Bipolar Bear
08-29-2006, 07:26 AM
This was a similar article posted in 1999 on Critical Miss Issue 4
(http://criticalmiss.com/issue4/index.html)
Since the author is one of my players, I thought it would be fair to repost it
Traumatic Injury for Gamers
By James West
An aggressive street cleaning robot mistakes our hero, Buck Starblaster, for a bit of litter and rams a spike through his chest in an effort to clean him up. He is knocked down, and decides to stay on the ground and not move. While he is lying there, he notices that he is exhaling a froth of blood onto the floor plates right next to his face. Breathing produces a sharp pain in his back. After the street cleaner has moved away, he tries to get up and collapses again in pain as he realises that his right arm won't support him - the spike has shattered his right scapula (shoulder blade).
He eventually makes it to his feet, but is feeling fairly wobbly. His breathing is rapid and shallow, and he's broken out into a cold sweat. Buck's the sort of guy that irons his underwear, and so he's upset when he looks down and finds that his crisp, starched uniform shirt is soaked in blood. He feels a rising irrational panic, and tears his shirt open to reveal the puncture wound. Buck doesn't have any medical skill, but he decides it would be a good idea to close the wound, so he sprays it with the foam bulkhead sealer that all experienced spacemen carry.
He staggers down the alleyway. He doesn't feel like he's getting any air, and his chest feels swollen. He gets to the end of the alleyway, and falls to his knees; his legs won't support him anymore, and in any case they're going numb. He still can't breathe, and his vision is going dark. He wipes his arm across his mouth, and his sleeve comes away covered in blood. He can't see well enough to find a taxi, and falls prostrate on the ground, panting. After a few minutes he passes out.
Fortunately for Buck, loitering is also illegal, and a passing police cruiser stops to pick him up.
More evocative than "12 hit points of damage", eh?
A warning: This article is intended to familiarise game-masters with the effects of traumatic injury, to allow them to add realism and tension to their darker games.
It absolutely should not be used as medical advice.
Hypovolemic (loss of blood volume) Shock
A great many of the injuries listed in this article will induce hypovolemic shock, a complex set of reactions evolved to compensate for loss of blood pressure. In shock, blood is diverted from skin and muscles to vital organs, and platelet aggregation is increased. Note that septic shock has essentially the same symptoms.
MILD TO MODERATE SHOCK (10%-25% OF BLOOD VOLUME LOST)
The patient will be pale, have rapid, shallow breathing and a high heart rate, will sweat, and will feel quite weak. He will be thirsty, his extremities will be cool, and his senses will start to cloud. Even the most stout of heroes will start to feel a rising panic, from purely physiologic hormonal reactions.
SEVERE SHOCK (30%-50% OF BLOOD VOLUME LOST)
Platelet aggregation in the lungs will lead to respiratory failure. Failure of cellular processes will lead to sequential systems failure, frequently starting with the heart and kidney. Basically, you stop breathing, your heart stops, everything else fails, and you die. This can take anywhere from hours to days after the initial injury.
Head Injuries
SCALP
Scalp wounds bleed copiously, making it a major source of haemorrhage and shock. They may also be incidental to damage to the skull.
SKULL
Skull fractures in different places have rather different effects, but for these purposes, symptoms include one or more of the following; a mixture of blood and cerebrospinal fluid leaking from the ears, nose, or throat, blood in the whites of the eyes, loss of the sense of smell, loss of vision in one eye, a dilated, fixed pupil, a worsening in the patients level of consciousness.
These last symptoms are indicative of pressure on the brain, caused either by swelling of the brain or bleeding into the skull. Swelling of the brain can cause serious damage or possibly death on its own, but has the advantage that its self-limiting (and in a modern setting, usually controllable with drugs). On the other hand, haemorrhage will almost always lead to continued degradation and death if left untreated.
The patient may have a headache localised at the injury. He may be lucid for a period after the injury, but this will rarely be a period of normalcy. He will usually feel drowsy, and may thereafter slip into a coma. The patient will lose one set of reflexes after another. He may gradually lose the use of one of his arms or legs, or become completely paralysed on one side of the body. This will happen gradually as pressure increases starting with a slurring of speech and clumsiness. His breathing may become uneven, and some part or all of his body may begin shaking uncontrollably (seizure activity.)
The time course for these degradations can be hours or days and the condition can worsen dramatically in minutes.
