
gest foods in hot climates can also cause dysentery
Dysentery is very contagious. Anyone living or associat-
ing with an infected individual risks catching dysentery
every day. The percentage risk depends on the hygiene
and how close the characters live.
Symptoms
Stomach pains and diarrhoea, often with blood. Some-
times vomiting and fever.
Risks
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
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 abil-
ity 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]. Other-
wise the character has got away easy from a potentially
very deadly condition.
Diagnosis
Modern: Examination (see below)
Medieval: Examination (see below)
Futuristic: Examination (see below)
Spell: Healing Vision
Diagnosing dysentery can be anything from easy to
tricky depending on how much of the character’s 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 dysen-
tery can be tolerated better.
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.
301A – Great Vessel Tear
An incomplete tear of the aorta or any great vessel is sur-
vivable with prompt surgical repair but untreated eventu-
ally leads to the same death as for a rupture [202B].
105
Symptoms Symptoms

Unless there is a hole in the abdomen from where the Severe abdominal pains and fever from the peritonitis.
blood can escape the bleeding is not immediately obvi-
Risks
ous but legs and then rest of body may soon feel cold. As
the bleeding is usually heavy or massive shock soon fol- Peritonitis [300A] is the big killer of a perforated stom-
lows. ach.
Surgery Diagnosis

Modern: Field Surgery (hard) Modern: Scan (tricky)

Hospital (tricky)
Medieval: Exploratory surgery only
Medieval: Surgery is usually not possible in the
abdomen due to infection risk, but if Futuristic: Hightech Scan (easy)
performed is usually hard or worse.
Spell: Healing Vision
Futuristic: Hightech Surgery (tricky)

Spell: Bloodmagic III (heavy), Bloodmagic

IV (massive)
A scan is usually needed to diagnose a perforated eso-
phagus, although a penetrating injury in the abdomen
near the stomach may indicate a high risk and justify ex-
Surgery is necessary to close the artery or replace dam- ploratory surgery to repair any damage.
aged parts with artificial tubes. Difficulty depends on
Surgery
severity, but is at the very least tricky and often hard or
worse. Depending on the damage and equipment avail-
able. Modern: Repair (tricky)
Clean Spilled Food (tricky)
301B – Great Vessel Rupture
Medieval: Surgery is usually not possible in the
With a complete tear or rupture blood rushes into the ab- abdomen due to infection risk, but if
performed is usually hard or worse.
domen, leading to exsanguination and death in minutes.
This happens the most quickly for the massive aorta Futuristic: Hightech Surgery (easy)
which pumps blood directly from the heart. Shock
quickly sets in. Spell: Regrow II (heal stomach), Cleanse III
(clean spilled food)
302 – Stomach
Treatment usually consists of closing the perforation and
The stomach is the sac between the esophagus which
cleaning out any food that has spilled into the abdominal
brings food from the mouth and the intestines.
cavity. The surgery is of tricky difficulty if there is no
significant spillage. However, if the character has re-
The stomach breaks down the food using acidic gastric
cently eaten a large meal, or been eating and drinking
juices to dissolve it. It absorbs some substances and
since the injury, the difficulty is at least tricky and often
passes the food on to the small intestines.
worse even with good surgical equipment.
Stomach injuries usually result from penetrating trauma,
Successful surgery allows the character a chance to re-
although severe blunt trauma can also damage the stom-
cover from the peritonitis, although it is far from certain.
ach.
See peritonitis [300A].
302A – Perforated Stomach 302B – Ruptured Stomach
If the stomach is punctured bacteria and partially diges-
A ruptured stomach has either burst from a blunt blow or
ted food spills into the normally sterile abdominal cavity
been cut wide open. In either case the stomach can no
of the peritoneum [300]. This invariably causes peritonit-
longer function and the bacteria and digested food that
is [300A].
spills into the abdominal cavity cause peritonitis [300A].

106
Symptoms
A dull pain that gradually spreads and becomes more in-
tense. Sensitivity to any shaking or sudden movement,
cramps and vomiting. Fever from the peritonitis.
forming the procedure on a badly ruptured stomach and
cleaning out the resulting mess is at least hard. Even in a
hospital setting.

Risks

Peritonitis [300A] is the big killer of a ruptured stomach.

Diagnosis

Modern: Scan (tricky)

Medieval: Exploratory surgery only

Futuristic: Hightech Scan (easy)

Spell: 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 explorat-
ory surgery.

Treatment
303 - Intestines
Modern: Gastrectomy (tricky) The intestines is the part of the digestive system between
Gastrectomy Severe Rupture (hard) the stomach and anus. It is about 7.5 meters long as it
coils down through the abdomen and is divided into the
Medieval: Gastrectomy is usually impossible. small and large intestine.

Futuristic: Hightech Gastrectomy (easy)
Spell: Regrow III (heal stomach),
Cleanse III (clean spilled food)
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.

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 gastrec-
tomy. It is possible to live without the stomach. The eso-
phagus is connected to the intestines and digestion starts
in the small intestines. The body adapts to this remark-
ably well although the diet usually needs to change. Sev-
eral smaller meals must be consumed with more protein
and less sugar. Gastrectomy does lead to B12 vitamin de-
ficiency and so it must be supplemented or will eventu-
ally lead to anaemia [2B].
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.
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 par-
tially spill outside the body.
Symptoms

At first no obvious symptoms apart from pain and other

The surgery itself is done by making an incision just be-
symptoms to be expected from an abdominal wound.
low the breastbone to the navel. Clamps are placed on the
Peritonitis can be an indication but it can be a symptom
esophagus and intestines as required and the stomach is
of any trauma to the abdomen.
removed. The esophagus is then connected to the intest-
ines. The procedure takes from one to three hours and is
of tricky difficulty in a hospital setting. However, per-
107
Risks
Peritonitis [300A] is easily the most dangerous and im-
mediate complication and always results from an intest-
inal 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. Fail-
ure to do so guarantees the character’s death as the peri-
tonitis can only get worse.
The tear can be repaired with a bowel resection. An in-
cision 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 im-

mediate 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: Examination (tricky)

Medieval: Examination (tricky)

Modern: Examination (tricky) Futuristic: Examination (tricky)
Medieval: Examination (tricky) Spell: Healing Vision
Futuristic: Examination (tricky)

Spell: Healing Vision

Surgery

Surgery
Modern: Colostomy (tricky)
Artificial Intestine (hard)
Modern: Bowel Resection (tricky)
Medieval: Colostomy is probably not possible
and if it is likely at least severe.
Medieval: If a bowel resection is even possible it
is likely at least hard.
Futuristic: Hightech Colostomy (tricky)
Artificial Intestine (tricky)
Futuristic: Hightech Bowel Resection (easy)
Spell: Regrow III
Spell: Regrow II

108
Treatment consists of surgery to repair the damage. Fail- Diagnosis
ure to do so guarantees the character’s death as the peri-
tonitis can only get worse until the intestines are healed.
Modern: Examination (tricky)
A whole section of the intestines must be replaced artifi-
Medieval: Examination (tricky)
cially or a colostomy must be performed.
Futuristic: Examination (tricky)
A colostomy is an incision into the large intestine to cre- Hightech Scan (easy)
ate an artificial opening out through the abdomen. This
opening serves as a substitute anus through which the in- Spell: Healing Vision
testines can eliminate waste. The waste is usually collec-
ted in a pouch.
Diagnosing appendicitis is at least tricky as the symp-
Difficulty is usually tricky in a hospital setting, but toms are similar to many other disorders.
quickly becomes much harder if the right tools are not
available. Surgery

304 - Appendix Modern: Appendicectomy (easy)

Vermiform Appendix
The appendix is attached to the first part of the large in-
testines and is about nine centimetres long.
The appendix can be removed through surgery without
any ill effects.
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 undiges-
ted food, because of infection and disease or even para-
sitic 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] devel-
ops 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
Clean Burst Appendix (tricky)
Medieval: Appendicectomy is usually not
possible and if it is likely at least
hard.
Futuristic: Hightech Appendicectomy (easy)
Spell: Purify II (treat appendicitis before it
bursts), Regrow III (heal burst
appendix), Cleanse III (clean burst
appendix)
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 antibi-
otics. However, any appendicitis treatment with antibiot-
ics that is not of normal or better success will see it re-
turn 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 in-
testines lie in front of the kidneys and they are well pro-
tected from behind by muscles.
The kidneys filter the blood and pass waste on as urine
into the bladder, as well as many other secondary func-
tions, such as regulating blood pressure.
The kidneys are most vulnerable to hard blows to the up-
per 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.
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
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 fa-
tigue, foul breath and buzzing ears.
Risks
Traumatic kidney failure is usually fatal. With both kid-
neys destroyed or severely damaged the only hope comes
from swift surgery and quite likely a kidney transplant.
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 fail-
ure.
If the character’s 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 character’s
life.
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. Keep-
ing the patient alive on dialysis is easy in the beginning
but then gets harder every few months.
Surgery
Modern: Transplant (tricky)
Medieval: No surgery is usually possible.
Futuristic: Hightech Transplant (tricky)
Artificial Kidney (tricky)
Spell: Regrow III (before failure)
Regrow IV (after failure)
Transplant surgery is at least tricky, even under good
conditions, and if the patient’s kidneys have already
failed and he is surviving on dialysis the difficulty should
be increased another level or two.
110
305B – Minor Kidney Damage 305D – Shattered Kidney
Grade 1-3 Renal Damage Grade 5 Renal Damage

Superficial damage to the kidney causing swelling and The kidney is torn into pieces from a high force impact
bleeding. or multiple penetration of the kidney. The kidney is no
longer able to function and soon dies. Bleeding is
Symptoms massive.

Pain in the back as well as small amounts of blood in the Symptoms

urine often not detectable without analysis.
Pain in the back as well as large amounts of blood in the
Risks urine are the main symptoms.

There is no immediate danger from minor kidney dam- Risks

age aside from a surgeon who decides to operate anyway.
The immediate risk is death from massive blood loss
Treatment leading to shock.

No treatment is needed but this condition can be con- If the blood loss is stopped but there is no secondary kid-
fused with more serious kidney damage and therefore ney to take over for the now dead kidney it leads to acute
prompt a dangerous and unnecessary surgical interven- renal failure [305A].
tion.
Surgery
305C – Severe Kidney Damage
Grade 4 Renal Damage Modern: Stop Bleeding (tricky)

Medieval: No surgery is usually possible, but if

Deep damage to the kidney and the main renal artery or
vein reduces the function of the kidney. allowed will be at least tricky.

Futuristic: Hightech Stop Bleeding (easy)

Symptoms
Spell: Regrow IV, Bloodmagic IV
Pain in the back as well as blood in the urine, often not
detectable without analysis.
Emergency surgery must be performed to stop the bleed-
Risks
ing. The surgery, which involves removing the destroyed
kidney, is usually of tricky difficulty in a well equipped
The immediate risk is the blood loss which can be signi-
hospital but can be more difficult if the injury is espe-
ficant. The reduced function of the kidney means that it
cially messy.
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 305E – Severed Renal Artery
made every month rather than every two hours.
Grade 5 Renal Damage
Treatment
The renal artery connecting the kidney to the bodies main
artery, the aorta, is severed. Starved of blood the kidney
Spell: Regrow III quickly dies. The massive bleeding from the artery is
usually fatal without treatment.

Immediate surgery can improve the function of the kid- Symptoms

ney somewhat but is often not worth it because of the ad-
ditional 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 even-
tually shock.

111
Risks
The immediate risk is death from massive blood loss
leading to shock. If the bleeding is stopped but the kid-
ney is not reconnected it will die. If there is another
healthy kidney this has no immediate consequence, oth-
erwise 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
Modern: Field Surgery (hard)
Hospital (tricky)
Reconnecting (severe – extreme)
Medieval: Surgery is usually not possible in the
abdomen due to infection risk, but if
performed is usually hard or worse.
Futuristic: Hightech Surgery (tricky)
Spell: Bloodmagic III (heavy),
Bloodmagic IV (massive)
Emergency surgery must be performed to stop the bleed-
ing. Simply closing the bleeding and removing the kid-
ney is tricky in a hospital and hard otherwise. Reconnect-
ing 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, nephrec-
tomy. See section on gangrene [4B] for treatment. The
difficulty of the surgery is tricky in a hospital setting.
306 – Liver
A wedge-shaped, spongy organ just under the chest, be-
neath 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 tox-
ins such as damaged blood cells, microbes, debris, am-
monia, drugs and alcohol. It also produces the main sub-
stance of urine, makes amino acids, breaks down fats to
produce cholesterol and stores vitamins and minerals.
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 liv-
er 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
Although well protected by the ribs the liver may still be
torn by a heavy blow or lacerated by penetrating trauma.
Symptoms
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
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: Stop Bleeding (tricky – hard)
Medieval: Surgery is usually not possible in the
abdomen due to infection risk, but if
performed is usually hard or worse.
Futuristic: Hightech Surgery (tricky)
Spell: Bloodmagic III (heavy),
Bloodmagic IV (massive)
Often the bleeding may stop on its own but without scan-
ners 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 al-
ways 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 re-
cover and the character’s 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.
306B – Ruptured Liver
The liver is ruptured and completely destroyed by a high
force impact.
Symptoms
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
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 trans-
planted. Primarily due to lack of glucose for the brain but
also due to rising levels of toxins in the body.
Surgery
Modern: Stop Bleeding (tricky – hard)
Medieval: Surgery is usually not possible in the
abdomen due to infection risk, but if
performed is usually hard or worse.
Futuristic: Hightech Surgery (tricky)
Artificial Replacement (tricky)
Spell: Bloodmagic IV
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 ma-
chine. The former is a tricky or hard operation in a hos-
pital setting, while the latter is only a theoretical possibil-
ity in a futuristic setting.
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 intest-
ines where it breaks down fat in the food.
307A – Gall stone
A gall stone forms when the cholesterol or other parts of
the bile crystallises into a stone-like material.
Symptoms
Pain and indigestion and so easily confused with stomach
disorders.
Risks
The main problem with gall stones is the pain and disab-
ility it causes as well as intolerance to fatty foods.
Treatment
If troublesome a gall stone can be removed surgically to-
gether 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.
308 – Pancreas
A broad strip of soft tissue stretched across the back of
the abdomen behind the intestines and stomach.
It is primarily a digestive gland but it also produces in-
sulin 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 regu-
late blood sugar and enzyme supplements taken to aid di-
gestion.
308A – Damaged Pancreas
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
A deep pain in the middle to upper stomach which radi-
ates through to the back. Vomiting and a gradual spread
of pain throughout the stomach as nearby organs are in-
flamed by the released enzymes from the damaged pan-
creas.
113
Risks
The organs surrounding the pancreas risk being autodi-
gested by the pancrea’s 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.
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 radi-
ates through to the back. Vomiting and a gradual spread
of pain throughout the stomach as nearby organs are in-
flamed by the released enzymes from the destroyed pan-
creas.

The damage to the pancreas reduces its function and the Risks
character now has to live with the effects of type two dia-
betes [17B]. The organs surrounding the pancreas risk being autodi-
gested by the pancrea’s enzymes. The leaking enzymes
Diagnosis break down the fat and protein of the surrounding organs.
The character is in effect digesting his own tissues. Un-
less the pancreas is removed the character’s health will
Modern: Physical Examination (insane) deteriorate over the next 5 + 1D10 days. Ending in death
Scan (hard) as organs fail and from internal bleeding.
Surgical Exploration (easy)

Medieval: Physical Examination (insane) More than likely peritonitis [300A] will kill the character
first. There is an immediate 20% risk. Every ten hours it
Futuristic: Hightech Scan (tricky) increases by 5% and another roll must be made until the
pancreas is either removed or infection occurs. The rolls
Spell: Healing Vision continue after the surgery but the risk is immediately re-
duced by 10% for every degree of success above margin-
al and it drops by 10% each time after that until it either
The pancreas is usually treated secondary to most other reaches zero or infection occurs. The surgery may of
serious abdominal injuries. Diagnosis can be difficult and course introduce its own risk of peritonitis.
only surgical exploration can determine severity and the
best treatment. Since the pancreas is destroyed the character now has to
live with the effects of type one diabetes [17A].
Surgery
Diagnosis

Modern: Removal (hard)

Repair (severe) Modern: Physical Examination (insane)
Scan (hard)
Medieval: Not usually possible but removal may Surgical Exploration (easy)
be possible, although likely severe
or worse. Medieval: Physical Examination (insane)

Futuristic: Hightech Removal (tricky) Futuristic: Hightech Scan (tricky)

Hightech Repair (tricky)
Spell: Healing Vision
Spell: Regrow III

Surgery can do little to treat a damaged pancreas al-
though it may in some cases be able to repair the dam-
age. 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 ex-
ceptional 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: Removal (hard)
Surgery
Medieval: Not usually possible but removal may
be possible, although likely severe
or worse. Modern: Splenectomy (easy)
Field Surgery, Stop Bleeding (hard)
Futuristic: Hightech Removal (tricky) Hospital , Stop Bleeding (tricky)
Artificial Replacement (hard)
Medieval: Surgery is usually not possible in the
Spell: Regrow IV abdomen due to infection risk, but if
performed splenectomy is usually
tricky or worse.
Since the pancreas is effectively destroyed the only treat-
ment is to remove it. A difficult procedure due to its loc- Futuristic: Hightech Splenectomy (easy)
ation. Failure to remove the pancreas is usually a death Hightech Stop Bleeding (easy)
sentence. The character can live without the pancreas but
Spell: Bloodmagic II (moderate),
will suffer from the effect of type one diabetes [17A]. Bloodmagic III (heavy),
Bloodmagic IV (massive)
309 – Spleen
The spleen is the most commonly injured organ in blunt If the bleeding is not life threatening surgery may be
abdominal trauma. A spongy organ full of blood the size avoided. If the bleeding is life threatening an easy opera-
of the heart and weighing just under a hundred grams in tion may remove the spleen in a splenectomy. Less
an adult. Located under the ribs behind the stomach on drastically, with the right equipment an operation of
the left side. tricky difficulty may repair the damage by sewing the
bleeding parts closed.
The spleen produces infection fighting white blood cells
and filters out old and defective red blood cells as well as 309B – Massive Bleeding in Spleen
bacteria, viruses and other debris. In this way the spleen
helps protect against infection. It can also act as a rudi- Grade 4 Spleen Damage
mentary blood reserve in emergencies. This last function
is often more developed in carnivorous animals. Severe damage to spleen causes uncontrollable bleeding.

It is possible to live without a spleen as most of its func- Symptoms

tions can be taken over by other organs. This will, how-
ever, make the character more vulnerable to infections, Symptoms vary widely. Some have no symptoms, while
doubling all infection risks and increasing all resistance others may have a tender and swollen abdomen. Light-
roll difficulties by one. headedness may develop as blood is lost.

Risks
As the most vascular organ of the body, 350 litres of
blood passes through it every day and it is for this reason
Bleeding is the primary cause of death. The possible loss
that damage to the spleen is easily fatal.
of the spleen itself is not life threatening, although it does
leave the character more exposed to future infections.
309A – Minor Spleen Damage
Diagnosis
Grade 1-3 Spleen Damage
Modern: Physical Examination (severe)
Minor damage to the spleen causing considerable but not Scan (tricky)
necessarily life threatening bleeding. Surgical Exploration (tricky)

Symptoms Medieval: Physical Examination (severe)

Symptoms vary widely. Some have no symptoms, while Futuristic: Hightech Scan (easy)
others may have a tender and swollen abdomen. Light-
Spell: Healing Vision
headedness may develop as blood is lost.

115
Diagnosing a damaged spleen is severe without advanced Diagnosing a damaged spleen is severe without advanced
medical equipment or exploratory surgery. medical equipment or exploratory surgery.

