#2: A Very Traumatic Experience, Part Two

[RPGnet Columns]

http://www.rpg.net/columns/medical/medical2.phtml

Summary:

Tension pneumothorax, fractures, compartment syndrome, ruptures, and head injuries. Ouch.

Go to the column (http://www.rpg.net/columns/medical/medical2.phtml) for more information.

[loseth]

As a super nit-picky realist obsessed with homebrewing combat systems, I LOOOOVE this column. I think it ranks as my favourite RPG.net column to date.

Can I just ask for a clarification on the liver rupture? If it is ruptured and no modern medical aid is available, can the victim recover (partly or fully) by him or hersef, through the body's natural healing mechanisms?

[Asklepios]

Thanks for the words, I appreciate the feedback. Personally I'm pretty disappointed with the first two columns in retrospect, but that's always the way when you're writing, painting or doing anything vaguely creative - older stuff never seems to measure up to standards.

Re: your question:

Liver rupture is unlikely to heal on its own, basically if not fixed it's a killer.

In a hospital situation the patient will turn up having suffered an abdominal trauma. A blunt or piercing injury will cause only a little bleeding, a gunshot wound will likely cause bleeding from multiple sites and fragmentation of the liver. Emphasise again - gunshots are a lot nastier than rpgs make them out to be, and are on order of magnitude of nastiness abover stabs and cuts.

The docs will notice that the patient has signs of losing blood - heart rate rises, blood pressure drops, conscious level falls, the patient looks pale and sweaty. The docs order units of blood crossmatched, and while waiting pump in a few units of O Negative.

The patient fails to respond to blood transfusion, and the surgeons suspect ongoing haemorrhage, so call for an urgent laparotomy. This involves rushing the patient up to theatre, knocking them out and laying them open.

The first goal is control of haemorrhage, with sutures or packing, but sometimes moving onto temporary occlusion of big blood vessels such as the inferior vena cava above, the portal vein and the hepatic artery.

The second goal is removal of devitalized (dead) liver fragments, as if let in these will turn into necrotic tissue and abscesses which in precise medical terms is known as "a very bad thing." :)

Sometimes a whole liver lobe needs to be taken out.

The patient is then stitched back together and survives. Probably.

Unfortunately there wasn't enough room to fit the above level of detail into the above article, but if anyone has requests for explanations of other injuries, I'd be more than happy to write here.

[loseth]

Thanks for the info Aesclupius. :)

[beeber]

i found both columns to be very informative. thank you!

[Asklepios]

No problem, I appreciate the feedback

[bildeb0rg]

hi

sorry to interrupt your reverie, but...

the dragon magazine published a similar real damage system some twenty odd years ago, which we foolishly adopted without pause.

within a month, stumpy, say what?, and the gimp were a shadow of their former adventuring selves, and the campaign withered faster than the gimps leg.

congratulations on being able to play doctor for real, but you should never take your work home with you.

and remember kids...it's just a GAME

[nerd42]

"The patient fails to respond to blood transfusion, and the surgeons suspect ongoing haemorrhage, so call for an urgent laparotomy. This involves rushing the patient up to theatre, knocking them out and laying them open."

Here in America, they'd probably get a CAT scan before doing anything. (I suspect this is also the reason healthcare is bankrupting America.) Your half-elven fighter has no access to CAT scans, of course. Magical radiology is an interesting possibility, I think.

Oh, if anyone is curious, an abscess is a localized collection of pus, usually secondary to infection. The key thing about abscesses is they have no blood supply, so antibiotics can't get there and they have to be drained surgically.

I think a relapsing-remitting disease like many of the autoimmune illnesses would make great roleplaying. It's not too hard to imagine making a player whose character has MS roll to see which part of his body he can't move that day.

Also, I can see why Cure Disease is a divine spell: of course the gods can wipe out ALL the bacteria. You don't want the one bacterium that resists Cure Disease to divide and produce Cure Disease-resistant bacteria. ;)

[Asklepios]

hi

sorry to interrupt your reverie, but...

the dragon magazine published a similar real damage system some twenty odd years ago, which we foolishly adopted without pause.

within a month, stumpy, say what?, and the gimp were a shadow of their former adventuring selves, and the campaign withered faster than the gimps leg.

congratulations on being able to play doctor for real, but you should never take your work home with you.

and remember kids...it's just a GAME

Well, it works for some games but not for all, and ultimately a cohesive story and fun play experience is the goal. I'd never dream of using trauma medicine ideas in a game where combat/physical danger is the raison d'etre, like Feng Shui,old school D+D or Truth and Justice.

OTOH, I've found it very useful when the style of the story demands that injury be threatening, visceral and brutal. For example, I ran a Battle Royale game where it added a great deal, and I tend to use realistic injury in a lot of modern games where the mood is enhanced by players knowing that people risk dying in firefights.

I aim to provide story tools, not didactic directions. I think "never" is probably too strong. "Use with caution and care" is better, and perhaps "always consult a doctor before use." :)

[bildeb0rg]

I aim to provide story tools, not didactic directions. I think "never" is probably too strong. "Use with caution and care" is better, and perhaps "always consult a doctor before use." :)[/QUOTE]

touche

as i currently game with an orthopeadic surgeon, i "always consult a doctor". however its more along the lines of "wheres the beer, or chips?"

given, in my opinion, the complexity of 3.5, i feel its uneccessary to complicate matters further with concerns over what is very specialised knowledge.

no disrespect, but most games can only handle one divine ego at a time, and thats usually to be found at the DM screen...

[Eosin the Red]

Here in America, they'd probably get a CAT scan before doing anything. (I suspect this is also the reason healthcare is bankrupting America.)

Usually, but not always. If the nature of the injury matches a suspected critical syndrome then off to the OR they go, CT scan or not. It doesn't happen that often but every once in awhile someone jumps the protocol :D


BTW - great article. My only complaint is that you trumped any hopes I had of doing a similar one. However, there is still "Real Deadly, Real Toxicology for your make believe games"

[Asklepios]

no disrespect, but most games can only handle one divine ego at a time, and thats usually to be found at the DM screen...

That's why I always GM in my group. Mwahahahaa!

[GrumpyOldKiwi]

Very nice work 'doc. If you're interested in having a look at an RPG that does treat most (most) of these wounding types with the respect they deserve, have a look at Millennium's End. (Wounds can be from Concussion (mostly explosives), Impact, Cutting, Puncturing, Hydrostatic Shock and Burns. Wounds result in blood loss, broken bones, shock, impairment and stunning).

I've been looking for descriptions of these types of wounds and their treatments to add a little 'yuck' factor in my games.