JAW
A broken jaw is associated with numbness, bleeding from tooth sockets, fractured or missing teeth, inability to close the jaw properly (teeth don't come together right), pain on moving the jaw, and sometimes with bleeding from the ear. Fractures of the jaw also allow the tongue and other soft tissues to intrude into the airway, leading to suffocation.
FACE
All sort of bones can be broken in the face: the face plate, sinuses, cheekbones, the orbits of the eye, and of course, the nose. There are a wide variety of possible symptoms, but severe facial injury usually results in progressive swelling, resulting in difficulty breathing, inhalation of blood, frequently eventually (~1 hour) completely closing off the airways, resulting in suffocation. There may also be numbness or paralysis in some part of the face. Facial injuries can also lead to extreme haemorrhage and shock.
Neck Injuries
As you may imagine, there are a lot of important things passing through the neck, including the spinal cord, larynx and trachea, phrenic nerve, brachial plexus, carotid artery, jugular vein, cranial nerves, oesophagus and pharynx, thyroid gland, and stellate ganglion. Of course, many of these may be damaged simultaneously. Possible symptoms for damage to each of these are listed below. Not all will necessarily be present.
Spinal cord: paralysis, partial paralysis (no surprise !)
Larynx and trachea (you breathe through your trachea): spitting blood, a sucking neck wound (see chest wounds), hoarseness, difficulty breathing, high-pitched, noisy respiration (stridor).
Brachial Plexus: numbness and/or partial paralysis in an arm.
Carotid artery: decreased level of consciousness, heavy bleeding (which may compress the trachea, causing difficulty breathing), and hypovolemic shock.
Jugular vein: heavy bleeding, hypovolemic shock.
Cranial nerves: inability to shrug a shoulder or rotate chin to opposite shoulder, paralysis of the tongue, hoarseness, and difficulty in swallowing.
Oesophagus and pharynx (connects to your stomach): difficulty swallowing, bloody saliva, sucking neck wound.
Stellate ganglion: dilated pupil.
Thyroid gland, phrenic nerve: no special short term effects.
Also, damage to the muscles in the neck will mean that the patient is unable to hold his head upright.
Chest (Thoracic) Injuries
Trauma that is inflicted on the chest can result in damage to the chest wall, lungs, trachea, major bronchi, oesophagus, thoracic duct, heart, diaphragm, mediastinal vessels, and spinal cord. Any combination of these injuries may occur.
"SUCKING WOUNDS"
A person inhales by moving a muscle called the diaphragm, creating a vacuum in the chest, which pulls air in through the mouth down into the lungs. However, if there is a hole in the chest wall, air can enter through that hole instead, preventing air from entering the lungs. The patient will feel short of breath, air will visibly be being sucked in through the hole in the chest wall. The resulting low oxygen will usually result in unconsciousness in fifteen minutes to an hour, but is unlikely to be fatal on a short time scale.
TENSION PNEUMOTHORAX
Sometimes, a hole in the chest wall acts as a one-way valve, letting air in, but not out again. Sometimes, the lung is punctured without the chest wall being punctured ( from a broken rib, for instance ). Alternatively, if a wound that punctured both the chest wall and the lung is treated with a tight compress, air will still escape from the lung but not from the chest cavity.
In these cases, the increasing air pressure in the chest cavity will cause hyperinflation of the chest, preventing the patient from breathing. The patient will have rapid, shallow breathing. He will fall unconscious from low oxygen in fifteen minutes or so, and will probably suffocate if left untreated.
TENSION HEMOTHORAX
Is a similar problem, but in this case it results from blood filling up the chest cavity. The patient will probably be suffering from shock, as well as suffocation. This will usually result from multiple rib fractures damaging internal tissues. Frequently seen together with tension pneumothorax (in which case it's a hemopneumothorax).
RIB FRACTURES
The main symptom of rib fractures is that it hurts to breathe, which will make exertion difficult. The amount it hurts depends on how many ribs are broken (a broken sternum is especially painful). Beyond this, unless the patient has flail chest, hemothorax, the ribs have damaged the lung, or the ribs are displaced to such an extent that their motion damages surrounding tissue, the ribs will probably be held in place by the surrounding muscle, and are largely ignorable.