Surgery Surgery

Modern: Splenectomy (easy) Modern: Splenectomy (easy)

Repair (severe)
Medieval: Surgery is usually not possible in the
Medieval: Surgery is usually not possible in the abdomen due to infection risk, but if
abdomen due to infection risk, but if performed splenectomy is usually
performed splenectomy is usually tricky or worse.
tricky or worse.
Futuristic: Hightech Splenectomy (easy)
Futuristic: Hightech Splenectomy (easy) Artificial Replacement (tricky)
Hightech Repair (tricky)
Spell: Bloodmagic III (heavy),
Spell: Bloodmagic III (heavy), Bloodmagic Bloodmagic IV (massive)
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 res-
ults in damage to one of the surrounding organs. The
pancreas [308A] being the most common 50% and stom-
ach [302A] 25% and intestines [303A] 25% occasionally.
309C – Ruptured Spleen
Grade 5 Spleen Damage
Nearly always the result of a high force impact a rup-
tured spleen is completely destroyed.
Symptoms
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)
Medieval: Physical Examination (severe)
Futuristic: Hightech Scan (easy)
Spell: Healing Vision
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 res-
ults in damage to one of the surrounding organs. The
pancreas [308A] being the most common 50% and stom-
ach [302A] 25% and intestines [303A] 25% occasionally.
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 oth-
er 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.
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
bladder is located in this cavity. In females the uterus and A correct diagnosis will confirm that the fracture is
vagina are also located here. The major blood vessels and stable.
nerves to the legs run along the bone in the pelvis. The
pelvis bone is a strong bone and therefore hard to break. 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 fe-

males 1-60 ruptures the bladder and 61-75 damages the
uterus [315A]. For both on 76-85 it has caused an intest-
inal 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
311A – Pelvis Fracture the major artery leading to heavy internal bleeding [2].

Avulsion Fracture Increase any surgery difficulty to treat the above com-
plications by one to reflect the fractured pelvis bone get-
This type of fracture is stable and will heal naturally ting in the way.
without surgery.

Symptoms
311C – Unstable Pelvis Fracture

Severe pain, inability to stand, severe swelling and bruis- This type of fracture is unstable and will not heal prop-
ing. erly without surgery.

Risks Symptoms

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 per-
manent 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 bruis-
ing.
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)

Modern: Physical Examination (tricky)
Scan (easy)
Scan (easy)
Surgical Exploration (easy)
Surgical Exploration (easy)
Medieval: Physical Examination (tricky)
Medieval: Physical Examination (tricky)
Futuristic: Hightech Scan (easy)
Futuristic: Hightech Scan (easy)
Spell: Healing Vision
Spell: Healing Vision

117
A correct diagnosis will confirm that the fracture is un- In the last two cases increase the severity if the same
stable and that surgery is needed. complication is rolled. A second major nerve means both
legs are paralysed. Two major arteries means massive in-
Surgery ternal bleeding and so on.

Increase any surgery difficulty to treat the above com-

Modern: External Fixation (tricky)
Medieval: External Fixation (hard) if possible.
Futuristic: Hightech repair may be able to heal
bone pretty much instantly
plications 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 diffi-
culty.

Spell: Regrow II Diagnosis

Treatment consists of stabilizing the fracture with an ex- Modern: Physical Examination (tricky)
ternal fixator. After this traction may be required to pull Scan (tricky)
Surgical Exploration (tricky)
the bones into position. Finally plates and screws of a
biocompatible metal are used to hold the fracture togeth- Medieval: Physical Examination (tricky)
er while it heals. They are not removed and so become a
permanent part of the pelvis. Futuristic: Hightech Scan (easy)

311D Complicated Unstable Spell: Healing Vision

Pelvis Fracture
A shattered pelvis is usually quite obvious but correctly
Same as a complicated pelvis fracture [311B] but with an
assessing the damage can be tricky with only a physical
unstable pelvis fracture [311C].
examination.
311E – Shattered Pelvis Surgery

A shattered pelvis has broken into several pieces and will

not heal without reconstructive surgery. There is usually Modern: External Fixation (hard)
considerable bleeding and the character may never walk
again. At least not properly and without pain. Medieval: External Fixation (extreme) if
possible.
Symptoms
Futuristic: Hightech Surgery (tricky)
Great pain, bleeding, inability to stand or move legs and
physical deformity are some possible symptoms of a Spell: Regrow III
shattered pelvis.
Surgical repair is hard as fragmented pieces must be lit-
Risks erally put back into place and held in place using screws,
plates and wires of biocompatible metal.
Bleeding and associated injuries are usually the surgeons
immediate priority as any trauma with enough force to 311F – Pulverized Pelvis
shatter the pelvis will usually cause massive damage to
the region. A pulverized pelvis is the result of an extreme force and
leaves the pelvis in a chaotic mess of bone fragments and
Roll 1D100 for complications. In males 1-50 ruptures the splinters. It will obviously not heal without radical treat-
bladder [314A], while in females 1-40 ruptures the blad- ment and the character is unlikely to survive, much less
der and 41-50 damages the uterus [315A]. For both on walk again.
51-60 it has caused an intestinal tear [303A]. 61-65
means the fragmented pelvis has caused serious intestinal Symptoms
damage [303B]. 66-70 cuts the major nerves to a leg
leaving it paralysed. 71-75 cuts a major artery leading to The trauma will usually leave the character unconscious,
heavy internal bleeding [2]. On 76-90 roll twice for two with massive bleeding and a clearly deformed pelvic
complications and on 91-100 roll three times. area.

118
Risks
Bleeding and associated injuries are usually the surgeons
immediate priority in order to save the character’s life.
The blow will likely cause serious damage to everything
in the area, but if not specifically mentioned the follow-
ing 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 com-
plications by one level to reflect the general mess of the
area. The pulverized pelvis must be treated separately.
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 abdo-
men and penetrating trauma can injure the bladder re-
gardless. In either case urine spills into the peritoneal
cavity causing peritonitis.
Symptoms
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

Diagnosis
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
Modern: Physical Examination (hard)
Scan (tricky)
likely to live.
Surgical Exploration (hard)
There is an immediate 10% risk of peritonitis. Make a
Medieval: Physical Examination (hard) new roll every day after that increasing the risk by 5%
each time if no drainage is performed. If drainage is per-
Futuristic: Hightech Scan (tricky) formed rolls are still made each day but the risk does not
increase. Once the bladder heals or is stitched the risk of
Spell: Healing Vision peritonitis will start to reduce. It is reduced by 5% each
day if no drainage is performed or 10% if drainage is per-
formed. Once the risk reaches zero there is no further
A pulverized pelvis is obvious, the really hard part is to danger of peritonitis.
correctly assess the damage.
Diagnosis
Surgery

Modern: Physical Examination (tricky)

Modern: Repair (extreme) Scan (easy)
Surgical Exploration (easy)
Medieval: Repair is unlikely to be possible.
Medieval: Physical Examination (tricky)
Futuristic: Hightech Surgery (hard)
Futuristic: Hightech Scan (easy)
Spell: Regrow IV
Spell: Healing Vision

The difficult level for surgical repair is extreme and will

require a skilled surgeon dedicating days and weeks of Surgery
meticulously piecing the fragments together as best as
possible. Anything but an exceptional success will leave
the character with some disability, pain and probably re- Modern: Stitching bladder (tricky)
quire the use of crutches to limp around. Drainage (tricky)

Medieval: Repair is unlikely to be possible but

312 – Bladder will certainly be tricky or worse.

Futuristic: Hightech Surgery (easy)

A flexible muscular bag collecting urine from the kid-
neys. It is located in the pelvis behind the pubic bone. Spell: Regrow II, Cleanse II (liquids)

119
Surgery consists of drainage of the leaking urine and re-
pairing 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 im-
prove 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.
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 wo-
man’s uterus and is born after nine months.
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 infer-
tile. The damaged ovaries may also stop making hor-
mones. 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.
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 in-
jury.
Risks

313A – Uterus Trauma Since the testes inside the scrotum produce the sperm any
injury to the scrotum and testes can leave the man sterile.
Womb Trauma The pain is severe and usually accompanied by nausea
and vomiting.
The uterus, also known as the womb, is about the size of
a pear and connected to the two ovaries which release an Diagnosis
egg every month into the uterus through the fallopian
tubes.
Modern: Scan (easy)
If the released egg is fertilised by a man it develops into
Medieval: Not possible to see if testes is
a baby in the uterus. Otherwise it is shed along with the
functional.
uterus lining, resulting in menstrual blood known as the
period. Futuristic: Hightech Scan (easy)

If the uterus is damaged during surgery or from trauma Spell: Healing Vision
fertility may be reduced or the woman could become in-
fertile.
Ultrasound may show if the testes are damaged or intact.

Spell: Regrow III Surgery

313B – Major Uterus Trauma Modern: Repair (extreme)

Medieval: Repair is not possible.

Major Womb Trauma
Futuristic: Hightech Surgery (tricky)
Same as uterus trauma [313A] but much more serious
and high risk of infertility. Spell: Regrow III

Spell: 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 Surgery
life-threatening. Ice, a jockstrap and drugs for the pain
and nausea can help to tolerate the injury. Modern: Immediate Surgery (tricky)
Microsurgery (tricky)

313E Crushed Scrotum & Testes Medieval: Immediate Surgery (hard)

A high force impact or explosion completely destroys the Futuristic: Hightech Surgery (tricky)
testes. The man will be infertile and there is no hope to Hightech Microsurgery (easy)
repair the damage. Nanosurgery (easy)

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: Regrow III (if member available)
Regrow IV (new)
The severed penis can be surgically reattached if done
promptly. The difficulty of doing this successfully de-
pends 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

313F – Severed Scrotum & Testes
The scrotum and with it the testes are severed.
Risks
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.

Not surprisingly having the scrotum and testes severed

315 – Diaphragm
leaves the man sterile and unable to have children. The
main risk is from the bleeding which will most likely be The chest and abdomen are separated by a muscle called
moderate. the diaphragm which is also an important muscle for
breathing. It is controlled by the phrenic nerve which
Surgery does not travel through the spinal cord but on its own dir-
ectly from the brain. This means that those paralysed
from spinal cord injury are still able to breathe.
Modern: Reattaching Scrotum (easy)
Reattaching Testes (insane) 315A – Small Diaphragm Tear
Medieval: Repair is not possible. Usually caused by a blunt force to the abdomen or a pen-
Futuristic: Hightech Repair (hard)
etrating injury to either the chest or abdomen.

Symptoms
Spell: Regrow IV

There are usually no immediate symptoms except for oc-

Reattaching the testes is normally not feasible but a bril- casional breathing problems.
liant surgeon may attempt an insane operation. Unless
Risks
the result is a normal or better success the man will still
be sterile. The scrotum can be reattached if done within a There is no immediate risk from the tear but it may have
few hours and is easy. It will be of little use without long term consequences as described below on treat-
testes though. ments.

313G – Severed Penis Diagnosis

Because it is exposed on the outside of the body the soft Modern: Long Observation (severe)
penis is very vulnerable to trauma.
Medieval: Long Observation (severe)
Risks
Futuristic: Long Observation (severe)
The main risk is the bleeding which will be moderate.
Spell: Healing Vision

121
A small diaphragm tear is severe to diagnose and that is Diagnosis
after long observation and careful examination.

Surgery Modern: Long Observation (hard)

Medieval: Long Observation (hard)

Modern: Repair Diaphragm (tricky)
Herniation Repair (hard) Futuristic: Long Observation (hard)

Medieval: This surgery is usually not possible Spell: Healing Vision

and will be at least hard if attempted
despite infection risks.
Futuristic: Hightech Repair (tricky)
Hightech Herniation Repair (tricky)
Spell: Regrow II (tear),
Regrow IV (herniation)
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 sur-
gery which is hard at best. 1D100 months after herni-
ation 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 in-
jury.
Symptoms
A major diaphragm tear is hard to diagnose and that is
after long observation and careful examination.
Surgery
Modern: Mesh Repair (hard)
Repair without Mesh (extreme)
Medieval: This surgery is not possible, and
certainly insane if attempted.
Futuristic: Hightech Mesh Repair (tricky)
Spell: Regrow III (tear),
Regrow IV (herniation)
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 sur-
gery 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 eventu-
ally after months or years, death. Alternatively the herni-
ation may lead to a more sudden death as circulation is
cut off from vital organs or an organ ruptures.

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 dia-
phragm. 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.
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 di-
vides into the radial and ulnar arteries at the elbow which
supply the forearm, wrist and hand.
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.
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.
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.
Risks
The immediate concern is bleeding [2], which will usu-
ally be heavy, and can quickly lead to shock [4]. Then
there is the obvious inconvenience of losing an arm.
Surgery
Modern: Microsurgery (hard) 10-14 hours
Medieval: Microsurgery is not possible.
Futuristic: Hightech Microsurgery (tricky)
Nanosurgery (easy)
Spell: Regrow IV (fuses arms back on)
See microsurgery under modern surgery for details on
how surgery may be able to reattach the arm. If microsur-
gery is not used reduce the degree of success by one.
Making a normal success the best possible result. Mar-
ginal 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.
400C Severed Arm below Elbow
Again this can be treated exactly as a severed arm at the
shoulder [400A]. However, because the shoulder and el-
bow 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 fore-
arm, 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.
123
Arterial blood loss will tend to be more rapid as it is un-
der higher pressure and will often spurt forth from the
wound in rhythm with the heart.
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
The bleeding can be internal if it was caused by some-
thing 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.
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 pain-
ful, 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 gan-
grene [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.
Surgery
Modern: 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)
Medieval: Depends on tools, probably more
difficult.
Futuristic: With hightech tools likely two or
three difficulties lower.
Spell: Bloodmagic III (heavy),
Bloodmagic IV (massive)
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 res-
ult 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 pro-
cedure 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 re-
moved 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 patient’s 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 suc-
cess or failure determines the arm’s recovery. In all cases
of failure the arm is paralysed without feeling or move-
ment. In all cases of success the arm swells and warms
with feeling and function gradually returning.
● Exceptional failure means that the arm had to be
amputated to save the character’s 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 be-
fore it dies and gangrene [4B] develops.
● Marginal success saves the arm but it will re-
main 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 func-
tion 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. Other-
wise 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 per-
formed in the first 4 hours after the artery was
severed the arm recovers completely by the time
the trauma heals. Otherwise it gradually recov-
ers over 1D12 months.
401C Lacerated Radial/Ulnar Artery
One or both of the radial and ulnar arteries providing
blood to the forearm, wrist and hand are damaged caus-
ing 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.
Risks
The primary 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.
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.
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 be-
cause 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 at-
tempted in the first 24 hours, it can be assumed beyond
recovery and dead. If the hand dies the muscles will li-
quidify and gangrene [4B] will develop in 2D10 weeks.
Surgery
Modern: 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)
Medieval: Depends on tools, probably more
difficult.
Futuristic: With hightech tools likely two or
three difficulties lower.
Spell: Bloodmagic II (moderate),
Bloodmagic III (heavy)
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 res-
ult 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 pro-
cedure 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. Reconnect-
ing one artery is usually enough to save the arm. Recon-
necting both takes two surgery attempts.
Usually a small part of the damaged artery must be re-
moved 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.
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 patient’s
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 suc-
cess or failure determines the hand’s 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.
● Exceptional failure means that the hand had to
be amputated to save the character’s 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 re-
main 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
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 stabil-
ity. 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.
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
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 in-
jury to the blood vessels and nerves running along the el-
bow. 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 ves-
sels are not repaired the paralysis becomes permanent in
about 24 hours.
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 sup-
plied with blood from the two arteries in the wrist. The
ulnar artery provides blood to the outer side and the radi-
al to the inner side.

Treatment

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 de-
tails 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. How-
ever because the bones have been displaced it needs sur-
gical repair to join the ends together or the impairment
becomes permanent. Treat it as a mal-union that needs Hand injuries are common since the hands are often used
resetting as described under closed fracture surgery [1A]. reflexively as a defence.
The longer it is left, counting in months, the more diffi-
cult any surgery will be. Infections spread easily through the hand and can cause
stiff joints. One or more stiff joints caused by infection or
402D – Open Displaced Elbow damage can seriously impair the hand.
Fracture
403A – Severed Hand
Compounded Displaced Elbow Fracture
The hand is completely severed.
Same as a displaced elbow fracture [402C] except that
the bone is exposed to bacteria through an open wound Risks
with a high risk of becoming infected. See open fracture
[1B] for details on infection risk and treatment. The immediate concern is bleeding [2], which will usu-
ally be heavy and can quickly lead to shock [4]. Then
there is the obvious inconvenience of losing a hand.
403 – Hand
The hand is both delicate and complicated. The hand it-
self is made up of eight small carpal bones joining the ra-
127
Surgery 403C – Palm Injury
Palm injuries can consist of damaged tendons, nerves,
Modern: Reattach Hand (tricky) 10-12 hours
vessels and fractured bones.
Medieval: Microsurgery is not possible.
Risks
Futuristic: Hightech Microsurgery (tricky)
Nanosurgery (easy) The hand cannot be used while it is healing.

Spell: Regrow IV (fuses hand back on)
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 mi-
crosurgery 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 re-
gained as explained under microsurgery.
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 treat-
ment, 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 in-
volving the hand.

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.
Treatment
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.

Risks

The hand is useless and will not recover. If an infection

takes hold it will not end until the hand is amputated.

Surgery

Modern: Amputation (easy)

Surgical Repair (insane)

Medieval: Amputation (easy)

Futuristic: Amputation (easy) 403D – Severed Finger

Hightech Surgical Repair (hard)
Spell: Regrow IV
Amputating the useless and often messy hand is the best
option as any infection that develops in the hand can be-
come 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.
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
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 in-
volving the hand, especially when it is holding some-
thing. If three fingers are lost the hand is almost useless
and holding things becomes very difficult. If all four fin-

128
gers are lost the hand is unable to hold practically any-
thing and so is useless for most tasks.
Surgery
Modern: Reattach Finger (tricky) 2-4 hours
Medieval: Microsurgery is not possible.
Futuristic: Hightech Microsurgery (easy)
Nanosurgery (easy)
Spell: Regrow III (fuses finger back on)
See microsurgery under modern surgery for details on
how surgery may be able to reattach the finger. If mi-
crosurgery 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 functional-
ity 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 com-
pletely.
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.
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.
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.
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.
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.
404A – Damaged Brachial
Plexus Nerve
The main nerve bundle of the arm, brachial plexus, is
damaged leaving the arm weak and numb.
Symptoms
The arm is weak, numb and often painful.
Risks
The nerve damage results in a –2D permanent impair-
ment to any action using the arm unless the nerve dam-
age 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, con-
tinuous damage to the nerve results in what is effectively
a severed brachial nerve.
If no surgery is attempted roll 1D100. On 1-10 the dam-
age will get worse and result in a severed brachial nerve
[404B]. On 11-30 the nerve will not heal properly and
129
the damage becomes permanent. Otherwise it heals as Symptoms
normal and the character makes a full recovery.
The arm is completely limp, without function or sensa-
Diagnosis tion.

Risks
Modern: EMG & nerve conduction (tricky)
EMG with MRI (tricky) A paralysed arm is already pretty bad and the greatest
risk is that it becomes permanent. If not surgically treated
Medieval: Nerve damage cannot be detected, quickly the nerve endings may not grow back together
only guessed from symptoms which and the paralyses becomes permanent. Without surgery
could also be muscle damage.
there is a 25% chance that the nerve endings will grow
Futuristic: Hightech Scan (easy) back together. This should be adjusted up or down to re-
flect the actual extent and type of trauma inflicted.
Spell: Healing Vision
Diagnosis

Diagnosis attempts to determine the severity, location

Modern: EMG & nerve conduction (tricky)
and cause of the nerve damage. EMG and nerve conduc-
EMG with MRI (tricky)
tion tests can be used for this purpose and to differentiate
between nerve damage and muscle damage. MRI can Medieval: Nerve damage cannot be detected,
also be useful for visualising the damage and detecting only guessed from symptoms which
bone fragments before surgery. could also be muscle damage.

Surgery Futuristic: Hightech Scan (easy)

Spell: Healing Vision

Modern: Microsurgery (tricky)

Medieval: No repair possible Diagnosis attempts to determine the severity, location

Futuristic: Hightech Microsurgery (tricky)
Nanosurgery (easy)
Spell: Regrow III
Immediate treatment consists of immobilising any frac-
tures 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 microsur-
gery is not used reduce the degree of success by one.
Making a normal success the best possible result. Mar-
ginal success stays as marginal success. The degree of
success determines how much functionality was regained
as explained under microsurgery.
404B Severed Brachial Plexus
Nerve
The main nerve bundle of the arm, brachial plexus, is
severed leaving the arm completely paralysed.
and cause of the nerve damage. EMG and nerve conduc-
tion 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: Microsurgery (hard)
Medieval: No repair possible
Futuristic: Hightech Microsurgery (tricky)
Nanosurgery (easy)
Spell: Regrow III
Immediate treatment consists of immobilising any frac-
tures to prevent further injury. Then surgery to ensure the
path between nerve endings is not blocked by bone frag-
ments, 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 microsur-
gery is not used reduce the degree of success by one.
Making a normal success the best possible result. Mar-
130
ginal success stays as marginal success. The degree of
success determines how much functionality was regained
as explained under microsurgery.
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
The fingers, palm and wrist are numb, weak and often
painful.
Risks
The nerve damage results in a –1D permanent impair-
ment to any action using the hand unless the nerve dam-
age 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, con-
tinuous 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 dam-
age 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
Modern: EMG & nerve conduction (tricky)
EMG with MRI (tricky)
Medieval: Nerve damage cannot be detected,
only guessed from symptoms which
could also be muscle damage.
Futuristic: Hightech Scan (easy)
Spell: Healing Vision
Diagnosis attempts to determine the severity, location
and cause of the nerve damage. EMG and nerve conduc-
tion 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: Microsurgery (tricky)
Medieval: No repair possible
Futuristic: Hightech Microsurgery (tricky)
Nanosurgery (easy)
Spell: Regrow III
Immediate treatment consists of immobilising any frac-
tures 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 microsur-
gery is not used reduce the degree of success by one.
Making a normal success the best possible result. Mar-
ginal success stays as marginal success. The degree of
success determines how much functionality was regained
as explained under microsurgery.
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.
Risks
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 re-
flect the actual extent and type of trauma inflicted.
131
Diagnosis
Modern: EMG & nerve conduction (tricky)
EMG with MRI (tricky)
Medieval: Nerve damage cannot be detected,
only guessed from symptoms which
could also be muscle damage.
Futuristic: Hightech Scan (easy)
Spell: Healing Vision
Diagnosis attempts to determine the severity, location
and cause of the nerve damage. EMG and nerve conduc-
tion 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: Microsurgery (hard)
Medieval: No repair possible
Futuristic: Hightech Microsurgery (tricky)
Nanosurgery (easy)
Spell: Regrow III
Immediate treatment consists of immobilising any frac-
tures to prevent further injury. Then surgery to ensure the
path between nerve endings is not blocked by bone frag-
ments, 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 microsur-
gery is not used reduce the degree of success by one.
Making a normal success the best possible result. Mar-
ginal success stays as marginal success. The degree of
success determines how much functionality was regained
as explained under microsurgery.
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.
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
Swelling, tenderness, pain, deformity and difficulty hold-
ing any weight.
Risks
The risk is that the wrist will be deformed with a perman-
ent –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 cor-
recting 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
Modern: X-Ray Scan (tricky)
Medieval: Physical Exam (hard)
Futuristic: Hightech Scan (easy)
Spell: Healing Vision
132
Diagnosis is used both to detect the fracture and to de-
cide if it is dislocated and so needs to be reset or just im-
mobilised.
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.
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

Surgery and Treatment Modern: X-Ray Scan (tricky)

Medieval: Physical Exam (hard)

Modern: Manual Bone Resetting (easy)
Surgical Deformity Repair (hard) Futuristic: Hightech Scan (easy)

Medieval: Manual Bone Resetting (easy) Spell: Healing Vision

Surgical correction usually not
available, and if known at least one
level higher difficulty.
Futuristic: Manual Bone Resetting (easy)
Hightech Surgical Deformity (easy)
Spell: Regrow II
Diagnosis is necessary to differentiate from a simple
fracture [405A]. The small size of the bones and their
overlapping alignment makes accurate diagnosis by X-
rays more difficult.
Surgery and Treatment

Supporting the wrist with a splint or some form of im- Modern: Surgical Correction (hard)
mobilisation is very important to allow any broken blood Splintering (tricky)
vessels to heal and thus prevent blood starvation to the
wrist. If any dislocated bones are reset in the first 24-48 Medieval: Surgical correction usually not
hours deformity does not occur. available, and if known at least two
levels higher difficulty.
Surgical removal of bones can repair deformity and its
Futuristic: Hightech Surgical Correct. (tricky)
resulting impairment if it occurs. This weakens the over-
all strength of the wrist which could result in a complic- Spell: Regrow II
ated fracture [405B] in the future. There is a 1% risk of
this happening every time the hand is involved in an ac- Supporting the wrist with a splint or some form of im-
tion placing a heavy load on the wrist. This would in- mobilisation is very important to allow any broken blood
clude heavy lifts, throwing objects, wielding close com- vessels to heal and thus prevent blood starvation to the
bat weapons and climbing. wrist and osteonecrosis [5].

405B – Complicated Wrist Fracture
In a complicated wrist fracture the bones have been dis-
located and shifted too far to heal without surgery. Usu-
ally resulting in more impairment of the hand than for a
simple wrist fracture.
Symptoms
Swelling, tenderness, pain, deformity and difficulty hold-
ing any weight.
Risks
The deformed wrist will not heal without surgery and so
the impairment is permanent.
Surgery to repair the dislocated fracture is the only pos-
sible treatment. The success determines the regained
functionality of the wrist and hand.
● 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
fingers and thumb. Each finger has two tendons, except
the thumb which has only one.
When a finger’s tendon is torn or severed, usually by a
cut, the finger is unable to bend and becomes useless.
Symptoms
Severe pain and inability to bend one or more fingers.
Risks
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 al-
though 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 some-
thing. If three fingers are affected the hand is almost use-
less 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
Modern: Physical Exam (tricky)
Medieval: Physical Exam (tricky)
Futuristic: Hightech Scan (easy)
Physical Exam (tricky)
Spell: Healing Vision
Diagnosing a severed tendon can be done with a physical
examination.
Surgery
Modern: Tendon Repair (tricky)
Late Reconstruction (severe)
Splintering (easy)
Medieval: Surgical repair usually not available,
and if known at least one level higher
difficulty.
Futuristic: Hightech Surgical Repair (easy)
Hightech Late Reconstruction (tricky)
Spell: Regrow III
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 can-
not 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 diffi-
culty 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.
406 – Shoulder Joint
The shoulder is a ball-and-socket joint, where the humer-
us bone in the upper arm ends in the ball, while the scap-
ula 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
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 per-
manent –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
Modern: Physical Exam (hard)
Medieval: Physical Exam (hard)
Futuristic: Hightech Scan (easy)
Physical Exam (hard)
Spell: Healing Vision
A dislocated shoulder is obvious but it is hard to dia-
gnose further complications such as fracture, nerve dam-
age or internal bleeding.
Treatment
Modern: Manipulate Back in Place (tricky)
Medieval: Manipulate Back in Place (tricky)
Futuristic: Manipulate Back in Place (tricky)
Spell: Regrow III
Manipulating the joint back into position is fairly straight
forward using first aid or for any doctor with basic med-
ical skills.
When the arm is manipulated back into position there is
again the risk of nerve damage and bleeding from dam-
aged blood vessels unless it’s 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 per-
manent –1D impairment. For marginal success the risk
for both are 10%, 30% for marginal failure, 50% for
normal failure and guaranteed for exceptional failure.
406B – Complicated Dislocation
A complicated dislocation involves damage to the ten-
dons. 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: No treatment
Medieval: No treatment
Futuristic: Medical nanobots or other hightech
treatment may be available.
Spell: Regrow III
The tendon damage cannot normally be treated effect-
ively.
406C – Torn Shoulder Tendon
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 dam-
aged tendon and is usually torn from a heavy lift, fall or
direct trauma.
Symptoms
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 per-
manent for the arm.
135
Diagnosis strong that the bone is more likely to break than the joints
are to be dislocated.
Modern: Physical Examination (tricky)
Scan (tricky)
407A – Collarbone Fracture

Medieval: Physical Examination (tricky) Fractured Clavicle

Futuristic: Physical Examination (tricky) The clavicle is weak and easily broken and so is one of
Hightech Scan (easy) the most common injuries in any shoulder or chest in-
jury.
Spell: Healing Vision
The sharp bone ends can cause further damage and are
often associated with pneumothorax [204A] or [204B],
A diagnostic scan using MRI is without a doubt the best and heavy internal bleeding from the subclavian and axil-
way to determine the extent of the damage, although x- lary vessels or the jugular vein [2A].
rays and ultrasound can be useful as well.
Symptoms
Surgery
Swelling and deformity at the injury site easily seen as
the collarbone is located just beneath the skin. Tender-
Modern: Tendon Repair (tricky)
ness and pain with movement of shoulder or arm. Inabil-
Late Reconstruction (severe)
ity to use arm or diminished sensation and weakness.
Medieval: Surgical repair usually not available,
and if known at least two levels Risks
higher difficulty.
The main risk is that the fracture heals poorly. Without
Futuristic: Hightech Surgical Repair (easy) treatment this is very likely, 75% chance, resulting in a
Hightech Late Reconstruction (tricky) –1D penalty to any physical action. With treatment the
risk is reduced to 10% or even zero if the character lies
Spell: Regrow III on his back with a pad between the shoulders as ex-
plained under treatment.

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 to-
gether, 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 diffi-
culty by one level.
There is also a 25% chance that the fracture causes a dis-
location. The dislocation must be surgically repaired or
the character will end up with a permanent –2D impair-
ment 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.

Eventually, six weeks can be assumed, the tendon ends Diagnosis

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 Modern: Physical Examination (tricky)
is possible but very difficult and the results are not as X-Ray Scan (easy)
good leaving a -1D impairment.
Medieval: Physical Examination (tricky)

407 – Collarbone
Futuristic: Physical Examination (tricky)
Clavicle Hightech Scan (easy)

Spell: Healing Vision

A bar from the breastbone (sternum) out to the shoulder-
blade (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: Sling and Bandage (tricky)

Medieval: Sling and Bandage (tricky)

Futuristic: Sling and Bandage (tricky)

Spell: 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: Dislocation repair (easy)

Medieval: Surgical repair usually not available,

and if known at least two levels
higher difficulty.

Futuristic: Dislocation repair (easy)

Spell: Regrow III

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 Great Vessels

Here the legs includes the toes, feet and everything up to The femoral artery and vein are the main vessels of the
the pelvis, which is covered by the abdomen. 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 con-

trol 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 usu-

ally be heavy and can quickly lead to shock [4]. Then
there is the obvious inconvenience of losing a leg. Walk-
ing is obviously no longer an option and standing is im-
possible without support.

Surgery

Modern: Microsurgery (hard) 10-14 hours

Medieval: Microsurgery is not possible.

Futuristic: Hightech Microsurgery (tricky)

Nanosurgery (easy)

138
 attack and more likely the result of a failed manoeuvre or
Spell: Regrow IV (fuses leg back on) a fall.

Symptoms
See microsurgery under modern surgery for details on
how surgery may be able to reattach the leg. If microsur- Swelling around the ankle, difficulty walking and pain
gery is not used reduce the degree of success by one. when putting any weight on it.
Making a normal success the best possible result. Mar-
ginal success stays as marginal success. The degree of Risks
success determines how much functionality was regained
as explained under microsurgery. The greatest risk is confusing a sprain with a fracture and
so failing to treat a serious ankle fracture.
At least normal success is required to be able to hold any
Diagnosis
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 re- Modern: Physical Examination (hard)
store the ability to run. X-Ray Scan (easy)

500B – Severed Leg below Knee Medieval: Physical Examination (hard)

This can be treated much like a severed leg above the Futuristic: Physical Examination (hard)
Hightech Scan (easy)
knee [500A]. However, because the knee remains un-
harmed the leg retains a lot more functionality. Spell: Healing Vision

The result is that the outcome of surgery will be more fa-

vourable and even a simple prosthesis can be quite ef- Diagnosing a sprain is not difficult but distinguishing
fective allowing normal movement and possibly even between a sprain and a fracture is hard without using x-
jogging or running. rays or some other type of scan to see the actual damage.
The difference is important as a fracture may require sur-
The surgical outcomes are as follows. gery.
● Marginal: The leg grows back together but does Treatment
not get enough blood. It is both paralysed and
bluish with ugly spots. With practice it is pos-
sible to stand and walk on the leg but injury will Modern: Ice and elevation (easy)
be common and because of lack of sensation in-
fection and eventual gangrene is likely. Medieval: Ice and elevation (easy)
● Normal: Healthy and will regain some sensation
and function over the next 1D12 months. If Futuristic: Ice and elevation (easy)
More hightech solutions to speed
treated well this will result in what is effectively
healing are likely available but
the perfect prosthesis and should allow full normally not needed.
movement with only a slight penalty to speeds
above jogging. Spell: Regrow I
● Exceptional: Healthy and in 1D12 months al-
most fully functional. For practical purposes, as
good as new. Sprains do not require treatment besides rest but ice to
reduce the swelling and elevating the ankle will speed
501 – Ankle healing times. The difficulty reflects knowing what to do
rather than the treatment itself which is trivial.
The ankle is a simple joint involving only one bone of
the foot and restricting movement in one direction. 501B – Ankle Fracture
Pott’s Fracture
501A – Sprain
An ankle fracture is like any other fracture and can be
A sprain is torn or stretched ligaments in the ankle. Al-
open, closed, fragmented, shattered, etc. with the same
though common a sprain is unlikely as a result from an

139
risks and treatments. It is only listed here because it can
be hard to distinguish from a sprain without a scan.
Symptoms
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 vulner-
able to any trauma to the back of the ankle.
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
Modern: Tendon Repair (tricky)
Late Reconstruction (severe)

Medieval: Surgical repair usually not available,

Symptoms
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
and if known at least two levels
higher difficulty.
Futuristic: Hightech Surgical Repair (easy)
Hightech Late Reconstruction (tricky)
Spell: Regrow III
If the tendon is severed surgery is necessary. Successful
surgery, where the tendon is stitched back together, res-
ults 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 diffi-
culty by one level.

Eventually, six weeks can be assumed, the tendon ends

Modern: Physical Examination (tricky)
Scan (tricky) retract and get stuck in scar tissue, the muscle shortens
and withers, the tunnels through which the tendons run
Medieval: Physical Examination (tricky) shrink and the joint stiffens. Late reconstruction surgery
is possible but very difficult and the results are not as
Futuristic: Physical Examination (tricky) good leaving a -1D impairment.
Hightech Scan (easy)

Spell: Healing Vision 502 – Blood Vessels

The main artery to the leg is the femoral artery. It starts
A successful diagnosis is needed to determine if the ten- from the iliac artery in the pelvis and runs along the
don is fully or partially severed and thus the best treat- thigh-bone (femur) along with the femoral nerve. It runs
ment. between muscles to the back of the knee. Where it con-
tinues into the calf as the popliteal artery. The femoral
Treatment vein runs together with the artery collecting the blood the
artery pumped out for its return to the heart.
Modern: Cast or splint (easy)
Arterial blood loss will tend to be more rapid as it is un-
Medieval: Cast or splint (easy)
der higher pressure and will often spurt forth from the
Futuristic: Cast or splint (easy) wound in rhythm with the heart.

Spell: Regrow III

140
502A – Lacerated Femoral Vessels
The femoral artery and/or the veins are damaged and
leaking blood, but not completely severed.
Symptoms
The bleeding can be internal if it was caused by some-
thing 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 is very ef-
fective 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
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 pain-
ful, 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 gan-
grene [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 im-
possible.
Surgery
Modern: 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)
Medieval: Depends on tools, probably more
difficult.
Futuristic: With hightech tools likely two or
three difficulties lower.
Spell: Bloodmagic III (heavy), Bloodmagic
IV (massive)
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 com-
pletely 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 re-
moved 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 patient’s 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 suc-
cess or failure determines the leg’s recovery. In all cases
of failure the leg is paralysed without feeling or move-
ment. In all cases of success the leg swells and warms
with feeling and function gradually returning.
● Exceptional failure means that the leg had to be
amputated to save the character’s 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 func-
tion 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. Other-
wise 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 func-
tion 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.
502C Lacerated Popliteal Vessels
The popliteal vessels are the continuation of the femoral
vessels into the calf. The artery, vein or both are dam-
aged causing moderate or heavy bleeding.
Symptoms
The bleeding can be internal if it was caused by some-
thing 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.
Treatment
Pressure treatment as for any bleeding injury is very ef-
fective and usually the only treatment needed.
502D – Severed Popliteal
Artery
The popliteal artery in the calf is severed, causing mod-
erate or heavy bleeding.
Symptoms
The bleeding can be internal if it was caused by some-
thing 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 at-
tempted 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
Modern: 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)
Medieval: Depends on tools, probably more
difficult.
Futuristic: With hightech tools likely two or
three difficulties lower.
Spell: Bloodmagic II (moderate),
Bloodmagic III (heavy), Bloodmagic
IV (massive)
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 com-
pletely 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.
503 – Foot
Usually a small part of the damaged artery must be re- The anatomy of the foot is similar to a larger version of
moved before the connection is made. If the damaged that of the hand. It has many groups of bones with large
part is too long, a graft is needed to connect the ends. muscles close to the ankle and many smaller muscles fur-
This will be the case 20% of the time. ther out in the foot. The smaller muscles are not vital to
the function of the foot. Nearly all fractures of the foot
The graft consists of a vein from another part of the are open fractures because the bones are so close to the
body. Usually the saphenous vein from the other leg. The skin.
vein is usually taken from the patient’s 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 suc-

cess or failure determines the leg’s recovery. In all cases
of failure the leg is paralysed without feeling or move-
ment. In all cases of success the leg swells and warms
503A – Broken Toe
with feeling and function gradually returning.
The fracture itself is not especially disabling, except for
● Exceptional failure means that the leg had to be
the pain, but the blood supply is often cut off by the dam-
amputated to save the character’s life.
age
● Normal failure means the leg does not have an
adequate blood supply and will die and develop Risks
gangrene [4B] in 1D10 days.
● Marginal failure means that the leg looks like it There is a 50% risk that blood starvation leads to the
will make it and it survives for 3D10 days be- death of the toe. If this happens the toe will turn blue and
fore it dies and gangrene [4B] develops. cold. Gangrene develops in 1D12 weeks and the toe must
● Marginal success saves the leg but it will be be amputated. The loss of a toe is not serious, but if more
useless and paralysed. or less all toes are lost it may affect balance.
● Normal success saves the leg. It will initially be
paralysed but in 2 to 3 days sensation and func- Surgery
tion 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 Modern: Vascular Repair (tricky)
completely by the time the trauma heals. Other- Amputation (easy)
wise it gradually recovers over 1D12 months,
increasing its ability to hold more and more Medieval: Lowtech Vascular Surgery (hard)
Amputation (easy)
weight. First the character will be able to walk
with support, then without and eventually an Futuristic: Hightech Vascular Surgery (tricky)
awkward jog will be possible but never a run. A Amputation (easy)
permanent –1D penalty to all actions depending
on the leg, such as climbing, remains. Spell: Regrow II
● Exceptional success saves the leg and most of
its function and sensation. Initially it will be A compromised blood supply can be repaired with care-
paralysed but in 2 to 3 days sensation and func- ful surgery but can be difficult. Amputation is of course
tion starts to return. If surgery was performed in easy.
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.

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.
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 dam-
age will get worse and result in a severed femoral nerve
[504B]. On a 11-50 the nerve will not heal and the dam-
age becomes permanent. Otherwise it heals as normal
and the character makes a full recovery.
Diagnosis

Nerves, except for in the brain and spinal cord, heal if the Modern: EMG & nerve conduction (tricky)
path between the broken nerve endings is not blocked. EMG with MRI (tricky)

Sensation and muscle control below a severed nerve is Medieval: Nerve damage cannot be detected,
impossible. The degree of paralysis below the injury only guessed from symptoms which
could also be muscle damage.
therefore depends on how large and central the nerve
was. Futuristic: Hightech Scan (easy)

504A – Damaged Femoral Nerve Spell: Healing Vision

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 conduc-
tion 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 es- Modern: Microsurgery (tricky)
pecially weak, which makes walking up or down stairs, Splintering (tricky)
steep hills and climbing in general more difficult. The
knee will be numb and have difficulty locking when the Medieval: No repair possible
leg is fully extended and so be unstable.
Futuristic: Hightech Microsurgery (tricky)
Risks Nanosurgery (easy)

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: Regrow III
Initial treatment is usually immobilisation of any frac-
tures to prevent further injury. Treatment consists of sur-
gery to relieve pressure from such things as bone frag-

144
ments, blood cloths and swelling and to make repairs to Diagnosis
allow the nerve to heal.

See microsurgery under modern surgery for details on Modern: EMG & nerve conduction (tricky)
EMG with MRI (tricky)
how surgery may be able to repair the nerve. If microsur-
gery is not used reduce the degree of success by one. Medieval: Nerve damage cannot be detected,
Making a normal success the best possible result. Mar- only guessed from symptoms which
ginal success stays as marginal success. The degree of could also be muscle damage.
success determines how much functionality was regained
as explained under microsurgery. Futuristic: Hightech Scan (easy)

504B – Severed Femoral Nerve Spell: Healing Vision

The femoral nerve is completely severed disabling all

Diagnosis attempts to determine the severity, location
motor function and sensation beneath the site of the in-
and cause of the nerve damage. EMG and nerve conduc-
jury. It can be a direct result of trauma inflicted or as a
tion tests can be used for this purpose and to differentiate
result of pelvic fractures or surgery to close the femoral
between nerve damage and muscle damage. MRI can
artery.
also be useful for visualising the damage and detecting
bone fragments before surgery.
The femoral nerve group helps control the straightening
of the leg and supplies sensation to the front of the thigh Treatment and Surgery
and part of the lower leg.