FLAIL CHEST (PARADOXICAL CHEST WALL MOTION)
Yet another way to suffocate: the ribs or the sternum are broken in such a way that breathing moves air from one part of the lungs to another, rather than in and out. This will usually result in unconsciousness from low oxygen in fifteen minutes to an hour, but not death.
CLAVICULAR (COLLAR BONE) OR SCAPULAR (SHOULDER BLADE) FRACTURES
Until it's splinted, pain in moving at all, inability to use the arm effectively, pain in attempting to use the arm. Can't really be fatal.
PULMONARY PARENCHYMA (DAMAGE TO THE LUNGS)
Lacerations of the lungs may cause pneumothorax, as above, as well as bleeding into the lungs. Contusions (blunt damage) will cause swelling of interstitial tissues and bleeding into the small airways. In either case, the patient will have difficulty breathing and will probably be coughing blood or exhaling blood. If this is severe enough, low oxygen may lead to unconsciousness and death.
HEART
Damage to the heart may result in massive blood loss, heart failure, and death in short order. However, less severe injuries can result in bleeding into the pericardial sack (tamponade). When this fills up with blood, it will put pressure on the heart, making it more difficult to beat, lowering blood pressure. The patient will initially feel very tired, leading to increasing stages of shock shortly.
AORTA AND GREAT VESSELS
With modern medical care, 85% of patients with multiple aortic ruptures will die at the scene, 20% of the survivors die within six hours, and 72% of the remainder will die within a week. This is, then, another good way of bleeding out in minutes. Massive hemothorax and loss of blood pressure are the most common symptoms for penetrating injury. However, for blunt injury initial manifestations are pain behind the sternum or between the shoulder blades, difficulty in swallowing, hoarseness, and difficulty breathing, leading to a left hemothorax and increasing levels of shock.
DIAPHRAGM
A penetrating chest wound at or below the level of the nipple is likely to enter the chest, pierce the diaphragm, and enter the abdominal cavity. Since the diaphragm is the muscle you use to breathe, injury to the diaphragm results in respiratory distress, often associated with hemothorax, pneumothorax, and shock.
Abdominal and Pelvic Injuries
The principal immediate danger resulting from abdominal and pelvic trauma is profound hemodynamic instability resulting from injury to the spleen, pancreas, liver, kidney, or tributaries of the aorta. Most abdominal injuries result in poorly localised and nonspecific pain, nausea and reflex vomiting. In general, blunt injuries to the abdomen are more dangerous than penetrating injuries.
INTESTINES
Abdominal pain and peritonitis. Peritonitis is an inflammation of the tissue that lines the abdominal cavity. Starting a day or so after the injury, it will lead to severe abdominal pain and distention, fever, vomiting, thirst, and, if left untreated, death in a week or two. It is easily treatable. Injury to the duodenum leads to more severe symptoms (severe abdominal tenderness in the upper right quadrant, sever vomiting), rise of fever within hours, and may have hemodynamic instability with time.
Note that evisceration isn't automatically fatal, in the absence of major haemorrhage, especially if the intestines aren't otherwise damaged, but that with poor medical care sepsis will probably be a killer.
SPLEEN OR LIVER
Abdominal pain in the upper left (spleen) or upper right (liver) quadrant, severe haemorrhage rapidly leading to increasing shock and death. The mortality rate without intervention is near 100% for splenic injuries, and almost as high for blunt injuries of the liver.
Sepsis (inflammation or infection) is a major postoperative complication for liver injuries. Splenic rupture can also occur up to two weeks after the initial injury, as an initial clot dissolves, or the splenic capsule ruptures under pressure of an initially small haemorrhage.
URINARY TRACT (BLADDER, KIDNEY)
Abdominal pain, back or flank pain, inability to void or blood in the urine. Some kidney injuries will result in massive haemorrhage, but others will not. In the long term, damage to the kidney may lead to renal failure (this can also be caused by shock and sepsis.) The course of renal failure can last weeks to months. This is fatal more than 50% of the time.
STOMACH MUSCLES
Damage to the stomach muscles will make it difficult or impossible to stand; just think of all the things it's hard to do after you've done too many sit-ups.
BLOOD VESSELS
Injury to major blood vessels in the abdomen may cut off the blood supply for the legs, making it impossible to stand in very short order. Depending upon where they're damaged, they make drain into the upper legs, causing extreme swelling.
PELVIS FRACTURE
Besides making it impossible to stand, it is likely to cut one of the major blood vessels leading into the legs. Pelvis fractures are commonly associated with massive haemorrhage.