Symptoms
Modern: Microsurgery (hard)
Splintering (tricky)
Loss of movement and sensation in the leg. Especially
noticeable is a weakness in the knee which makes walk-
Medieval: No repair possible
ing up or down stairs, steep hills and climbing in general
more difficult. Also the knee will be numb and unable to
Futuristic: Hightech Microsurgery (tricky)
lock when the leg is fully extended and so be unstable.
Nanosurgery (easy)
Risks
Spell: Regrow III
While the severing of the femoral nerve does not result in
Initial treatment is usually immobilisation of any frac-
paralysis it will have a serious impact on the use of the
tures to prevent further injury. Treatment consists of sur-
leg.
gery to ensure the path between nerve endings is not
blocked by bone fragments, blood cloths or other objects.
Balance, climbing and similar actions involving use of
This allows the nerve endings to grow back together.
the knee suffer a –1D impairment penalty. When jogging
or running there is an increased risk of falling due to the
See microsurgery under modern surgery for details on
weakened knee. Make an attribute roll, typically Agility,
how surgery may be able to repair the nerve. If microsur-
against a difficulty of easy for jogging and tricky for run-
gery is not used reduce the degree of success by one.
ning. Make several rolls if the action is for an extended
Making a normal success the best possible result. Mar-
duration or the terrain is challenging.
ginal success stays as marginal success. The degree of
success determines how much functionality was regained
Long leg braces and other leg supporting equipment may
as explained under microsurgery.
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.
504C – Damaged Sciatic Nerve
The sciatic nerve is contused or lacerated. Either as a dir-
ect result of the trauma or as a result of swelling or other
pressure. Motor function and sensation is impaired be-
neath 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
The leg is weak, numb and often in pain.
Risks
The nerve damage results in a limping walk with no pos-
sibility of moving faster and a –2D permanent impair-
ment 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 re-
quired to repair the damage and remove clotted blood,
bone fragments or otherwise relieve the nerve of un-
wanted 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 dam-
age becomes permanent. Otherwise it heals as normal
and the character makes a full recovery.
Diagnosis
Modern: EMG & nerve conduction (tricky)
EMG with MRI (tricky)
Medieval: Nerve damage cannot be detected,
only guessed from symptoms which
could also be muscle damage.
Futuristic: Hightech Scan (easy)
Spell: Healing Vision
Diagnosis attempts to determine the severity, location
and cause of the nerve damage. EMG and nerve conduc-
tion 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: Microsurgery (tricky)
Splintering (tricky)
Medieval: No repair possible
Futuristic: Hightech Microsurgery (tricky)
Nanosurgery (easy)
Spell: Regrow III
Initial treatment is usually immobilisation of any frac-
tures to prevent further injury. Treatment consists of sur-
gery to relieve pressure from such things as bone frag-
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 microsur-
gery is not used reduce the degree of success by one.
Making a normal success the best possible result. Mar-
ginal 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 mo-
tor 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
The leg is completely limp and without feeling.
Risks
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.
146
Diagnosis Starting from the sciatic nerve above the knee, the tibial
and peroneal nerve branches supply all the structure be-
low the knee.
Modern: EMG & nerve conduction (tricky)
EMG with MRI (tricky) Symptoms

Medieval: Nerve damage cannot be detected, Chronic pain, numb calf and no sensation in the top of
only guessed from symptoms which
could also be muscle damage.
the foot and ankle.

Risks
Futuristic: Hightech Scan (easy)

Spell: Healing Vision While damage to the tibial or peroneal nerve does not
result in paralysis it will have a serious impact on walk-
Diagnosis attempts to determine the severity, location ing and running. Any manoeuvre that requires movement
and cause of the nerve damage. EMG and nerve conduc- such as jogging, running and balancing suffers a –1D
tion tests can be used for this purpose and to differentiate impairment penalty.
between nerve damage and muscle damage. MRI can
also be useful for visualising the damage and detecting The nerve will frequently heal, but often surgery is re-
bone fragments before surgery. quired to repair the damage and remove clotted blood,
bone fragments or otherwise relieve the nerve of un-
Surgery wanted pressure. Untreated, continuous damage to the
nerve can result in what is effectively a severed sciatic
nerve.
Modern: Microsurgery (hard)
Splintering (tricky) If no surgery is attempted roll 1D10. On 1 the damage
will get worse and result in a severed sciatic nerve
Medieval: No repair possible [504D]. On a 1 - 5 the nerve will not heal and the dam-
age becomes permanent. Otherwise it heals as normal
Futuristic: Hightech Microsurgery (tricky) and the character makes a full recovery.
Nanosurgery (easy)
Diagnosis
Spell: Regrow III

Modern: EMG & nerve conduction (tricky)

Initial treatment is usually immobilisation of any frac- EMG with MRI (tricky)
tures to prevent further injury. Treatment consists of sur-
Medieval: Nerve damage cannot be detected,
gery to ensure the path between nerve endings is not
only guessed from symptoms which
blocked by bone fragments, blood cloths or other objects. could also be muscle damage.
This allows the nerve endings to grow back together.
Futuristic: Hightech Scan (easy)
See microsurgery under modern surgery for details on
how surgery may be able to repair the nerve. If microsur- Spell: Healing Vision
gery is not used reduce the degree of success by one.
Making a normal success the best possible result. Mar-
ginal success stays as marginal success. The degree of Diagnosis attempts to determine the severity, location
success determines how much functionality was regained and cause of the nerve damage. EMG and nerve conduc-
as explained under microsurgery. tion tests can be used for this purpose and to differentiate
between nerve damage and muscle damage. MRI can
504E – Damaged Tibial or also be useful for visualising the damage and detecting
bone fragments before surgery.
Peroneal Nerve
Surgery
Tibial or Peroneal Nerve Palsy

The tibial or peroneal nerve is contused or lacerated. Modern: Microsurgery (tricky)

Either as a direct result of the trauma or as a result of Splintering (tricky)
swelling or other pressure. Motor function and sensation
is impaired beneath the site of injury. Medieval: No repair possible

147
 Diagnosis
Futuristic: Hightech Microsurgery (tricky)
Nanosurgery (easy)
Modern: EMG & nerve conduction (tricky)
Spell: Regrow III EMG with MRI (tricky)

Medieval: Nerve damage cannot be detected,

only guessed from symptoms which
Initial treatment is usually immobilisation of any frac- could also be muscle damage.
tures to prevent further injury. Treatment consists of sur-
gery to relieve pressure from such things as bone frag- Futuristic: Hightech Scan (easy)
ments, blood cloths and swelling and to make repairs to
allow the nerve to heal. Spell: Healing Vision

See microsurgery under modern surgery for details on

how surgery may be able to repair the nerve. If microsur-
gery is not used reduce the degree of success by one.
Making a normal success the best possible result. Mar-
ginal success stays as marginal success. The degree of
success determines how much functionality was regained
as explained under microsurgery.
Diagnosis attempts to determine the severity, location
and cause of the nerve damage. EMG and nerve conduc-
tion 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
Modern: Microsurgery (hard)
Tibial or Peroneal Nerve Palsy Splintering (tricky)

The tibial or peroneal nerve is completely severed. Medieval: No repair possible

Starting from the sciatic nerve above the knee, the tibial Futuristic: Hightech Microsurgery (tricky)
and peroneal nerve branches supply all the structure be- Nanosurgery (easy)
low the knee.
Spell: Regrow III
Symptoms

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 slap-
ping gait.
Risks
Initial treatment is usually immobilisation of any frac-
tures to prevent further injury. Treatment consists of sur-
gery 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

The slapping gait caused by the loss of the nerve comes
how surgery may be able to repair the nerve. If microsur-
from the fact that the foot cannot be held horizontal when
gery is not used reduce the degree of success by one.
lifted, causing the toes to drag when walking. This makes
Making a normal success the best possible result. Mar-
walking a challenge and the foot is lifted higher than nor-
ginal success stays as marginal success. The degree of
mal and swung forward and then down to land hard on
success determines how much functionality was regained
the heel, making a slapping sound. All movement speeds
as explained under microsurgery.
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.
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 hap-
pen there is usually massive damage to the whole area.
Fractures in the pelvis, legs and back are especially com-
mon as is damage to nerves and blood vessels.
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 an-
terior dislocation, where the thighbone slips out and for-
ward. The hip will only be slightly bent and the leg will
twist out and away from the middle of the body.
Symptoms
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 dislo-
cation, otherwise it is a posterior dislocation. If not spe-
cified 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
blood vessels and damage nerves. Roll 1D100 on the
table below.
Hip Dislocation Risk
1D100 Complication
The femoral artery is severed resulting in
1-5
heavy bleeding [502A].
The femoral vessels are damaged resulting
6 – 10
in moderate bleeding [502A].
The sciatic nerve is severed [504D] for
11 – 15 posterior dislocations and femoral nerve
[504B] for anterior dislocations.
The sciatic nerve is damaged [504C] for
16 – 30 posterior dislocations and femoral nerve
[504A] for anterior dislocations.
31+ 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 perman-
ent –1D impairment for any action where the leg is in-
volved. Every year there is a 20% chance that the condi-
tion 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 os-
teoarthritis 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] res-
ulting 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
Modern: Physical Exam (easy)
X-Ray Scan and CT Scan (easy)
Medieval: Physical Exam (easy)
Futuristic: Physical Exam (easy)
Hightech Scan (easy)
Spell: Healing Vision
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: Manipulate Back in Place (tricky)
Unassisted Manipulation (tricky)
Medieval: Manipulate Back in Place (tricky)
Unassisted Manipulation (tricky)
Futuristic: Manipulate Back in Place (tricky)
Unassisted Manipulation (tricky)
Spell: Regrow III
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 dif-
ficulty 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 com-
plications 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 sup-
port, like a cane. Unless there has been nerve damage the
limp eventually disappears and there is a full recovery.
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.
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. Other-
wise there is a 60% risk of necrosis developing.
Diagnosis
Modern: X-Ray Scan and CT Scan (tricky)
Medieval: Can be diagnosed but extent of
fracture cannot be determined.
Futuristic: Hightech Scan (easy)
Spell: Healing Vision
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)
Medieval: Surgery will usually not be an option.
Futuristic: Any hightech surgery is likely one or
two difficulties lower than for modern
surgery.
Spell: Regrow III
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 diffi-
culty 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 move-
ment, 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 fixa-
tion because of damage and misalignment of the bone. In
these cases only a prosthesis or total hip replacement can
150
help the character. Surgeons will often prefer to do a Usually the failed prosthesis has come loose or been
prosthesis anyway, because of the high risk of os- worn down and the failed part can be replaced with a
teonecrosis. tricky surgery.

The second method of replacing the head and neck of the In all cases sexual activity is not recommended for at
thighbone with a prosthesis is easier than a total hip re- least the first month of recovery.
placement. Also with a recovery time only twice as long
as normal it heals significantly faster than with an intern-
al fixation. The character can move with assistance
506 – Knee
already on the day after surgery. The leg can bear some
weight right away but assistance or crutches are needed Patella
for the first three weeks. After this a walking stick or
cane is enough until the hip heals completely. There is no The knee joint is made up of four bones. The two main
risk of osteonecrosis with this technique but the prosthes- bones are the thighbone and shinbone, while the fibula
is, which is usually of metal, will not last forever. and kneecap provide stability.

10% of hip fractures cannot be treated with this method The knee joint functions like a hinge, allowing forward
and require a total hip replacement due to damage to the and backward motion. Four strong ligaments, several ten-
socket in the pelvic bone. dons and strong muscles hold the knee joint together
while still allowing some side-to-side motion.
A total hip replacement involves replacing both the upper
thighbone and the socket in the pelvic bone with a pros- The meniscus is a disk-like pillow made up of two pieces
thesis. Effectively replacing the entire joint. Recovery of cartilage to form a cushion between the thighbone and
times are as normal and so very fast for a hip fracture. shinbone.
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 in-
clude 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 cumu-
lative 1% risk that the prosthesis fails. Roll once each
year. Thus after ten years there is a 5% risk that the pros-
thesis 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 in-
creases 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 in- Knee fractures can be treated as any other bone fractures.
creases by one until the leg can no longer be moved and The kneecap tends to break into fragments which usually
causes constant pain. heal well.

151
506A – Closed Knee Fracture Surgery

The kneecap tends to break into fragments which usually

Modern: Surgical Stitching (tricky)
heal well. A closed knee fracture like this can be treated Kneecap Removal (easy)
like any closed fracture [1A]. Splintering (tricky)

506B – Open Knee Fracture Medieval: Kneecap Removal (tricky)

The kneecap tends to break into fragments which usually Futuristic: Hightech Surgical Repair (tricky)
Kneecap Removal (easy)
heal well. An open knee fracture like this can be treated
like any open fracture [1B]. Spell: Regrow III

506C – Fragmented Knee
Comminuted Knee Fracture
The knee is splintered into fragments which unlike nor-
mal 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
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 liga-
ments [506G] and another 10% risk of torn knee tendons
[506H].
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 sur-
face. 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 nor-
mal 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.

Diagnosis Treat as a fragmented knee [506C] but with risk of infec-

tion as for a open fracture [1B].

Modern: X-Ray Scan (tricky) 506E – Shattered Knee

Medieval: Physical Exam (tricky) The knee is completely shattered beyond any hope of re-
pair or healing. Because of the massive damage tendons
Futuristic: Scan (easy)
and ligaments are also torn making the joint unstable and
Spell: Healing Vision so the leg becomes impossible to stand on.

Risks

A knee fracture is pretty obvious but a careful diagnosis

The shattered kneecap can usually just be removed sur-
is needed to determine the exact extent of the damage
gically which leaves the character with a permanent –1D
and best treatment.
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 Torn ligaments can easily be diagnosed by a skilled doc-
tor or surgeon. A more certain and detailed diagnosis can
be obtained with a MRI scan.
Modern: Kneecap Removal (easy)
Treatment and Surgery
Medieval: Kneecap Removal (tricky)

Futuristic: Kneecap Removal (easy)

Modern: Therapy and Bandaging (easy)
Spell: Regrow IV Stitching Back Together (tricky)

Medieval: Therapy and Bandaging (easy)

Removing the kneecap is not difficult but further surgery
Futuristic: Therapy and Bandaging (easy)
to repair ligaments and tendons are necessary. Hightech Repair (easy)

506F – Open Shattered Knee Spell: Regrow II

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.
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 buck-
ling 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
Pain, swelling, instability and difficulty walking or stand-
ing on the leg are typical symptoms of damaged liga-
ments.
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 ori-
ginal 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 al-
low the knee to heal completely.
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.

Risks The tendons are easily injured by piercing and slashing

trauma or by a crushing blow that damages the knee.
Ligament damage heals poorly without surgery and is
prone to future relapse. Symptoms

Diagnosis
Pain, swelling, inability to straighten the knee and in-
stability causing the character to fall over.
Modern: Physical Examination (tricky)
Risks
MRI Scan (tricky)

Medieval: Physical Examination (tricky) The character is unable to stand on the leg since the knee
cannot be locked into place without the tendons.
Futuristic: Physical Examination (tricky)
Hightech Scan (easy) The severed tendon does not heal unless repaired. If not
repaired the tendons function is permanently lost, making
Spell: Healing Vision

153
walking and standing permanently impossible without If the tendon is severed surgery is necessary. Successful
aid. surgery, where the tendon is stitched back together, res-
ults in a full recovery, but the foot will still need to be
Diagnosis immobilised for about four weeks.

Delay in treatment increases the difficulty. For every two

Modern: Physical Examination (tricky) weeks since the tendon was severed increase the diffi-
Scan (tricky) culty by one.
Medieval: Physical Examination (tricky)
Eventually, six weeks can be assumed, the tendon ends
Futuristic: Physical Examination (tricky) retract and get stuck in scar tissue, the muscle shortens
Hightech Scan (easy) and withers, the tunnels through which the tendons run
shrink and the joint stiffens. Late reconstruction surgery
Spell: Healing Vision is possible but very difficult and the results are not as
good leaving half the impairment.

A successful diagnosis is needed to determine if the ten-

don is fully or partially severed and thus the best treat-
ment. If unsure if the tear is partial, surgery is recom-
mended.

Treatment

Modern: Cast or splint (easy)

Medieval: Cast or splint (easy)

Futuristic: Cast or splint (easy)

Spell: 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 ten-
don, such as when running, climbing or jumping, that it
will rupture again.

Surgery

Modern: Tendon Repair (tricky)

Late Reconstruction (severe)

Medieval: Surgical repair usually not available,

and if known at least two levels
higher difficulty.

Futuristic: Hightech Surgical Repair (easy)

Hightech Late Reconstruction (tricky)

Spell: Regrow III

154
Trauma Tables
The trauma tables can be used either during or after com-
bat. If used during combat the first paragraph in italics
paints a creative picture of the damage done as experi-
enced by the combatants. It will often need to be custom-
ised in creative terms by the GM depending on the exact
nature of the attack.

The second paragraph is only revealed upon examina-

tion, 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 ex-
amined 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 charac-
ter 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 Crush Pierce
A weak spray of blood colours the hair Headache inducing blow to the head. The cheek is pierced and there is an
and face before it settles into a trickle open hole into the mouth.
from the slash across the side of the Nasty headache from a mild concussion
head. [105A]. Will heal.
1-2
(1) Hair and face is red from blood running
from a wound to the side of the head.

Quick slash across the side of the head
cuts of half the ear.
A cut across the side of the head has cut
3-4 off half the ear [101A].
(2)
Smashes into the centre of the face, Lucky hit pierces an eye.
breaking the nose and starting a
nosebleed. Pierced eye [102B].
Hit on the nose has broken it causing
much pain and some bleeding.

Hits across the nose, breaking it and
starting a serious nosebleed.
A hit across the nose has broken it and
5-6 started it bleeding. [104A].
(3)
Hard swing to the side of the head is Deep cut across the face.
sure to leave the ears ringing and lobes
throbbing. Nasty scar is likely from this deep facial
wound.
Impact to the side of the head leaves a
cruel headache and dizziness from a mild
concussion [105A].

Teeth are smashed and knocked loose, Hit to the back of the head, cracks the Punctures the neck and releasing a
and the lip cut badly by slash across the skin and leaves a small bleeding wound. spray of blood.
mouth.
Hit to the back of the head causes some The jugular vein is punctured causing
7-8 Several teeth are broken and lost in a bleeding and a concussion [105A] heavy bleeding.
(4) nasty cut across the mouth, splitting the
lips [103AB]. Bleeding (Heavy)

Cuts a gaping gash in the back of the Smack across the eye. Splits the lip and breaks a couple of
head, which bleeds profusely. teeth.
Smack across the eye causes blunt eye
No damage to skull. trauma [102C]. Lip is split and a couple of teeth lost
9 [103AB].
(5) Bleeding (Moderate)

Cuts across the face and eye, splitting Dislocates the jaw and knocks out sever- Punctures the windpipe, causing heavy
the eyeball and drawing blood. al teeth in a stunning blow. wheezing and laboured breathing.

Cut lacerates an eye [102B] and leaves a Jaw is dislocated [108A] and a few teeth Windpipe [110A] is pierced causing
10 scar across the face and eye. lost in the process [103B]. breathing difficulties.
(6)

156
 Head: Nasty Wound
1D10
(1D6) Slash Crush Pierce
Splits the lower lip and knocks out sev- Hit smack bang in the the face, splitting Pierces deep into the neck and with a
eral teeth. the lip and knocking out several teeth. jerk the head seems to be involuntarily
twisted to the left.
Cut lower lip and knocked out teeth Cut lip and teeth knocked out [103AB].
1-2 [103AB]. The accessory nerve is damaged in the
(1) neck causing the head to be involuntarily
twisted to the side [107I].

A spray of blood erupts as the ear is Skull cracking hit to the back of the Leaves a long cut along the side of the
chopped clean off, but settles down to a head. Sent reeling forward, disoriented. head.
steady flow from the deep gash to the
side of the head. Cracked skull [109A]. Nasty meat wound to the side of the
3-4 head.
(2) Ear has been cut clean off [101A] and
there is serious bleeding.

Bleeding (Moderate)
Blood is splattered everywhere from Staggers sideways as a hard hit to the Pierces into the skull in a worrying
ghastly deep cut down the side of the side of the head lands with a satisfying wound.
face and across the ear. crack.
Cranial fracture [109A] and some bleed-
5-6 Skull is fractured [109A] and the inner Fractured skull [109A] and damaged in- ing.
(3) ear damaged [101B]. ner ear causing intracranial bleeding
[100A]. The severity of the impact has
Bleeding (Moderate) caused a concussion [105A].

Cuts into the throat ripping out a large Teeth go flying in jaw breaking blow. Pierces the throat leaving the victim
wound that leaves the victim gasping for Wobbles in a stunned daze but does not gasping painfully for air as a small
air. fall, the disfigured face a ghastly sight. stream trickles down from each breath.

7-8 A sucking sound from the throat and Fractured jaw [108B], entire lower row Windpipe is punctured [110A] and vocal
(4) difficult breathing reveals a deep cut of teeth knocked out on one side [103B]. cord damaged [110B] from a pierced
into the windpipe [110A]. Severe concussion [105A] and danger of throat.
suffocation. Ugly.

Slashes across the face, breaking the
nose, putting out an eye in a bloody
mess.
One eye damaged [102B], broken nose
9 [104A] and bleeding badly.
(5)
Bleeding (Moderate)
Bleeding (Moderate)
Blow across the face breaks the nose and Pierces the cheek. Not too deep but im-
leaves a rapidly swelling eye. Reels back mediately starts bleeding.
from the blow with one eye closed and
the other squinting to see. Facial fracture [109B] which will leave a
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].

Bleeding (Moderate)
A wide, continuous spray of blood is re- Hard hit to the throat leaves the victim Penetrates straight throat the neck,
leased by a quick but deep slash across gasping for air. leaving a sizeable hole. Blood gushes
the neck. forth in great quantities colouring
The windpipe has partially burst [110A] everything blood red.
10 Partially severed carotid artery [106A]. making it hard to breathe and the vocal
(6) cord is damaged [110B]. The carotid artery is pierced [106A].
Bleeding (Heavy)
Bleeding (Heavy)

157
 Head: Grievous Wound
1D10
(1D6)
Slash Crush Pierce
Nasty cut across the back of the head Staggers sideways from the hard hit Pierces and buries itself in the neck.
bleeds hard. across the ear. A small trickle of blood
emits from the ear canal. Damaged vagus nerve [107H].
Deep cut.
1-2 Has damaged the workings of the inner Bleeding (Moderate)
(1) Bleeding (Moderate) ear [101B]. Some bleeding from the ear
but it is not intracranial.

Deep slash down the side of the head, A sharp blow cracks the temple. Takes Hit to the centre of the face, digs into
cuts into the air and causes serious an involuntary step backwards but does the face, through the nose. Ugly.
bleeding. not falter.
Broken nose [104A] and facial fracture
3-4 Fractured skull [109A] has caused Non-depressed skull fracture [109A] has [109B].
(2) trauma to the inner ear [101B] with severed arteries and nerves with serious
blood leaking from the ear canal due to intracranial bleeding [100A]. Bleeding (Moderate)
intracranial bleeding [100A].
Bleeding (Moderate)
Bleeding (Moderate)
Mighty swing cuts into the cheek and Direct hit leaves face in a bit of a mess, Pierces the skull in a spray of blood.
jaw, tearing out teeth and leaving a nose shattered, one eye smacked shut
bleeding cut across the face and broken and rapidly swelling and face strangely
jaw. Spitting blood and teeth. disfigured. A small non-depressed skull fracture
5-6 [109A] and serious bleeding.
(3) Fractured jaw [108B]. Most teeth on one Shattered nose [104B], blunt eye trauma
side are lost or broken [103B]. [102C] and a facial fracture [109B]. Bleeding (Moderate)

Bleeding (Moderate) Bleeding (Moderate)

Cleaves the top of the skull in a cruel
mess of blood, skull and hair.
Skull cracked [109A] in open fracture
7-8 with brain infection risk, minor brain
(4) damage [105B], severe concussion
[105A].
Cold hearted skull breaking blow to the Bullseye, literally.
back of the head.
Eye has been penetrated and destroyed
Depressed cranial fracture [109A] has in the process [102D].
caused minor brain damage [105B] with
frequent nausea, vomiting and dizziness.
An open fracture risk of brain infection.

Bleeding (Moderate)
Deep cut across face lacerates one eye, Sent reeling sideways, stunned by a bru- Pierces the throat, compromising the
breaks the upper part of the nose bone tal blow to the side of the head. ability the breathe. Complicated by sig-
and narrowly misses the other eye leav- nificant bleeding.
ing a badly bleeding gash to the bone Temporal bone fractured [109A] causing
just below it. severe damage to the inner ear [101C]. Damaged esophagus [110C] and dam-
9 Intracranial bleeding [100A] evidenced aged the windpipe [110A] causing suf-
(5) Lacerated eye is permanently blinded by bleeding from the ear. focation.
[102B]. Broken nose [104A] and open
facial fracture [109B], serious bleeding. Bleeding (Moderate) Bleeding (Moderate)

Bleeding (Moderate)
Cuts the throat with blood spilling forth Perfect swing at the larynx lands with Violates the ear canal as it follows the
in generous amounts from the wide devastating force, seemingly crushing path of least resistance into the side of
wound. the pliable throat. Left gasping and the head
gargling for air, pitiful and stunned.
10 Vocal cord severed [110B] and the ca- Severe inner ear trauma [101C], intra-
(6) rotid artery severed [106A]. Suffocating from damaged windpipe cranial bleeding [100A] and minor brain
[110A]. Damaged vocal cord [110B]. damage [105B].
Bleeding (Heavy)

158
 Head: Grim Wound
1D10
(1D6) Slash Crush Pierce
The face is left a bleeding wreck from a Brutal blow breaks and dislocates the Skull is pierced above eye, releasing a
deep cut from the cheek diagonally upper jaw, severing tongue. Knock out. stream of blood as the body sinks to the
across the face. ground.
Unconscious from a broken upper jaw
Fractured cheek bone [109B]. Severe fa- [109B]. The dislocated maxilla bone has Skull fracture [109A]. Concussion
1-2 cial nerve damage [107E]. Unconscious pushed the teeth down and severed the [105]. The damage above the eye will
(1) for 2D10 minutes from concussion tongue [103C]. Serious intracranial lead to pressure blindness [102A].
[105A], followed by problems seeing as bleeding is hidden by the more obvious
for any facial fracture. bleeding from nose and mouth [100A]. Bleeding (Moderate), Unconscious

Bleeding (Moderate), Unconscious Bleeding (Moderate), Unconscious

Cuts an opening in the cranium straight Hit between the eyes lands with a satisfy- Pierces neck with blood surging forth.
to the brain, deflating all will as the ing crack. Sinks into a pile of bones. Tongue out, eyes rolled back falls back-
eyes roll back and the body collapses in wards like a felled tree.
a heap. Disfiguring facial fracture [109B]. The
impact and secondary fracture damage Severed hypoglossal nerve [107J] and
3-4 Depressed open fracture, unconscious has caused blunt eye trauma on one eye carotid artery [106A].
(2) until surgically repaired [109A]. Serious [102C], destroyed the other completely
intracranial bleeding [100A]. [102D]. Broken nose [104A]. The facial Bleeding (Heavy), Unconscious
nerve suffers very severe damage [107E].
Bleeding (Moderate), Unconscious
Bleeding (Moderate), Unconscious
Cuts into the forehead bone, splitting Sent flying by skull cracking hit to the Pierces skin and bone burrowing
open the skull in a spray of blood and side of the head. through the face and into the brain.
pieces of brain. Sinks to the ground as
the face is covered in blood. Massive cranial damage [109A] and res- Facial fracture [109B], minor brain
ulting in severe ear trauma [101C], intra- damage [105B] and intracranial bleed-
5-6 Open skull fracture [109A], major brain cranial bleeding [100A] and minor brain ing [100A].
(3) damage [105B]. Blood loss is bad but at damage [105B].
least most of it is running down the face, Bleeding (Moderate), Unconscious
rather than filling up inside the skull. Bleeding (Moderate), Unconscious

Bleeding (Heavy), Unconscious

Body goes limp from chop across the Heavy strike to the neck and jaw from the Shatters teeth as it penetrates through
neck, leaving deep cut bleeding heavily. side fractures the jaw in a spray of the roof of the mouth, penetrating deep
blood. into the head.
Neck broken, immobilising head and
7-8 causing terrible pain. A jugular vein is Fractures jaw [108B] and cut carotid in Mouth pierced [103A], shattered teeth
(4) severed and the fractured vertebrae [7A] the neck [106A]. [103B], minor brain damage [105C]
threatens spinal cord damage. and intracranial bleeding [100A].
Bleeding (Heavy), Unconscious
Bleeding (Heavy), Unconscious Bleeding (Heavy), Unconscious
Throat cut open, releasing a rush of Hefty hit crushes the forehead, pushing Penetrates through the skull, exiting the
blood. Speechless, breathless and the pieces of cranium into the brain. Grim. head on the other side. Bloody and
quickly running out of blood. gory.
Open skull fracture [109A] with detached
9 Severed windpipe [110A], damaged vo- segments of the cranium causing major Skull is fractured [109A] and brain tis-
(5) cal cord [110B] and esophagus [110C]. brain damage [105C]. Intracranial bleed- sue has suffered major damage [105C].
ing inside the brain [106B].
Bleeding (Heavy), Unconscious Bleeding (Moderate), Unconscious
Bleeding (Moderate), Unconscious
Vicious slash perforates the skull caus- A killing blow crushes the back of the Enters through the eye, penetrating
ing havoc as it cuts through grey matter. head in an explosion of skull and brain deep into the brain. Things fall apart,
matter. the centre cannot hold.
Open skull fracture [109A], major brain
10 damage [105C]. Heavy intracranial Back of head crushed [109A], massive Destroyed eye [102D], massive brain
(6) bleeding from severed carotid inside the brain damage [105D]. Heavy intracranial damage [105D]. Breathing has stopped
brain [106B]. bleeding from severed carotid [106B]. [105E]. Intracranial bleeding [100A].

Bleeding (Heavy), Unconscious Bleeding (Heavy), Pretty Much Dead Bleeding (Heavy), Good as Dead

159
 Head: Mortal Wound
1D10
(1D6)
Slash Crush Pierce
A deep gash is cut across the neck, col- A blow of frightening force shatters the The attack punches through the skull.
lapsing the body like cutting the strings jaw completely. Drops unconscious to Eyes roll back as the opposition faints
on a puppet. the ground like a log. Timber! from the shock.
1-2 The spine is completely severed and the Shattered jaw [108C]. The sheer force of Skull has been penetrated [109A] with
(1) 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

Half the face is sliced open from a long, Direct hit to the larynx ruptures the The cranium cracks and the attack penet-
deep and brutal slash. Starting above windpipe. Wide eyed and on knees, un- rates deep into the brain tissue, in a
the ear, to the neck. able to act, speak, breathe or presum- messy and disturbing display of gore.
ably even live for very much longer.
The facial nerve is totally severed [107E] Penetrating attack has cracked the crani-
3-4 and the fractured temporal bone has Ruptured windpipe [110A], vocal cord um [109A] and caused massive brain
(2) caused severe ear trauma [101C]. Deadly [110B] and esophagus [110C]. Suffocat- damage [105D].
pressure builds from the heavy intracra- ing [100B].
nial bleeding [100A]. Bleeding (Heavy), Unconscious (dead)
Bleeding (Moderate), Shock Incapacitated
Bleeding (Heavy), Unconscious
A swift slash is greeted with a spray of A powerful upwards strike breaks off the Puncturing the skull, the weapon comes
blood as it opens the throat. nose and pushes it into the brain. away covered in brain and blood. The
legs fail to support the body, which col-
Severed windpipe [110A], vocal cord The broken nose [104A] is pushed into lapses in a heap.
5-6 [110B], esophagus [110C] and carotid the brain causing massive brain damage
(3) arteries [106A]. Life is short. [105D]. Attack penetrated through skull [109A]
causing major brain damage [105C] and
Bleeding (Heavy), Unconscious Bleeding (Moderate), Dead intracranial bleeding [100A].

Bleeding (Heavy), Unconscious

The skull is hacked in two and the brain The side of the skull crumbles from the Attack goes through ear and retracts
compromised by the blade. Collapses force of the impact, exposing soft brain with a squirt of blood. Collapses.
like a sack of potatoes in a terrible mess. tissue. Collapses, blood streaming from
the wound. Severe damage to the inner ear [101C] as
7-8 Coma [10], major brain damage [105C] well as major brain damage [105D] and
(4) and breathing stop [105E] are the very Skull crushed [109A]. Massive brain intracranial bleeding [100A]
deadly results. damage [105D] and coma [10].
Bleeding (Moderate), Unconscious
Bleeding (Massive), Dead Bleeding (Heavy), Coma
Skull is opened like an egg and the con- In a sickening sight, the face caves in Hit between the eyes goes through the
tents spilled on the ground. Messy. from the sheer force of the blow. Now ut- skull creating a peep hole to the soul.
terly unrecognisable. Crashing to the ground, blood pouring.
Massive brain damage resulting in death
9 [105D]. Massive brain damage resulting in death Hit between eyes has penetrated the skull
(5) [105D]. and caused massive brain damage [101D]
Bleeding (Massive), Dead and death.
Bleeding (Massive), Dead
Bleeding (Heavy). Dead
The neck is severed, separating the head Unable to halt or slow the impact, the Entering one ear and exiting the other
from the body in a fatal parting. A foun- skull explodes in a rain of brain and covered in brain tissue, the body remains
tain of blood erupts to celebrate. bone fragments. standing for a second before falling for-
ward.
10 Neck severed with a great deal of blood No brain, no pain.
(6) spillage [100C]. Both ears are pierced [101C] with
Bleeding (Massive), Incredibly Dead massive brain damage [105D] and
Bleeding (Massive), Utterly Dead breathing stop [105E].

Bleeding (Massive), Dead

160
 Chest: Superficial Wound
1D10
(1D6)
Slash Crush Pierce
Painful cut across the chest. Hard blow to the chest will leave a col- Painful but shallow cut.
ourful and painful bruise.

1-2
(1)

A long, but not deep cut. Strong impact leaves chest black-and- Deep cut has damaged some muscle but
blue. there's little bleeding.

3-4
(2)

Bleeding slash across the chest. A good hit to the chest, but nothing wants Bleeding cut.
to break.
Bleeding (Moderate)
Painful, sore and bruised chest but noth-
5-6 ing broken.
(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 Excellent crushing blow definitely broke Nasty hole in the chest releases a stream
half a step backwards. something. of blood that doesn't stop.

Impact has fractured a rib [207A]. Three ribs are broken causing quite a bit No serious internal damage, but bleeding.
9 of pain and discomfort [207A].
(5) Bleeding (Moderate)

A deep gash reveals a fractured rib. 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.
Exposed fractured rib risks infection Whips back in obvious agony.
[207B]. Chest cavity is penetrated causing a
10 Bad hit to the spine has fractured a ver- small sucking chest wound [204A]. Evid-
(6) Bleeding (Moderate) tebrae [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 Crush Pierce
Hard impacting slash cracks a rib and Hard blow to the chest breaks a rib. The chest is pierced leaving a deep
draws some blood. wound.
Broken rib [207A].
Broken rib [207A]. No immediate symptoms, but as lung tis-
1-2 sue is soaked with blood and fluids from
(1) burst microvascular vessels, symptoms of
pulmonary contusion [211] will start to
appear in the next 2D10 hours

A long cut across the entire chest covers Hard impact to the chest gives a satisfy- A nasty meat wound in the chest.
the blade in blood. Blood immediately ing crack.
gushes forth from the cut. Grits teeth in Painful chest wound.
pain. Several ribs have been broken by the im-
3-4 pact [207A].
(2) Bleeding (Moderate)

Deep chest gash immediately soaks The chest is punched in, breaking several Deep chest wound.
clothing in blood. ribs and forcing their sharp edges
through the skin. A grotesque wound Bleeding (Moderate)
Bleeding (Moderate) [207B] with exposed ribs and bleeding.
5-6
(3) Compound rib fracture [207B].

A long diagonal cut spews forth a wor- The chest gives way to the blow. Sent Chest is punctured causing a steady
rying amount of blood. staggering backwards. trickle of blood.

Bleeding (Moderate) Multiple fractures in the ribcage resulting Muscles and blood vessels are damaged
7-8 in flail chest [207E]. causing serious bleeding.
(4)
Bleeding (Moderate)

Nasty, deep cut is stopped by the rib- Twisting to avoid the impact, the blow Deep puncture on the left side of the
cage. Blood gushes from the chest. lands heavily between the shoulder chest causes a trickle of blood.
blades, forcing a gasp of pain.
Compound rib fracture [207B]. One lung is punctured with shortness of
9 Heavy blow to the spine ruptures liga- breath and stabbing pains in the chest
(5) Bleeding (Moderate) ments [7C]. Difficulty moving and pain [204B].
in the back and legs when doing so, evid-
encing the risk to the spinal cord.

Disgusting wide and deep cut does hor- Hard impact to the centre of the chest The attack penetrates deep into the chest
rific damage to the chest muscles and makes a satisfying crack. cavity and comes out covered in blood.
severs enough veins and arteries to
cause a torrent of blood. Several ribs are fractured by the heavy Aorta torn causing heavy internal bleed-
10 blow [207A] but more serious is the fact ing [201A] with few immediate signs of
(6) Bleeding (Heavy) that the heart has been bruised causing the tragedy taking place.
myocardial contusion felt as an uneven
heartbeat. [202A]. Bleeding (Heavy)

162
 Chest: Grievous Wound
1D10
(1D6) Slash Crush Pierce
The chest is slashed open and ribs The strike to the chest lands hard leaving The chest is pierced, leaving a nasty ,
broken in a bloody gash. no doubt to the damage done. bloody wound.
1-2 Large open gash reveals two fractured Rib is broken [207A] and has pierced the Serious internal bleeding [2A] resulting in
(1) ribs [207B]. 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
blood. ping sound as it crashes squarely into muscle tissues, creating a vulgar, bloody
the chest. mess.
Chest cavity breached resulting in a
Multiple rib fractures result in flail chest Arteries and veins have been severed
3-4 sucking chest wound [204A].
[207E]. Harder to detect, the impact and causing heavy internal bleeding [2A].
(2) Bleeding (Moderate) sharp ends of the broken ribs have
caused significant internal bleeding [2A], Bleeding (Heavy)
a hemothorax is building up [204C].
Bleeding (Moderate)
The cut goes deep into the right side of Severe hit to the back. Brought to knees. The chest is breached in a spray of blood
the chest, the weapon covered in 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 para-
5-6 vessels of a lung to burst leading to pul- lysis from severed spinal cord [7D], on Nasty wound has done significant damage
(3) monary contusion [211] as well as intern- 41 - 50 partially severed cord [7E] with to muscle tissue, but apart from the blood
al bleeding [2A]. severe pain, swelling and reduced ability loss nothing life threatening or too per-
to move. manent is damaged.
Bleeding (Moderate)
Bleeding (Moderate)
The slash travels down the back, cutting The hefty blow lands with such force that A deep puncture tears a hole in the chest
deep causing wide eyed and deep agony. it crushes the ribcage. Reels back several which immediately starts bleeding.
steps from the great force of the impact.
Spine ligaments have been cut [7C]. Air enters the pericardial cavity. Unable
to leave, the building air pressure increas-
7-8 Moving arms and legs is difficult, painful Several ribs have splintered into frag-
ingly constricts the heart in a classic
and poses a risk to the spinal cord. ments [207C]. The damage to underlying
(4) tissues causing internal bleeding [2A] pneumopericardium [202E]. For shock
Bleeding (Moderate) and pulmonary contusion [211]. purposes treat the air build up as a cardiac
tamponade of moderate bleeding.
Bleeding (Moderate). Bleeding (Moderate)
The mighty cut slices through the chest The heavy blow crushes the chest leaving The attack punches a large hole in the
with little resistance ending deep inside a grotesque sight of sharp edged, broken chest, blood streaming freely from the
the chest and leaving a long slash. Blood ribs protruding through the skin. wound.
erupts forth in a steady stream colouring
Exposed, protruding broken ribs [207B].
9 everything red.
More immediately fatal is the cardiac
Tiny bubbles can be seen in the blood
running from a large hole in the chest.
(5) No damage to internal organs but does tamponade [202D] which is forming Evidence of a sucking chest wound
cut deep enough to cause heavy blood from the internal bleeding [2A]. [204A].
loss.
Bleeding (Moderate)
Bleeding (Heavy) Bleeding (Moderate)
A neat incision cuts a narrow but deep Direct hit to middle of the chest yields a The attack penetrates into the chest cavity
slit from which thick blood wells forth in satisfying crack as the ribcage gives to a disturbing depth. Takes a step back
copious amounts. way. Forced down on one knee. in shock and pain.