Extremities
The nature of damage to extremities (arms and legs) is fairly intuitive. Generally, minor damage will make the extremity painful or difficult to use; major damage will make it impossible to use. Major blood vessels may be damaged, leading to heavy haemorrhage. Joints can be dislocated, bones broken, muscles and tendons cut. Note that damage to the scapula (shoulder blades) or clavicles will make the arm nigh-on unusable.
Sepsis
Fever, shock, decreasing mental status, can easily lead to death if untreated. A common problem, especially with poor medical care, in the days and weeks after injury.
Unconsciousness
To recap - what makes you fall unconscious is either direct injury to the brain, or inability to feed it enough blood or oxygen. If you lose all blood supply to the brain, you fall unconscious in seconds. Massive haemorrhage can lead blood pressure to drop fast enough that unconsciousness follows in seconds to minutes. If you lose oxygen supply, you fall unconscious in ~4-30 minutes, depending upon how restricted your air supply is. Poisoning - as from sepsis - can also cause unconsciousness.
Putting it all Together
Probably the easiest way to use this guide to traumatic injury is to use the damage system for your game, and if you want a graphic description look up an injury of the appropriate severity to the appropriate body part.
Note that there are major blood vessels just about anywhere, so if you want blood loss, you can feel free to add it in.
The trick to making it seem especially nasty is not to read the whole laundry list of symptoms at once. Give them a few at a time, so that they have a chance to sink in. Remember to add in the effects of sepsis, and of torn muscles and broken bones.
If they have to continue operating while septic, make sure to make them feel it - weakness, fever, chills, reflex vomiting, trembling hands, occasional unconsciousness.
"And they all died horribly. The End.
If you have reasonably sane players, one advantage to using a system like this is that your players will try a lot harder not to get hurt, which means less gratuitous violence. On the other hand, some players will engage in even more gratuitous violence because they get some kind of sick thrill out of stomach-churning, excruciatingly painful, anatomically explicit injury.
We hope that the addition of grotesque description will enrich your games, whether you're using role-playing to explore the cultural implications of minor societal perturbations, or you're a warped pervert with an acute case of blood-lust. In either case, the devil's in the details!
(http://criticalmiss.com/issue4/index.html)
Since the author is one of my players, I thought it would be fair to repost it
Traumatic Injury for Gamers
By James West
An aggressive street cleaning robot mistakes our hero, Buck Starblaster, for a bit of litter and rams a spike through his chest in an effort to clean him up. He is knocked down, and decides to stay on the ground and not move. While he is lying there, he notices that he is exhaling a froth of blood onto the floor plates right next to his face. Breathing produces a sharp pain in his back. After the street cleaner has moved away, he tries to get up and collapses again in pain as he realises that his right arm won't support him - the spike has shattered his right scapula (shoulder blade).
He eventually makes it to his feet, but is feeling fairly wobbly. His breathing is rapid and shallow, and he's broken out into a cold sweat. Buck's the sort of guy that irons his underwear, and so he's upset when he looks down and finds that his crisp, starched uniform shirt is soaked in blood. He feels a rising irrational panic, and tears his shirt open to reveal the puncture wound. Buck doesn't have any medical skill, but he decides it would be a good idea to close the wound, so he sprays it with the foam bulkhead sealer that all experienced spacemen carry.
He staggers down the alleyway. He doesn't feel like he's getting any air, and his chest feels swollen. He gets to the end of the alleyway, and falls to his knees; his legs won't support him anymore, and in any case they're going numb. He still can't breathe, and his vision is going dark. He wipes his arm across his mouth, and his sleeve comes away covered in blood. He can't see well enough to find a taxi, and falls prostrate on the ground, panting. After a few minutes he passes out.
Fortunately for Buck, loitering is also illegal, and a passing police cruiser stops to pick him up.
More evocative than "12 hit points of damage", eh?
A warning: This article is intended to familiarise game-masters with the effects of traumatic injury, to allow them to add realism and tension to their darker games.
It absolutely should not be used as medical advice.
Hypovolemic (loss of blood volume) Shock
A great many of the injuries listed in this article will induce hypovolemic shock, a complex set of reactions evolved to compensate for loss of blood pressure. In shock, blood is diverted from skin and muscles to vital organs, and platelet aggregation is increased. Note that septic shock has essentially the same symptoms.