Short, deep gash bleeds profusely as the The sharp edge of one of several broken Heavy internal bleeding [2A] is causing a
10 aorta artery has been damaged [201A]. ribs [207A] is pointed straight at and cardiac tamponade to quickly build up
already touching the heart. Any further [202D].
(6) Bleeding (Heavy) chest impacts or strenuous physical effort
will pierce the heart [202B], unless sur- Bleeding (Heavy)
gery is performed to repair the broken
rib.
Bleeding (Moderate)

163
 Chest: Grim Wound
1D10
(1D6) Slash Crush Pierce
The chest is slashed open in a rush of The blow lands hard on the upper back. The attack is driven deep into the upper,
blood, fracturing and exposing the ribs The violence of the attack forces the right side of the chest. Spitting blood,
shoulder out of position. Knocked down eyes roll back and smashes into the
Several ribs fractured and exposed by the and dazed. ground.
1-2 open wound [207B]. More serious, the
(1) heart has been bruised causing myocardi- The scapula has been forced out of posi- Deep, penetration has lacerated the major
al contusion felt as a very rapid heartbeat tion. Tearing muscles, blood vessels and bronchus leading to suffocation [210] and
[202A]. nerves. The result, flail shoulder [208B]. death within minutes.

Bleeding (Moderate), Unconscious Bleeding (Moderate) Dazed Bleeding (Moderate), Unconscious

Thick, red blood gushes forth as the cruel Brutal attack crashes into the chest, Punches hole in chest that starts bleed-
cut slashes deep into the chest. Drops to cracking the rib cage. Drops like a sack ing. Drops to knees, gasping for breath.
knees dazed. of potatoes.
Shortness of breath and gradually turns
3-4 Deep cut has breached the chest cavity Several ribs broken [207A], one has blue, together with the tell tale sucking
(2) resulting in a sucking chest wound pierced a lung and resulted in a punc- sound, it all point to the rather large suck-
[204A]. Bleeding is bad. tured lung [204B]. Gradually the face ing chest wound [204A].
swells from traumatic asphyxia [209]
Bleeding (Heavy), Dazed Bleeding (Moderate), Unconscious Bleeding (Moderate), Dazed
The blade goes deep inside the chest and Brutal hit breaks the breastbone with a The attack pierces the chest and burrows
retracts with thick blood and flesh. loud snap. Thrown backwards, landing deep inside the chest cavity. Immediately
Drops unconscious to the ground. in a heap. a stream of blood erupts from the wound,
drenching everything in thick, deep red
5-6 Breathing will get harder and harder as Broken breastbone [206A] and bruised blood. Collapses.
(3) blood collects between the chest wall and heart [202A], with the associated risk of
lung compressing the lung and puts pres- a cardiac tamponade. Internal bleeding Arteries and the esophagus has been dam-
sure on the heart, hemothorax [204C]. [2A]. aged [203A].

Bleeding (Moderate), Unconscious Bleeding (Moderate), Unconscious Bleeding (Heavy), 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.
7-8 Microvascular vessels in the lung have
been lacerated by broken rib ends
(4) [207B]. Build up of blood and fluids in
lung tissue will lead to pulmonary contu-
sion [211] in 2D10 hours.
Bleeding (Moderate), Unconscious
Cut slashes across chest, severing ribs
and cutting deep. Blood gushes forth.
The blow lands with devastating force on The attack pierces deep into the back,
the spine. Knocked down, face first and between the shoulder blades. Immediately
still. collapses.
Hit to the back has fractured the spine A vertebrae has been fractured [7A], with
[7A]. Roll 1D100, on 1 - 40 paralysis the associated risk of spinal cord damage.
from severed spinal cord [7D], on 41 - 60 Roll 1D100, on 1 - 40 paralysis from
partially severed cord [7E] with severe severed spinal cord [7D], on 41 - 60 par-
pain, swelling and reduced ability to tially severed cord [7E] with severe pain,
move. swelling and reduced ability to move.
Unconscious Bleeding (Moderate), Unconscious
Square chest impact crushes the ribcage. Pierces chest straight to heart. Coughs
Vomits blood and stoops forward. blood and faints.

Several ribs are fractured [207A] and the Part of the ribcage fragmented [207C] The heart has been pierced [202B] caus-
9 deep cut bleeds heavily as the aorta artery pieces of which penetrated the heart ing internal bleeding [2A] and quite likely
(5) has been damaged [201A]. [202B]. Internal bleeding [2A] and im- impending death.
minent death from the penetrated heart.
Bleeding (Heavy) Bleeding (Heavy), Unconscious
Bleeding (Heavy), Unconscious
Cuts straight into the centre of the chest. The brutal force of the impact rams the Cruel attack penetrates deep into the
A geyser of blood erupts. Falls like a log. ribcage into the chest with a great crack. chest. Splutters blood and tips forward.
Reels back spewing blood.
10 Cut deep into the chest fractured ribs Main aorta ruptured where it connects to
(6) [207B] and ruptured the aorta artery Cracked ribcage [207A] severed aorta heart [201B]. Massive amounts of blood
[201B] causing massive bleeding [2A]. [201B], massive internal bleeding [2A]. is pumped into the chest cavity [2A].

Bleeding (Massive), Unconscious Bleeding (Massive), Unconscious Bleeding (Massive), Unconscious

164
 Chest: Mortal Wound
1D10
(1D6) Slash Crush Pierce
Cuts a deep wedge into the shoulder, Hurled backwards into a heap by smash Stab through the chest just below the
bleeding profusely. Legs fail, eyes roll hit to the heart of the chest. throat leaves the victim gasping, wide
back and collapses. eyed and oblivious.
The heart has stopped from a hard hit
1-2 Significant tissue damage to shoulder, during the most vulnerable part of its A lacerated windpipe causes suffocation
(1) large veins severed and arm is useless cycle. Death from commotio cordis [205A]. Internal bleeding from serious
due to a shoulder fracture [208A]. [202F]. Ribcage fragmented [207C] and damage to surrounding tissues [2A].
internal bleeding [2A].
Bleeding (Heavy), Unconscious Bleeding (Moderate), Dazed
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].
3-4 Multiple rib fractures has resulted in a Dislocated vertebrae in the spine [7B]. Bleeding (Moderate)
(2) flail chest [207E] and hemothorax [204C] Spinal cord damage is likely. Internal
from the internal bleeding [2A]. bleeding [2A].

Bleeding (Heavy), Unconscious Bleeding (Moderate), Dazed

Bloody cut along the side of the chest The breastbone cracks audibly from the Attack penetrates disturbingly deep into
leaves a large open wound, with blood crushing blow, visibly pushing the rib- the chest cavity between the lung and the
rushing forth to soak clothing. Collapses. cage back. Knocked back unconscious. heart. Collapses like a deflated doll.

5-6 Severed several ribs [207B] and resulted Fractured breastbone in multiple loca- A hemothorax is fast making breathing
(3) in a sucking chest wound [204A]. Blood tions [206B]. Heart bruised [202A], in- harder as heavy internal bleeding [2A]
loss is heavy. ternal bleeding [2A] and punctured lung between the lungs and chest wall com-
with tension pneumothorax [204B]. presses the lungs [204C].
Bleeding (Heavy), Unconscious
Bleeding (Moderate), Unconscious Bleeding (Heavy), Unconscious
Deep cut leaves severed ribs protruding Massive blow crushes the chest. Coughs Penetrates deep into the chest. Hands
and quickly covered in a stream of blood. blood before eyes roll back, legs turn to grab feebly at the violation before going
jelly and sinks into a pile of bones. limp and falls backward.
Open rib fracture [207B]. Deep gash
7-8 bleeds badly from ruptured aorta artery Fractured breastbone [206A] forced Heavy internal bleeding [2A] and a cardi-
(4) [201B], massive internal bleeding [2A]. through the heart [202B]. Internal bleed- ac tamponade [202D].
ing [2A].
Bleeding (Heavy), Unconscious
Bleeding (Massive), Dazed Bleeding (Massive), Unconscious
Heartless cut slices open chest. Gasps for Perfect hit between the shoulder blades Blood rushes out in a massive, red
air, eyes wide in shock and collapses in sounds like it shatters the spine. Evid- stream through the large new hole in the
agony. ence supported by the sudden collapse. chest. Everything is covered with blood.

9 Deep cut has punctured and caused Spine shattered beyond repair, spinal Blood rushes out of a large hole in the
(5) massive damage to both lungs as well as cord completely severed [7D]. chest providing a window straight to the
surrounding tissues. Unable to breathe, ruptured main aorta artery [201B].
suffocation [100B] is guaranteed. Unconscious
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].
10 Chest is slashed open and heart split in Shattered ribs [207D] and heart [202G]. Last desperate heart contractions only
(6) 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 Crush Pierce
Painful and bleeding cut. Juicy, direct hit to the stomach. A grazing strike that leaves a nasty slash,
but no deep wound.
Blow to the stomach will leave a mark
for a while but nothing serious.
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. Penetrates to the side of the stomach with
some blood trickling from the wound.
Painful to touch for some time and huge
bruise.
5-6
(3)

Deep cut bleeds hard. Heavy hit sends reverberations through- Punctures the stomach in a bloody
out the belly. wound.
Bleeding (Moderate)
Painful, discoloured bruise is the only Scary hole in abdomen, but has not
7-8 lasting long term effect. caused any internal damage.
(4)

Horrendous cut across the belly parts the Hard hit immediately starts to turn red. Does not pierce too deep, but the cut is
skin revealing muscle and large amounts long and bleeds badly.
of blood. Some internal bleeding [2A].
Serious wound with serious bleeding.
9 Messy and bloody wound that looks Bleeding (Moderate)
(5) worse than it is. Bleeding (Moderate)

Bleeding (Moderate)

Worryingly deep stomach wound bleeds Satisfying blow to the belly knocks the Deep puncture releases a spray of blood.
liberally wind out of the lungs.
Attack has pierced the abdominal lining
Perforated abdominal lining. Although no The impact has caused serious internal which means that any infection risks peri-
10 internal organs were damaged there is a bleeding [2A]. tonitis [300A]. Lots of blood.
(6) lot of bleeding and any infection may
lead to peritonitis [300A]. Bleeding (Moderate) Bleeding (Moderate)

Bleeding (Moderate)

166
 Abdomen: Nasty Wound
1D10
(1D6)
Slash Crush Pierce
Vicious cut leaves a bleeding slash Heavy hit to the solar plexus. Blood rushes forth in a tiny stream from
across the abdomen. the puncture to the lower abdomen.
Heavy hit to the solar plexus has caused
Cut looks worse than it is. a lot of pain, but apart from a sore and The small intestine is pierced causing
1-2 bruised belly there are no long term im- food and bacteria to contaminate the ab-
(1) Bleeding (Moderate) plications. dominal cavity [303A].

Bleeding (Moderate)

Blood but no guts are spilled. Shockingly hard blow to the belly. Nasty deep and bloody cut, bleeds over
everything.
Bleeding (Moderate) Some internal bleeding [2A].
Nasty deep cut bleeds a lot but otherwise
3-4 Bleeding (Moderate) not too bad.
(2)
Bleeding (Moderate)

Rough stomach slash sprays forth blood. The agony caused by the hard hit to the Stab to the lower back, bleeds.
abdomen is obvious from gritted teeth.
Lots of blood. One kidney is grazed by the penetrating
Dangerous internal bleeding [2A]. trauma causing some back pain [305B].
5-6 Bleeding (Moderate)
(3) Bleeding (Moderate) Bleeding (Moderate)

Long slash across the belly releases a
burst of blood that immediately steadies
into a steady trickle.
7-8 Cut bleeds hard.
(4)
Bleeding (Moderate)
Very deep cut to the lower abdomen re-
leases a small stream of blood. Messy.
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
not falter. the belly button in a steady trickle.
Kidney is bruised causing back pain and Despite the hole no internal organs were
hardly detectable blood in the urine damaged.
[305B]. Some internal bleeding [2A].
Bleeding (Moderate)
Bleeding (Moderate)
Blow to the middle of the back hits dir- Nasty penetrating wound immediately
ectly over the spine. starts bleeding.

The colon is perforated [303A] causing Heavy blow to the spine ruptures liga- Has pierced the peritoneum [300A] but
9 digested food and bacteria to mix with in- ments [7C]. Difficulty moving and pain otherwise caused no life threatening in-
(5) ternal bleeding [2A]. in the back and legs when doing so evid- ternal damage.
encing the risk to the spinal cord.
Bleeding (Moderate) Bleeding (Moderate)

Cuts deep into the upper abdomen where Doubles over from hard hit to the stom- Deep puncture immediately starts to
the stomach is situated, releasing a ach, but recovers immediately. bleed.
steady trickle of blood.
Spleen is damaged by the heavy impact The spleen is perforated [309A]. Internal
10 Punctures the stomach allowing food and causing internal bleeding [309A]. bleeding from the organ is significant.
(6) bacteria into the normally sterile environ-
ment of the abdominal cavity [302A]. Bleeding (Moderate) Bleeding (Moderate)

Bleeding (Moderate)

167
 Abdomen: Grievous Wound
1D10
(1D6)
Slash Crush Pierce
A glistening blood-red slash across the Forceful uppercut lands hard. A deep stab to the side.
belly immediately starts to bleed
Caught between the force of the blow Only some visible blood loss with most
Wound bleeds a lot but no other serious and a rib the spleen has been torn result- of it being internal [2A].
1-2 internal damage. ing in serious internal bleeding [309A].
(1) Bleeding (Moderate)
Bleeding (Moderate) Bleeding (Moderate)

As the abdomen is pierced by the deep The blow lands with an audible crack as The belly is punctured deep.
cut, deep red blood gushes forth in a it crashes into the pelvis.
steady stream. Penetrating trauma has lacerated the liver
The stable pelvis bone fracture [311A] after bypassing ribs and piercing the sur-
3-4 Abdomen is pierced by deep cut which does not prevent standing or running, but rounding tissues [306A]. Luckily the
(2) starts the spleen bleeding [309A]. does cause an awkward gait. The damage damage is not great but there is internal
has led to internal bleeding [2A]. bleeding from the liver [2A].
Bleeding (Moderate)
Bleeding (Moderate) Bleeding (Moderate)
The belly is pierced by the deep cut and Hard hit to the lower back. Pierces the lower back, just missing the
for a second it seems to hesitate. Then a spine. Gasps in pain.
surge of deep red blood pours forth in a Hard hit to the spine has dislocated a ver-
mighty river of blood. tebrae [7B]. Severe pain, swelling and re- Direct hit to one kidney [305C] has per-
5-6 duced ability to move and great danger of manently damaged its function and
(3) The liver has been cut causing heavy serious spinal cord damage. causes moderate internal bleeding [2A].
bleeding [306A].
Bleeding (Moderate)
Bleeding (Heavy)
Swift cut to the back causes a stumble, Heavy hit to the stomach is greeted with Deep stab right in the middle of the belly
and crash to the ground, following by a grunt and wheeze. Struggling to regain draws blood.
agonised squirming. breathing.
Although bleeding is serious and the
7-8 Spine ligaments have been cut [7C]. The impact has damaged the spleen peritoneum has been pierced no internal
(4) Moving arms and legs is difficult, painful [309A] causing internal bleeding [2A]. organs suffered serious damage. Not seri-
and poses a risk to the spinal cord. The bleeding and damage is significant ous as long as an infection does not de-
but survivable. velop into peritonitis [300A].
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
9 Cut has punctured the stomach, allowing sharp end lacerates the liver [306A]. food and bacteria into the normally
(5) 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 caus-
10 causing heavy internal bleeding [301A]. The renal artery has been ruptured from ing heavy internal bleeding [301A].
(6) the impact causing heavy internal bleed-
Bleeding (Heavy) ing [305E]. Bleeding (Heavy)

Bleeding (Heavy)

168
 Abdomen: Grim Wound
1D10
(1D6)
Slash Crush Pierce
A slash across the stomach exposes the A crushing hit to the pelvis forces a fal- A bloody wound is cut deep into the stom-
intestines in a mess of blood and gut. tering step and collapse. ach. The legs falter and no arms reach
out to stop the fall.
Nasty cut across the abdomen has cut The impact has created an unstable pel-
1-2 into the intestines [303B] causing havoc vis fracture [311C]. Unable to stand until Deep trauma has damaged the pancreas
(1) and bleeding [2A]. immobilised. If woman uterus also in- [308A], caused internal bleeding [2A] and
jured [313A]. If man scrotum also par- a large tear in the diaphragm [315B].
Bleeding (Moderate), Dazed tially hit [313D]. Internal bleeding [2A].
Bleeding (Moderate), Unconscious
Bleeding (Moderate), Dazed
A long slash across the upper abdomen Doubles up from a severe blow to the Punctures the belly in a spray of blood,
slices deep. Collapses. stomach and crashes, face first, with the leaving a nasty, fleshy wound and uncon-
ground. scious body.
The pancreas is damaged [308A] and
3-4 there is a lot of bleeding from a very long The liver is lacerated [306A] and the The kidney has been pierced and des-
(2) and deep slash across the upper abdo- pancreas damaged [308A]. There is in- troyed [305D] causing massive internal
men. ternal bleeding from the liver [2A]. bleeding [2A].

Bleeding (Moderate), Unconscious Bleeding (Moderate), Unconscious Bleeding (Massive), Unconscious

Deep slash opens the stomach in a A thrashing blow to the pelvis lands with Pierces the abdomen deeply, but only a
ghastly wound. Gasps in pain, dazed. the sharp snapping sound of bone, small wound with light bleeding. Deflated
knocking life out of legs and limbs. and unconscious.
The stomach has been cut open emptying
all its contents into the abdominal cavity A complicated unstable pelvis fracture Direct hit to the spleen is causing heavy
5-6 [302B]. [311D] has done serious internal dam- internal bleeding with a deceptively small
(3) age. There is at least some internal bleed- amount visibly bleeding from the wound
Bleeding (Moderate), Dazed ing [2A] and if the major artery has been [309B].
cut it will be massive.
Bleeding (Heavy), Unconscious
Bleeding (Moderate), Unconscious
A short but very deep cut draws forth a Vanquished by a heavy blow to the back, Burrows right into the spine in what
rush of blood, quickly soaking clothes as the body goes limp and drops like a could have been a poorly attempted spin-
with blood and forming a pool around rock. al tap.
the collapsed body.
7-8 Hit to the lower back has fractured the A vertebrae has been fractured in the
(4) The liver has been badly lacerated caus- spine with the associated risk of spinal spine with the associated risk of spinal
ing heavy bleeding [306A]. cord damage [7A]. cord damage [7A].

Bleeding (Heavy), Unconscious Unconscious Bleeding (Moderate), Dazed

The bowels are eviscerated in a nasty, The abdomen takes some serious punish- Cuts through skin and muscle to penet-
wide cut across the belly. Blood and guts ment from direct hit to the stomach that rate deep into the abdomen and protrud-
spill out. Gutted! knocks the lights out. ing out the back. Knocked out.
9 The intestines are damaged and spill out The impact has ruptured the aorta artery The liver is lacerated [306A] and the pan-
(5) unless 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

The cut is buried deep in the gut opening The abdomen is massacred by a smash Skewered by penetrating trauma as blood
a nauseating wound. The legs crumple hit causing vomit to spew forth before pours forth from both ends of the wound.
and a pool of blood start growing sinking to the ground. Faints.
around the body.
10 The spleen has been ruptured by the The trauma has ruptured the aorta artery
(6) Deep cut has sliced open the liver caus- heavy impact causing massive internal [301B] and damaged the intestines
ing massive bleeding [306B]. bleeding [309C]. The diaphragm also [303B].
suffered a small tear [315A].
Bleeding (Massive), Unconscious Bleeding (Massive), Unconscious
Bleeding (Massive), Unconscious
169
 Abdomen: Mortal Wound
1D10
(1D6)
Slash Crush Pierce
The stomach is perforated in a spray of Sent reeling by a walloping hit to the Blood squirts from the wound as the
blood. Eyes roll back. Body sinks to the stomach. stomach is pierced deep. Sinks to the
ground. ground dazed and oblivious.
The spleen has been ruptured by the
1-2 The stomach has been perforated [302A] heavy impact causing heavy internal The stomach is pierced, the ruptured sack
(1) and a lot of damage leading to life threat- bleeding [309C]. emptying its contents in the usually
ening blood loss. sterile cavity in the abdomen [302B].
Bleeding (Heavy), Unconscious
Bleeding (Heavy), Unconscious Bleeding (Moderate), Dazed
Deep cut devastates the intestines and Heavy blow to the back seems to crack A deep puncture in the abdomen emits a
leaves blood pouring forth in ample the spine. Sent hurling to the ground, jet of dark, red blood. Sinks to the
amounts. Falls to the ground. face first. ground as the pouring blood drenches
clothes and stars gathering in a pool.
3-4 Devastated intestines [303B] with heavy Heavy blow to the back has dislocated
(2) bleeding. vertebrae in the spine [7B]. Spinal cord The liver has been ruptured causing
damage is likely. Internal bleeding [2A]. massive internal bleeding [306B].
Bleeding (Heavy), Unconscious
Bleeding (Moderate), Unconscious Bleeding (Massive), Unconscious
Slash leaves a deep and bloody lacera- Hefty blow to the belly knocks out both Nasty, bleeding stab wound. Doubles
tion across the abdomen. Collapses. wind and dinner. Sinks unconscious to over and collapses.
the ground in a mess.
Intestines [303A] and liver [306A] have The pancreas has been ruptured in a
5-6 been lacerated causing heavy internal Both the pancreas [308B] and the stom- rather nasty stab wound [308B].
(3) bleeding. ach [302B] has ruptured. Significant in-
ternal bleeding as well. Bleeding (Moderate), Unconscious
Bleeding (Heavy), Unconscious
Bleeding (Moderate), Unconscious
Goes limp and crumples to the ground Crumples and topples over from a hard, The abdomen is deeply pierced emitting
from mortally deep cut into the stomach. rib shattering blow to the upper abdo- an instant stream of deep, red blood.
men. Knees buckle and give in.
Deep cut has sliced open the liver caus-
ing massive internal bleeding [306B]. A hard blow has fragmented the ribs Having been punctured the spleen is los-
7-8 [207C] and ruptured the liver [306B]. ing a lot of blood [309C].
(4) Bleeding (Massive), Unconscious The force of the impact has also torn the
diaphragm [315B]. The internal bleeding Bleeding (Heavy), Unconscious
from the liver is severe.

Bleeding (Massive), Unconscious

Deep and wide slash opens the stomach Crushing impact shatters spine in lower The guts are punctured in a deep, prob-
in a spray of blood. The legs buckle, but back. Collapses vanquished and useless. ing stab to the lower abdomen. Doubles
the blood keeps coming. over with a gasp and ends up on the
Shattered spine beyond repair and com- back, hands clasping the wound, dazed.
9 Damaged intestines [303A], split open pletely severed spinal cord [7D]. Has
(5) the stomach [302B] and most seriously also done severe damage to both kidneys Serious intestinal damage [303B] and
cut into the spleen causing massive in- resulting in acute kidney failure [305A]. rupturing the bladder [312A]. Heavy in-
ternal bleeding [309C]. ternal bleeding [2A].
Unconscious
Bleeding (Massive), Unconscious Bleeding (Heavy), Dazed
Disembowelling cut splits the belly wide The devastating high force impact col- The stomach is rudely ruptured and torn.
open. Entrails spill to the ground along lapses the pelvis, crushing bone which Falls headlong to the ground as blood
with stomach contents. Blood is every- pierces the skin in a bloody, gruesome starts streaming from the cruel wound.
where as the body sinks to the ground. mess. Sent spinning to the ground.
10 Massive internal damage. Liver ruptured
(6) Intestines disembowelled [303B]. Stom- Shattered pelvis [311E] and ruptured [306B], stomach punctured [302B] and
ach ruptured [302B], pancreas [308A] bladder [312] and main aorta artery pancreas badly cut [308B]. Bleeding is
and liver [306A] are both damaged. [301B]. massive, mostly from the liver.

Bleeding (Massive), Unconscious Bleeding (Massive), Unconscious Bleeding (Massive), Unconscious

170
 Arm: Superficial Wound
1D10
(1D6) Slash Crush Pierce
Nasty slash down the arm. Impact leaves the arm banged up, but not Small puncture in lower arm with some
broken. very light bleeding.
Nasty cut but it will heal.
Will be sore and bruised but otherwise Wound hardly even bleeds and will heal
1-2 will heal fine. without trouble.
(1)

Deep, bleeding cut along the upper arm. Flinches from the pain but the arm re- Pierces the upper arm in a small spray
mains largely intact. of blood that immediately settles down to
Deep cut but no lasting damage. a little stream.
More painful than anything.
3-4 Some bleeding from the rather deep
(2) wound.

Long cut up along the arm immediately Heavy blow lands on the upper arm caus- Cuts through muscles in the upper arm
starts bleeding. ing a gasp of pain. leaving a deep, bleeding laceration.

No permanent damage. Nothing is broken, although the pain Muscles are pierced but will heal per-
5-6 could make you think so. fectly.
(3)

Winces from the pain of a serious, bleed- Hits the upper arm hard leaving a dark- Nasty, large, bleeding wound is cut in
ing cut along the lower arm. ening bruise. the arm.

Painful and serious cut, but nothing that A large black and blue bruise on the arm A large red wound that looks much
7-8 wont heal is hurt. is a certainty but it will heal completely. worse than it is.
(4)
Bleeding (Moderate)

Blood spurts from a rather deep slash Crushing blow to the lower arm lands A deep wound in the upper arm which
along the length of the arm. satisfyingly with a crack. bleeds significantly running down the
length of the arm and dripping from the
Deep cut has severed a large vein. The radius bone in the lower arm has fingers.
9 been fractured [1A].
(5) Bleeding (Moderate) Bleeding is significant from the small but
deep wound.

Bleeding (Moderate)
A nasty gash in the arm leaks a lot of Crashes into the lower arm with a loud Wrist is pierced and blood pulsates forth
blood that drips and streams, covering snap. running down the hand and dripping
everything in blood. from the fingers.
The impact has fractured the ulna bone in
10 Nothing beyond the obvious bleeding. the lower arm [1A]. A severed artery is losing a lot of blood.
(6)
Bleeding (Moderate) Bleeding (Moderate)

171
 Arm: Nasty Wound
1D10
(1D6)
Slash Crush Pierce
Evil bleeding cut. Hard hit to the upper arm. Nasty, bleeding wound to the arm.

Evil cut that bleeds a lot. Muscles are bruised badly but no perman- Nasty wound has done very little serious
ent damage. damage.
1-2 Bleeding (Moderate)
(1) Bleeding (Moderate)

Quick slash severs a finger from the Nice hit to the lower arm seems to snap a Ugly cut has the forearm is pierced.
hand. bone.
Ugly cut narrowly misses arteries but
Severed finger [403D]. The radius bone in the lower arm has does damage the ulnar nerve [404C].
3-4 been fractured [1A].
(2)

A long cut is made that starts bleeding Direct hit to the upper arm impacts with A spray of blood is followed by a pulsat-
quite a lot. a satisfying crack. ing stream of blood as the forearm is
punctured. Blood pours forth covering
Length of cut causes moderate blood The humerus bone of the upper arm has everything.
5-6 loss. been partially fractured by the heavy im-
(3) pact [1A]. The radial artery has been punctured, the
Bleeding (Moderate) heavy bleeding [401C].

Bleeding (Heavy)
The forearm is cut deeply and blood Heavy, downward swing to the lower arm The forearm is pierced and bleeding.
streams forth running down to the hand seems to snap something.
and dripping from the fingers. Punctured ulnar artery [401C].
The impact has fractured the ulna bone in
7-8 The ulnar artery has been cut [401C]. the lower arm [1A] damaging the ulnar Bleeding (Moderate)
(4) nerve in the process [404C].
Bleeding (Moderate)

A deep, bleeding laceration is cut into Hard hit to the forearm, leaves a rapidly Muscles are cut forming a deep, bleed-
the lower arm. spreading dark, red bruise. ing wound.

Damaged ulnar nerve [404C]. Hard hit has broken the radius [1A] Blood loss is the only immediate danger.
9 which has torn the artery [401C].
(5) Bleeding (Moderate) Bleeding (Moderate)
Bleeding (Moderate)

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].
10 Heavy bleeding from a lacerated radial to the hand [403E].
(6) artery is the most serious part of the
deep cut [401C].

Bleeding (Heavy)

172
 Arm: Grievous Wound
1D10
(1D6) Slash Crush Pierce
Slash severs two fingers from the hand. Cracks the bone in the lower arm. Pierces the lower arm leaving a bleed-
ing wound.
Two fingers are severed from the hand The ulnar bone in the lower arm has been
[403D]. fractured [1A]. The radial nerve has been damaged
1-2 [404C].
(1)
Bleeding (Moderate)

Slices deeply across the top of the fore- Heavy hit to the forearm lands with a Nasty puncture pierces the biceps
arm, releasing a pulsating stream of bone crushing force. muscle leaving a gaping, bleeding
blood. wound.
The radius bone [1A] has been fractured
3-4 The ulnar nerve has been damaged by damaging the radial nerve [404C]. Upper arm is pierced and the brachial
(2) the cut [404C] and the artery starts plexus nerve damaged [404A].
bleeding [401C].
Bleeding (Moderate)
Bleeding (Moderate)
Slash across the wrist leaves a bloody The blow breaks a bone in the lower arm The arm is punctured and starts bleed-
gash. and cracks the skin in a spray of blood. ing.

Four tendons are severed in the wrist The lower arm radius bone has been A lot of blood.
5-6 disabling two fingers [405C]. broken [1A] damaging the artery [401D].
(3) Bleeding (Moderate)
Bleeding (Moderate) Bleeding (Moderate)

Heavy cut lands on the forearm with a The wrist snaps from the mighty impact. Muscles are torn and bleed as the arm is
snap and releases a pulsating stream of punctured.
blood. The wrist has been fractured by the blow
[405A]. Meaty wound bleeds a lot.
7-8 Hard impact has fractured the radius
(4) bone [1A], the cut bleeds from a dam- Bleeding (Moderate)
aged radial artery [401C].

Bleeding (Moderate)
A long and deep cut opens the artery in The skin and bone cracks from the force The forearm is punctured and starts
the forearm as evidenced by a fountain of the blow and blood pours forth in a bleeding.
of blood spraying everything with blood heavy stream.
in a pulsating geyser of blood. The ulnar nerve has been severed
9 The radial bone has been broken [1A] [404D].
(5) Damaged radial nerve [404C] and damaging the radial nerve [404C] and the
severed artery [401D]. radial artery [401C]. Bleeding (Moderate)

Bleeding (Heavy) Bleeding (Heavy)

Hard hit cracks the wrist and cuts the The shoulder crumbles from the powerful Direct hit penetrates right through the
artery which sprays blood everywhere in blow. forearm, bleeding hard.
a rhythmic geyser of blood.
The collarbone has been fractured [407A] The radius bone has been fractured [1A]
10 Hit to the wrist has caused a wrist frac- and shoulder tendon torn [406C]. and the radial artery severed [401D].
(6) ture [405A] and severed the artery
[401D]. Bleeding (Heavy)

Bleeding (Heavy)

173
 Arm: Grim Wound
1D10
(1D6)
Slash Crush Pierce
The thumb is severed from the hand and Heavy blow dislocates the shoulder. The hand is pierced, leaving a red, gap-
a nasty, bloody gash left in its place. ing hole.
The shoulder has been dislocated from the
The thumb is severed from the hand heavy blow making it impossible to move The hand has been pierced, the injury
1-2 [403F ]and the hand badly cut [403C]. the arm. Intense pain [406A]. disabling it from further use while it
(1) heals [403C].
Bleeding (Moderate)

Heavy hit to the forearm cuts a deep, Hard hit dislocates the shoulder from its Penetrates the upper arm somewhere
bloody cut. socket. between the biceps and triceps.

The ulna bone is fractured [1A] and the A complicated shoulder dislocation with A deep wound to the upper arm has
3-4 artery damaged [401C] and nerve damaged tendons has occurred, disabling damaged the brachial plexus nerve
(2) severed [404D]. the arm [406B]. [404A].

Bleeding (Moderate)

Cut to the bone in the lower arm. A loud crack can be heard as the impact The forearm is hit hard, flesh torn re-
strikes the lower arm. vealing the white of the bone. Blood
The radius bone has been fractured, the starts streaming from the wound.
cut exposing the bone [1B]. The nerve The radius bone in the lower arm has been
5-6 has also been damaged [404C]. fragmented by the hard impact [1C]. Ar- The radius bone has been broken from
(3) teries and nerves can easily be damaged the hard hit, the white of the bone vis-
by careless handling. ible in the vicious, open wound [1B].

Bleeding (Moderate)
Hard impact on the wrist cuts a shallow Crushing blow to the upper arm lands The thumb is severed from the hand.
but wide slash. with a satisfying crack.
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 use-
7-8 ated wrist fracture [405B] and severed 7 ing the brachial plexus nerve [404B]. The less.
(4) tendons [405C]. arm is completely limp and without sensa-
tion.

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
9 The humerus bone in the upper arm has The wrist has been smashed dislocating [1A] damaging the brachial plexus
(5) 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
10 Bleeding (Heavy) is deformed and the lower arm will slowly
(6) turn pale, blue, cold and numb. Its blood
supply has been cut off [401D] and the
nerves are damaged [404C].
The lower arm has been hit and the ulna
bone broken [1A]. The nerve [404D]
and artery [401D] both severed.
Bleeding (Heavy)

Bleeding (Moderate)
174
 Arm: Mortal Wound
1D10
(1D6)
Slash Crush Pierce
Powerful cut across the lower arm The bones in the forearm are crushed and Direct hit to the shoulder leaves a
lands with a snap and leaves broken so deformed by the force that one is left bleeding laceration.
bone protruding through the bleeding severely protruding from the wound. The
wound. lower arm is horribly deformed at an im- Direct hit to the collarbone has fractured
possible angle, blood running in a little it [407A].
Deep cut across the lower arm breaks stream down the protruding bone.
1-2 the radius bone, the damaged bone vis- Bleeding (Moderate)
(1) ible in the middle of the bleeding wound Fragmented ulna bone [1C], fractured and
[1B]. protruding radius bone [1B]. Unstable
fracture and arteries and nerves could eas-
Bleeding (Moderate) ily be severed by careless handling.

Bleeding (Moderate)
Slashes through muscle tissue, likely all The bone in the upper arm snaps and is The lower are is punctured and left
the way to the bone with blood rushing left protruding through an open wound. bleeding heavily.
forth.
3-4 Protruding humerus bone [1B]. Careless Direct hit to the radius bone has frag-
(2) Deep cut severs muscle, nerves [404B] handling can easily sever the brachial mented it [1C] severing the nerve
and arteries [401B] in the upper arm. artery and nerve. [404D] and artery [401D] in the process.

Bleeding (Heavy) Bleeding (Heavy)

A jet of blood is emitted as the hand is Brutal blow completely crushes the hand, Direct hit to the elbow penetrates to the
severed with a savage slash. leaving it mangled and broken. bone, leaving an open wound with pro-
truding bone and serious bleeding.
Severed hand [403A]. The hand has been completely crushed by
5-6 the heavy blow [403B]. Direct hit to the elbow fractures it and
(3) Bleeding (Heavy) exposes the bone in an open elbow frac-
Bleeding (Moderate) ture [402B].

Bleeding (Moderate)
With a mighty swing the arm is severed Brutal impact to the elbow splits open the The upper arm is pierced deeply and
below the elbow in a spray of blood. skin and crushes muscle to reveal the immediately a surge of blood pours
broken bone below in a bloody wound. forth in epic proportions.
The arm has been severed below the el-
7-8 bow [400C]. Open displaced elbow fracture [402D]. The humerus bone is only bruised but
(4) The displacement of the elbow severed the the massive wound bleeds profusely
Bleeding (Heavy) arteries and nerves in the arm, cutting off from the severed brachial artery [401B].
the blood supply to the lower arm.
Bleeding (Massive)
Bleeding (Moderate)
A wheeling swing severs the arm half Crashes into the upper arm, crushing the The lower are is pierced, leaving a
way down from the shoulder, leaving a bone with its fierce force. bleeding hole straight through the arm.
bloody stump gushing with blood.
Fragmented humerus bone [1C], severing The ulna bone is fractured [1A] and the
9 The arm has been severed below the both the brachial artery [401B] and the ulnar artery [401D] and ulnar nerve
(5) shoulder and fallen to the ground brachial plexus nerve [404B]. The bleed- [404D] severed.
[400B]. 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 be-
in 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 hu-
10 The arm has been completely severed at merus bone broken [1A]. The brachial
(6) 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)

175
 Leg: Superficial Wound
1D10
(1D6)
Slash Crush Pierce
Painful and deep cut. Blow to the thigh is mostly absorbed by Lightly pierces the thigh.
the muscles, but will likely leave a bruise.
That's it, painful and deep, what more Small but painful cut.
do you want from the lowest roll of a Big leg bruise.
1-2 minor leg wound?
(1)

A bloody cut across the calf bleeds Hard hit just above the knee. Penetrates the heavy muscle tissue of
lightly. the thigh.
Painful and colourful.
No complications. Some bleeding from the deep wound.
3-4
(2)

Long slash down the leg starts bleeding. Juicy blow to the thigh. Pierces the calves.

No complications. Will leave huge bruise but otherwise no Cut muscles and some bleeding.
lasting complications.
5-6 Bleeding (Moderate)
(3)

Painful, bloody cut across the shin. Hard hit just below knee cracks the skin. Leaves a fairly deep, bleeding cut just
below the knee.
No complications. Skin is broken but no significant bleeding
or other complications. Wound bleeds some but no other com-
7-8 plications.
(4)

A nasty cut into the thigh immediatelyDirect hit to the shin lands with a delight- Small bleeding, puncture wound in the
starts bleeding. ful snap, almost certainly the music of thigh.
broken bones.
No complications beyond the bleeding. Small wound that bleeds more than it
9 The lower leg tibia [1A] has been frac- should.
(5) Bleeding (Moderate) tured by the impact.
Bleeding (Moderate)

Rough cut across the heel bites deep Hefty blow to the knee leaves the kneecap Direct hit to the achilles heel.
and draws blood. deformed and broken.
Hit has broken the achilles tendon
Cut has severed the achilles tendon Hit to the knee fractures the kneecap [501C].
10 [501C] [506A].
(6)

176
 Leg: Nasty Wound
1D10
(1D6)
Slash Crush Pierce
A long cut down the leg immediately Hard hit bounces of the thigh muscles. Pierces the calf muscles in a deep
starts bleeding. wound.
Painful bruise, that's all.
A long cut down the leg that is losing Deep penetrating hit has damaged
1-2 serious amounts of blood. nerves in the lower leg [504E].
(1)
Bleeding (Moderate)

Painful looking slash across the heel. Good hit to the calf. Pierces the thigh muscles in a deep
wound.
Achilles tendon has been cut [501C]. The tibia is fractured [1A].
Thigh is pierced but only some blood is
3-4 drawn.
(2)

Nasty, bleeding cut across the shin. Mighty swing catches the foot with toe Cuts across the heel.
crushing force.
Will heal. Achilles tendon has been cut [501C].
Crushed 1D10 / 2 toes [503A].
5-6 Bleeding (Moderate)
(3)

Cuts deep into the thigh, leaving a Crashes into the knee with crushing force. Immediately starts bleeding from a very
bleeding laceration. deep puncture wound in the thigh.
Hit to the knee fractures the kneecap
Deep thigh cut. [506A]. Thigh-muscles penetrated almost to the
7-8 bone.
(4) Bleeding (Moderate)
Bleeding (Moderate)

Fierce swing to the calf lands with a Lands hard on the heel, cracking the skin The calf is pierced and starts bleeding.
crack as it cuts deep into the calf and starting a light bleed.
muscles, releasing a small but steady Only bleeding.
stream of blood. Achilles tendon has been ruptured by the
9 impact [501C]. Bleeding (Moderate)
(5) Tibia has been fractured [1A].

Bleeding (Moderate)

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
10 the knee have been severed [506H] by a the impact [1A]. Knee ligaments are severed [506G].
(6) nasty cut.