MILD TO MODERATE SHOCK (10%-25% OF BLOOD VOLUME LOST)
The patient will be pale, have rapid, shallow breathing and a high heart rate, will sweat, and will feel quite weak. He will be thirsty, his extremities will be cool, and his senses will start to cloud. Even the most stout of heroes will start to feel a rising panic, from purely physiologic hormonal reactions.
SEVERE SHOCK (30%-50% OF BLOOD VOLUME LOST)
Platelet aggregation in the lungs will lead to respiratory failure. Failure of cellular processes will lead to sequential systems failure, frequently starting with the heart and kidney. Basically, you stop breathing, your heart stops, everything else fails, and you die. This can take anywhere from hours to days after the initial injury.
Head Injuries
SCALP
Scalp wounds bleed copiously, making it a major source of haemorrhage and shock. They may also be incidental to damage to the skull.
SKULL
Skull fractures in different places have rather different effects, but for these purposes, symptoms include one or more of the following; a mixture of blood and cerebrospinal fluid leaking from the ears, nose, or throat, blood in the whites of the eyes, loss of the sense of smell, loss of vision in one eye, a dilated, fixed pupil, a worsening in the patients level of consciousness.
These last symptoms are indicative of pressure on the brain, caused either by swelling of the brain or bleeding into the skull. Swelling of the brain can cause serious damage or possibly death on its own, but has the advantage that its self-limiting (and in a modern setting, usually controllable with drugs). On the other hand, haemorrhage will almost always lead to continued degradation and death if left untreated.
The patient may have a headache localised at the injury. He may be lucid for a period after the injury, but this will rarely be a period of normalcy. He will usually feel drowsy, and may thereafter slip into a coma. The patient will lose one set of reflexes after another. He may gradually lose the use of one of his arms or legs, or become completely paralysed on one side of the body. This will happen gradually as pressure increases starting with a slurring of speech and clumsiness. His breathing may become uneven, and some part or all of his body may begin shaking uncontrollably (seizure activity.)
The time course for these degradations can be hours or days and the condition can worsen dramatically in minutes.
JAW
A broken jaw is associated with numbness, bleeding from tooth sockets, fractured or missing teeth, inability to close the jaw properly (teeth don't come together right), pain on moving the jaw, and sometimes with bleeding from the ear. Fractures of the jaw also allow the tongue and other soft tissues to intrude into the airway, leading to suffocation.
FACE
All sort of bones can be broken in the face: the face plate, sinuses, cheekbones, the orbits of the eye, and of course, the nose. There are a wide variety of possible symptoms, but severe facial injury usually results in progressive swelling, resulting in difficulty breathing, inhalation of blood, frequently eventually (~1 hour) completely closing off the airways, resulting in suffocation. There may also be numbness or paralysis in some part of the face. Facial injuries can also lead to extreme haemorrhage and shock.
Neck Injuries
As you may imagine, there are a lot of important things passing through the neck, including the spinal cord, larynx and trachea, phrenic nerve, brachial plexus, carotid artery, jugular vein, cranial nerves, oesophagus and pharynx, thyroid gland, and stellate ganglion. Of course, many of these may be damaged simultaneously. Possible symptoms for damage to each of these are listed below. Not all will necessarily be present.
Spinal cord: paralysis, partial paralysis (no surprise !)
Larynx and trachea (you breathe through your trachea): spitting blood, a sucking neck wound (see chest wounds), hoarseness, difficulty breathing, high-pitched, noisy respiration (stridor).
Brachial Plexus: numbness and/or partial paralysis in an arm.
Carotid artery: decreased level of consciousness, heavy bleeding (which may compress the trachea, causing difficulty breathing), and hypovolemic shock.
Jugular vein: heavy bleeding, hypovolemic shock.
Cranial nerves: inability to shrug a shoulder or rotate chin to opposite shoulder, paralysis of the tongue, hoarseness, and difficulty in swallowing.
Oesophagus and pharynx (connects to your stomach): difficulty swallowing, bloody saliva, sucking neck wound.
Stellate ganglion: dilated pupil.
Thyroid gland, phrenic nerve: no special short term effects.
Also, damage to the muscles in the neck will mean that the patient is unable to hold his head upright.
Chest (Thoracic) Injuries
Trauma that is inflicted on the chest can result in damage to the chest wall, lungs, trachea, major bronchi, oesophagus, thoracic duct, heart, diaphragm, mediastinal vessels, and spinal cord. Any combination of these injuries may occur.
"SUCKING WOUNDS"
A person inhales by moving a muscle called the diaphragm, creating a vacuum in the chest, which pulls air in through the mouth down into the lungs. However, if there is a hole in the chest wall, air can enter through that hole instead, preventing air from entering the lungs. The patient will feel short of breath, air will visibly be being sucked in through the hole in the chest wall. The resulting low oxygen will usually result in unconsciousness in fifteen minutes to an hour, but is unlikely to be fatal on a short time scale.
TENSION PNEUMOTHORAX
Sometimes, a hole in the chest wall acts as a one-way valve, letting air in, but not out again. Sometimes, the lung is punctured without the chest wall being punctured ( from a broken rib, for instance ). Alternatively, if a wound that punctured both the chest wall and the lung is treated with a tight compress, air will still escape from the lung but not from the chest cavity.
In these cases, the increasing air pressure in the chest cavity will cause hyperinflation of the chest, preventing the patient from breathing. The patient will have rapid, shallow breathing. He will fall unconscious from low oxygen in fifteen minutes or so, and will probably suffocate if left untreated.
TENSION HEMOTHORAX
Is a similar problem, but in this case it results from blood filling up the chest cavity. The patient will probably be suffering from shock, as well as suffocation. This will usually result from multiple rib fractures damaging internal tissues. Frequently seen together with tension pneumothorax (in which case it's a hemopneumothorax).
RIB FRACTURES
The main symptom of rib fractures is that it hurts to breathe, which will make exertion difficult. The amount it hurts depends on how many ribs are broken (a broken sternum is especially painful). Beyond this, unless the patient has flail chest, hemothorax, the ribs have damaged the lung, or the ribs are displaced to such an extent that their motion damages surrounding tissue, the ribs will probably be held in place by the surrounding muscle, and are largely ignorable.
FLAIL CHEST (PARADOXICAL CHEST WALL MOTION)
Yet another way to suffocate: the ribs or the sternum are broken in such a way that breathing moves air from one part of the lungs to another, rather than in and out. This will usually result in unconsciousness from low oxygen in fifteen minutes to an hour, but not death.
CLAVICULAR (COLLAR BONE) OR SCAPULAR (SHOULDER BLADE) FRACTURES
Until it's splinted, pain in moving at all, inability to use the arm effectively, pain in attempting to use the arm. Can't really be fatal.
PULMONARY PARENCHYMA (DAMAGE TO THE LUNGS)
Lacerations of the lungs may cause pneumothorax, as above, as well as bleeding into the lungs. Contusions (blunt damage) will cause swelling of interstitial tissues and bleeding into the small airways. In either case, the patient will have difficulty breathing and will probably be coughing blood or exhaling blood. If this is severe enough, low oxygen may lead to unconsciousness and death.
HEART
Damage to the heart may result in massive blood loss, heart failure, and death in short order. However, less severe injuries can result in bleeding into the pericardial sack (tamponade). When this fills up with blood, it will put pressure on the heart, making it more difficult to beat, lowering blood pressure. The patient will initially feel very tired, leading to increasing stages of shock shortly.
AORTA AND GREAT VESSELS
With modern medical care, 85% of patients with multiple aortic ruptures will die at the scene, 20% of the survivors die within six hours, and 72% of the remainder will die within a week. This is, then, another good way of bleeding out in minutes. Massive hemothorax and loss of blood pressure are the most common symptoms for penetrating injury. However, for blunt injury initial manifestations are pain behind the sternum or between the shoulder blades, difficulty in swallowing, hoarseness, and difficulty breathing, leading to a left hemothorax and increasing levels of shock.
DIAPHRAGM
A penetrating chest wound at or below the level of the nipple is likely to enter the chest, pierce the diaphragm, and enter the abdominal cavity. Since the diaphragm is the muscle you use to breathe, injury to the diaphragm results in respiratory distress, often associated with hemothorax, pneumothorax, and shock.
Abdominal and Pelvic Injuries
The principal immediate danger resulting from abdominal and pelvic trauma is profound hemodynamic instability resulting from injury to the spleen, pancreas, liver, kidney, or tributaries of the aorta. Most abdominal injuries result in poorly localised and nonspecific pain, nausea and reflex vomiting. In general, blunt injuries to the abdomen are more dangerous than penetrating injuries.