Bleeding (Moderate)

177
 Leg: Grievous Wound
1D10
(1D6)
Slash Crush Pierce
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
1-2 [501B].
(1) Bleeding (Moderate)

Slashes across the ankle and heel. Severe blow to the thigh lands with a loud Burrows deep into the thigh.
snap.
Achilles tendon cut [501C]. The sciatic nerve has been damaged
The femur in the thigh has been broken by [504C].
3-4 the impact [1A].
(2) Bleeding (Moderate)

Deep cut across the side of the knee Compassion less blow cracks the shin Pierces deep into the upper thigh. The
draws of blood. bone. wound immediately starts bleeding.

Knee ligaments have been severed The tibia is fractured in the lower leg The femoral nerve has been damaged
5-6 [506G]. [1A], damaging nerves [504E]. [504A].
(3)
Bleeding (Moderate) Bleeding (Moderate)

Swing hits the shin hard cutting straight Brutal swing fractures the shin bone. Pierces deep into the upper thigh. The
to the bone. wound immediately starts bleeding.
The tibia is fractured in the lower leg
The tibia is fractured and there is a [1A], damaging the popliteal vessels Muscle tissue has been seriously dam-
7-8 nasty open bleeding wound [1B]. [502C]. aged by a deep wound.
(4)
Bleeding (Moderate) Bleeding (Moderate) Bleeding (Moderate)

Deep cut across the calf is greeted by a Direct hit shatters the kneecap. Pierces deep into the thigh triggering a
spray of blood, that settles into a heavy steady trickle of bleeding.
flow of blood down the leg. Direct hit has fragmented the kneecap
[506C] severing the femoral nerve [504B]. The popliteal artery [502C] and the
9 The tibial nerve in the lower leg has peroneal nerve [504E] have been dam-
(5) been damaged [504E] and the popliteal aged.
artery severed [502D].
Bleeding (Moderate)
Bleeding (Heavy)
The thigh is sliced like a piece of ham, Heavy blow to the the thigh lands with Drills deep, disappearing into the thigh.
cutting deep in a spray of blood. The bone breaking force.
gory wound bleeds hard, drenching the The femoral artery has been punctured
leg in blood. The femur in the thigh has been broken [502A] leading to heavy internal bleed-
10 [1A] damaging the sciatic nerve [504C] ing [2A].
(6) 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) Bleeding (Heavy)

178
 Leg: Grim Wound
1D10
(1D6)
Slash Crush Pierce
Tears into the side of the knee, leaving
The kneecap is cracked by crushing blow. Nasty laceration in the lower leg as its
a bleeding cut all the way through the pierced deep. Starts bleeding.
back of the knee. Direct knee hit has fragmented it [506C]
and torn the knee tendons [506H] and the Penetrating hit in the lower leg has seri-
1-2 Tendons in the knee have been severed femoral nerve [504A] at the same time. ously damaged muscle tissue, the tibial
(1) [506H] by a deep and nasty cut. nerve [504E] and lacerated the popliteal
artery [502C].
Bleeding (Moderate)
Bleeding (Moderate)
Slices through the shin bone leaving it Heavy swing lands with bone breaking vi- Penetrates through the kneecap.
protruding in an ugly, bloody wound. olence.
The knee has been fractured [506A] and
The tibia has been fractured and left ex- The femur in the thigh has been broken femoral nerve severed [504B] by a dir-
3-4 posed by the open wound [1B]. The [1A] damaging the sciatic nerve [504C]. ect hit.
(2) tibial nerve is also severed [504F] and
the popliteal artery lacerated [502C]

Bleeding (Moderate)
Cuts across the kneecap, leaving it Hefty hit to the hip cripples the leg, leav- Drills deeply into the lower leg, tearing
broken and exposed in a messy wound. ing it crooked and bent unnaturally in- skin and muscle tissue.
wards.
Hit to the knee has fractured it, the cut The tibia bone has been fractured [1A]
5-6 exposing the bone [506B]. The cut also The heavy impact has resulted in a hip and the nerve severed [504F].
(3) 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 Crushes the knee. Penetrates straight through the thigh
draws blood. and bleeds badly from both ends.
The knee has been fractured [506C] with
The sciatic nerve has been severed at torn knee ligaments [506G] and tendons The popliteal artery has been severed
7-8 the back of the thigh paralysing the leg [506H]. The femoral nerve has been [502D] and the sciatic nerve damaged
(4) [504D]. severed [504B]. [504D].

Bleeding (Moderate) Bleeding (Heavy)

Slices through thigh muscles in a The thigh is clobbered, visibly breaking Cuts deeply across the ankle.
bloody cut, leaving a wide open gash. the thigh bone and will likely leave a
With only a slight hesitation blood massive bruise. The achilles tendon has been severed
surges forth. [501C] along with the nerves [504F] in
9 The femur in the thigh has been broken the ankle.
(5) A deep cut into the thigh has severed [1A] severing both the sciatic [504D] and
the femoral artery [502B]. the femoral [504B] nerves.

Bleeding (Heavy)
The leg is nearly hacked off below the The shin is broken by a crippling bone Punctures deep into the thigh with a
knee, bone and muscle tissue severed that splits the skin with the bone protrud- steady flow of blood running down the
and heavy bleeding. ing and heavy bleeding. leg.

10 Although still attached by a bit of skin The tibia has been broken [1B] severing The femur in the thigh has been frac-
(6) and muscle tissue the leg is practically the tibial nerve [504F] and popliteal artery tured [1A] and the sciatic nerve dam-
severed below the knee [500B]. [502D]. aged [504C].

Bleeding (Heavy) Bleeding (Heavy) Bleeding (Moderate)

179
 Leg: Mortal Wound
1D10
(1D6)
Slash Crush Pierce
Cuts to the shin bone but does not stop The knee is massacred by a pulverizing Deep, bleeding puncture through the
there. The bone is severed and visible blow. lower leg.
for a second before streaming blood
fills the wound and rushes down to the Heavy blow to the knee shatters it [506E], The tibia has been broken [1A] and the
1-2 foot. tearing cartilage and ligaments in the pro- blood vessels damaged [502C].
(1) cess [506G].
Deep cut in the lower leg has broken the Bleeding (Moderate)
tibia bone, leaving it exposed [1B].

Bleeding (Moderate)
Bites deep into the thigh releasing a Hefty blow crushes the hip, the force and Cuts deeply across the heel, bleeding
steady stream of blood running down broken bone shredding muscle and skin, hard.
the leg. leaving a messy, bleeding wound.
The achilles tendon has been severed
3-4
Deep cut has severed the femoral nerve Hip fracture [505B]. Worse the femoral [501C] along with blood vessels [502D]
(2) [504B] and damaged the sciatic nerve vein has been damaged [502A] and the and nerves [504F] in the ankle
[504C] and femoral artery [502A]. femoral nerve severed [504B].
Bleeding (Moderate)
Bleeding (Moderate) Bleeding (Moderate)
A low but sinister cut severs the foot Sideways impact cracks the knee, tearing Spray of blood as it penetrates to the
from the leg. Blood gushes forth. tissues and leaves a bleeding wound. thigh bone in a large, fleshy wound,
which bleeds heavily.
The foot has been severed from the leg Fractured knee [506A], torn tendons
5-6
[500B]. [506H], cartilage and ligaments [506G] Open femur fracture [1B]. The femoral
(3) and severed the femoral nerve [504B]. artery damaged [502A] and the femoral
Bleeding (Heavy) nerve completely severed [504B].
Bleeding (Moderate)
Bleeding (Heavy)
A spray of blood as the leg is nearly Blow knocks the hip out of its socket, Direct hit to the knee has smashes it
hacked off just above the knee. crushing bone which punctures the skin, into fragments, exposing the bone in an
leaving a mangled, bleeding leg. ugly, open wound.
The leg has been more or less severed
above the knee. Some muscle tissue and Dislocated hip [505A]. Both thighbone Open knee fracture [506B]. The femoral
7-8
skin still keeps the leg hanging in place and pelvis bone is fractured [1A] severing nerve severed [504B] and both the knee
(4) [500A]. the femoral nerve [504B] and damaging ligaments [506G] and tendons [506H]
both the sciatic nerve [504C] and blood are torn.
Bleeding (Heavy) vessels [502A].
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
9 The leg has been cleanly severed below The tibia has been fragmented by the im- nerve [504F] have been severed.
(5) 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 The thick thigh bone is broken, its sharp Punches its way right through the leg
thigh, severing the leg completely in a edge pushed through the leg tissue. Dis- above the knee, leaving a large, shock-
spray of blood. The blood keeps coming turbingly jutting out at a straight angle, ing, see-through hole that immediately
in disturbing quantity. blood rapidly pumped along its length. erupts in a fast flowing, pulsating
stream of blood.
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]. femoral nerve [504B] along the bone also [504B] and femoral artery [502B] are all
severed, as is the femoral artery [502B]. severed.
Bleeding (Massive)
Bleeding (Massive) Bleeding (Massive)
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 Chest Abdomen
The current burns a deep mark across The body is convulsed like a rag doll and The body is convulsed like a rag doll
the nose and forehead and both eyes tongue bitten clean off. and tongue bitten clean off.
bulge and explode.
1-2 The convulsions have caused ribs to frac- Convulsed jaws severed tongue [103C].
(1) Utterly destroyed eyes [102D]. ture [207A] and puncture the lung [204B].
Convulsed jaws severed tongue [103C]. Dazed
Blind
Dazed
Arcs and sparks fly from the head in all The electric current burns through the Collapses with shake and a rattle as 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.
3-4 The liver has been torn by the current
(2) Horrificly scarred face, minor brain Heart Attack [202C]. [306A].
damage [105B] and coma [10].
Unconscious, Dying Bleeding (Heavy), Unconscious
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
lapses. show for a bizarre dance of convulsion
Major brain damage [105C]. to the tune of crackling current. Col-
5-6 Heart Attack [202C]. lapses in a final bow as the show stops.
(3) Unconscious
Unconscious, Dying The spleen is ruptured by the current
[309C].

Bleeding (Heavy), Unconscious

In a brief flash the skull can be seen il- Thrown back by the shock and collapses Sparks fly and clothes smoke in a terrif-
luminated through the skin. in a heap. ic electrocution. Collapses.

7-8 Minor brain damage [105B] results in Heart Attack [202C]. The stomach has been ruptured by the
(4) coma [10] and breathing stop [105E] current [302B] with its deadly risk of
that leads to death. Unconscious, Dying Peritonitis [300A].

Unconscious, Dying Unconscious

Sparks emit from the head in a show of Arms are flung wide, eyes wide and teeth Massive current tears through the body
mini fireworks that peaks as the hair barred in a death grin as the legs fail. setting clothes on fire and a sickly smell
catches fire. of barbecue.
9 Heart is ruptured by the current [202G].
(5) Brain is heated to a pulp, massive brain The great vessel has been ruptured by
damage resulting in death [105D]. Bleeding (Massive), Unconscious the current [301B].

Dead Bleeding (Massive), Unconscious

An electric arc forms between the eyes, Arches backwards in spasms with visible Arches backwards in spasms with vis-
which start emitting smoke and a smell current and sparks across the body, ible current and sparks across the body,
of burnt brain. clothes and hair catching fire. clothes and hair catching fire.
10
(6) Brain is burnt to cinders. Internal organs cooked. Internal organs cooked.

Dead Dead Dead

181
 Electricity Burn: Grim & Mortal Wounds
1D10
(1D6) Arm Leg
The jolt of the current is enough to twist the arm in The leg shakes violently as it is burnt by the powerful
an unhealthy direction with an audible snap. current.

1-2 Broken radial bone [1A]. The tibia is fractured in the lower leg [1A].
(1)

The jolt of the current is enough to twist the arm in The leg shakes violently as it is burnt by the powerful
an unhealthy direction with an audible snap. current.

3-4 Upper arm humerus bone broken [1A]. The femur in the thigh is broken [1A].
(2)

As the arm is burnt by the current it is also twisted A loud crack announces the breaking of bones by the
out of its socket. merciless current racing through the leg as it convulses
muscles and burns flesh.
5-6 Dislocated shoulder makes it impossible to move the
(3) arm, intense pain [406A]. The femur in the thigh has been broken [1A] damaging
the sciatic nerve [504C].

The arm is twisted around and burnt in a shower of The crackling current whips the leg about violently in a
electric sparks. freakish dance that leaves the leg out of shape and a
lingering smell of burnt flesh.
7-8 The radial bone has been broken [1A] damaging the
(4) radial nerve [404C] and the radial artery [401C]. The tibia is fractured in the lower leg [1A], damaging
nerves [504E].
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.
9 Dislocated hip [505A].
Complicated shoulder dislocation has damaged ten-
(5)
dons disabling the arm [406B].

The loud crackle of the current fails to mask a very The powerful current surges through and breaks the leg
loud crack as the arm convulses and burns from the in a violent spasm.
deadly current.
10 Broken tibia bone [1A] severs the popliteal artery [502D]
Broken humerus [1A] has severed the brachial plexus and tibial nerve [504F].
(6)
nerve [404B]. Arm is completely limp and without
sensation. 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 re-
duced 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
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.
1-2 Clean cut, will heal. Bruised but not broken.
(1)

A neat incision in the wing. Hard but ineffective hit. Pierces the wing.

Clean cut, will heal. Bruised but not broken. A small hole will heal.
3-4
(2)

Slash cuts a long jagged wound. Direct hit, but does not tear wing. Punctures the wing.

Long cut, will heal with some scar- Bruised but not broken. A small hole will heal.
5-6 ring.
(3)

Cut across the length of the wing
does not sever it, but leaves a long,
nasty cut.
7-8
(4) Long cut, heals but leaves scar.
Wing tears from impact. Punctures the wing leaving a small
hole.
A small tear, will heal.
A small hole will heal.

Nasty bleeding cut on the wing. 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 scar-
9 A small tear and bruising, will heal. ring.
(5)

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.
10 A small tear and bruising, will heal. Will heal with nasty scarring.
Will not heal without stitching.
(6)
With crude stitching may leave a
permanent –1D flying impairment.

184
 Wing: Grim & Mortal Wounds
1D10
(1D6)
Slash Crush Pierce
Long cut across the wing ruins its Direct hit manages to snap wing. The wing is punctured, leaving a
ability to flap. large hole.
Bruised and broken.
1-2 Long cut, will heal. Large hole, will heal.
Inability to fly
(1)
Inability to fly Inability to fly

Cruel slash cuts a red, bleeding
wound across the wing. The wing
hangs limply.
3-4
(2) Will heal with scarring.
Inability to fly
Hard and heavy hit catches the wing Pierces and tears the wing.
and tears it badly.
A hole and tear, will heal with scar-
Large tear and bruising, but will heal. ring.
Inability to fly Inability to fly

Nasty cut badly damages wing and The blow lands hard and breaks the Punctures an obscenely large hole
leaves it useless for flight. wing with a snap, creating a tear. in the wing.

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.
7-8 Only heals with stitching. Even
(4) then with –1D permanent impair-
ment to flying.
Inability to fly
Cuts a diagonal, ragged and bleed- Hard hit snaps the wing causing it to
ing wound that leaves the wing
broken.
9
Will not heal without stitching.
(5) Even then best result is –1D impair- Inability to fly
ment to flying. Cruel scarring.
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 Pierces and tears the wing badly.
it broken and useless.
Tear will only heal with stitching
Wing tears and bruises, heals with and thick scarring.
scarring.
Inability to fly
Inability to fly
Tears a long scar in the wing as it
tear badly. burrows through it.
Thick scarring. Long tear will only heal with stitch-
ing and considerable scarring.
Inability to fly

Inability to fly
Badly cuts the wing leaving it Perfect hit snaps the wing and causes Terrific hit both punctures and tears
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 A large hole and nasty tearing
The hole length of the cut must be with stitching and then with –1D causes considerable bleeding. Not
(6) stitched to heal. Even then best res- impairment to flying at best. possible to repair hole completely
ult is –1D impairment to flying. Im- even with stitching, so permanent
pressive scar. Inability to fly –1D impairment to flying.

Inability to fly 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
2 – Bleeding .......................................................34
2A – INTERNAL BLEEDING.........................................35
2B – ANAEMIA.........................................................35
2C – BLOOD TRANSFUSION........................................35
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
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
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
12 – Fever...........................................................54
12A - LIGHT FEVER..................................................54
12B - SEVERE FEVER................................................54
12C - DEADLY FEVER...............................................54
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
19 – Blood Clot..................................................58
20 - Stroke..........................................................58
HEAD......................................................................59
Anatomy.............................................................59
VITAL ORGANS.........................................................59
GREAT VESSELS........................................................59
VITAL STRUCTURES...................................................59
NERVES....................................................................59
SKELETON.................................................................59
100 - General......................................................59
100A – INTRACRANIAL BLEEDING...............................59
100B – SUFFOCATION...............................................60
100C – SEVERED NECK.............................................61
100D – BRAIN INFECTION..........................................61
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
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
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
106 – Carotid Arteries........................................78
106A – CAROTID SEVERED IN NECK...........................78
106B – CAROTID SEVERED IN HEAD...........................78
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
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 107G - GLOSSOPHARYNGEAL NERVE...........................79
107H - VAGUS NERVE..............................................79
107I - ACCESSORY NERVE.........................................80
107J - HYPOGLOSSAL NERVE.....................................80
108 – Jaw............................................................81
108A – DISLOCATED JAW..........................................81
108B – FRACTURED JAW...........................................81
108C – SHATTERED JAW...........................................82
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
Anatomy.............................................................86
VITAL ORGANS.........................................................86
GREAT VESSELS........................................................86
VITAL STRUCTURES...................................................86
NERVES....................................................................86
SKELETON.................................................................86
200 - Infection....................................................86
200A – CHEST INFECTION.........................................87
200B – TETANUS IN CHEST.......................................88
200C – CHEST GANGRENE.........................................88
200D – CHEST FASCIITIS...........................................88
200E - PNEUMONIA...................................................88
201 - Great Vessels.............................................89
201A – GREAT VESSEL TEAR....................................89
201B – GREAT VESSEL RUPTURE...............................89
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
203 – Digestive Tract ........................................92
203A – DAMAGED ESOPHAGUS..................................92
204 – Lungs........................................................93
204A – SUCKING CHEST WOUND...............................93
204B – PUNCTURED LUNG.........................................94
204C – HEMOTHORAX...............................................95
205 – Windpipe .................................................97
205A – DAMAGE TO WINDPIPE..................................97
206 – Breastbone................................................97
206A – BROKEN BREASTBONE...................................97
206B – FLAIL STERNUM............................................98
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
208 – Shoulder Blades .....................................100
208A – SHOULDER FRACTURE..................................100
208B – FLAIL SHOULDER........................................100
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
300 – Peritoneum .............................................103
300A – PERITONITIS...............................................103
300B – BOWEL GANGRENE......................................105
300C – DYSENTRY.................................................105
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
303 - Intestines.................................................107
303A – INTESTINAL TEAR........................................107
303B – SERIOUS INTESTINAL DAMAGE......................108
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
306 – Liver.......................................................112
306A – TORN OR LACERATED LIVER........................112
306B – RUPTURED LIVER........................................113
307 – Gall Bladder...........................................113
307A – GALL STONE...............................................113
308 – Pancreas..................................................113
308A – DAMAGED PANCREAS..................................113
308B – MUTILATED PANCREAS................................114
309 – Spleen.....................................................115
309A – MINOR SPLEEN DAMAGE.............................115
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 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
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
315 – Diaphragm..............................................121
315A – SMALL DIAPHRAGM TEAR............................121
315B – MAJOR DIAPHRAGM TEAR............................122
ARMS....................................................................123
Anatomy...........................................................123
GREAT VESSELS......................................................123
NERVES..................................................................123
SKELETON...............................................................123
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
402 – Elbow......................................................126
402A – ELBOW FRACTURE......................................126
402B – OPEN ELBOW FRACTURE..............................127
402C DISPLACED ELBOW FRACTURE.........................127
402D – OPEN DISPLACED ELBOW FRACTURE.............127
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
404 – Nerves.....................................................129
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
407 – Collarbone .............................................136
407A – COLLARBONE FRACTURE..............................136
LEGS.....................................................................138
Anatomy...........................................................138
GREAT VESSELS......................................................138
NERVES..................................................................138
SKELETON...............................................................138
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
502 – Blood Vessels.........................................140
502A – LACERATED FEMORAL VESSELS....................141
502B – SEVERED FEMORAL ARTERY..........................141
502C LACERATED POPLITEAL VESSELS......................142
502D – SEVERED POPLITEAL ARTERY.......................142
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
505 – Hip Joint.................................................149
505A – DISLOCATED HIP............................................149
505B – HIP FRACTURE...............................................150
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
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