INTESTINES
Abdominal pain and peritonitis. Peritonitis is an inflammation of the tissue that lines the abdominal cavity. Starting a day or so after the injury, it will lead to severe abdominal pain and distention, fever, vomiting, thirst, and, if left untreated, death in a week or two. It is easily treatable. Injury to the duodenum leads to more severe symptoms (severe abdominal tenderness in the upper right quadrant, sever vomiting), rise of fever within hours, and may have hemodynamic instability with time.
Note that evisceration isn't automatically fatal, in the absence of major haemorrhage, especially if the intestines aren't otherwise damaged, but that with poor medical care sepsis will probably be a killer.
SPLEEN OR LIVER
Abdominal pain in the upper left (spleen) or upper right (liver) quadrant, severe haemorrhage rapidly leading to increasing shock and death. The mortality rate without intervention is near 100% for splenic injuries, and almost as high for blunt injuries of the liver.
Sepsis (inflammation or infection) is a major postoperative complication for liver injuries. Splenic rupture can also occur up to two weeks after the initial injury, as an initial clot dissolves, or the splenic capsule ruptures under pressure of an initially small haemorrhage.
URINARY TRACT (BLADDER, KIDNEY)
Abdominal pain, back or flank pain, inability to void or blood in the urine. Some kidney injuries will result in massive haemorrhage, but others will not. In the long term, damage to the kidney may lead to renal failure (this can also be caused by shock and sepsis.) The course of renal failure can last weeks to months. This is fatal more than 50% of the time.
STOMACH MUSCLES
Damage to the stomach muscles will make it difficult or impossible to stand; just think of all the things it's hard to do after you've done too many sit-ups.
BLOOD VESSELS
Injury to major blood vessels in the abdomen may cut off the blood supply for the legs, making it impossible to stand in very short order. Depending upon where they're damaged, they make drain into the upper legs, causing extreme swelling.
PELVIS FRACTURE
Besides making it impossible to stand, it is likely to cut one of the major blood vessels leading into the legs. Pelvis fractures are commonly associated with massive haemorrhage.
Extremities
The nature of damage to extremities (arms and legs) is fairly intuitive. Generally, minor damage will make the extremity painful or difficult to use; major damage will make it impossible to use. Major blood vessels may be damaged, leading to heavy haemorrhage. Joints can be dislocated, bones broken, muscles and tendons cut. Note that damage to the scapula (shoulder blades) or clavicles will make the arm nigh-on unusable.
Sepsis
Fever, shock, decreasing mental status, can easily lead to death if untreated. A common problem, especially with poor medical care, in the days and weeks after injury.
Unconsciousness
To recap - what makes you fall unconscious is either direct injury to the brain, or inability to feed it enough blood or oxygen. If you lose all blood supply to the brain, you fall unconscious in seconds. Massive haemorrhage can lead blood pressure to drop fast enough that unconsciousness follows in seconds to minutes. If you lose oxygen supply, you fall unconscious in ~4-30 minutes, depending upon how restricted your air supply is. Poisoning - as from sepsis - can also cause unconsciousness.
Putting it all Together
Probably the easiest way to use this guide to traumatic injury is to use the damage system for your game, and if you want a graphic description look up an injury of the appropriate severity to the appropriate body part.
Note that there are major blood vessels just about anywhere, so if you want blood loss, you can feel free to add it in.
The trick to making it seem especially nasty is not to read the whole laundry list of symptoms at once. Give them a few at a time, so that they have a chance to sink in. Remember to add in the effects of sepsis, and of torn muscles and broken bones.
If they have to continue operating while septic, make sure to make them feel it - weakness, fever, chills, reflex vomiting, trembling hands, occasional unconsciousness.
"And they all died horribly. The End.
If you have reasonably sane players, one advantage to using a system like this is that your players will try a lot harder not to get hurt, which means less gratuitous violence. On the other hand, some players will engage in even more gratuitous violence because they get some kind of sick thrill out of stomach-churning, excruciatingly painful, anatomically explicit injury.
We hope that the addition of grotesque description will enrich your games, whether you're using role-playing to explore the cultural implications of minor societal perturbations, or you're a warped pervert with an acute case of blood-lust. In either case, the devil's in the details!