Trauma & Life Threats
Four injuries kill on a clock: a collapsed lung, blood around the heart, a blocked airway and a broken pelvis. They come on top of the normal injuries, and each one has its own fix.
These are hidden. None of them shows on the chart until you examine the patient. A patient with a gunshot to the chest and falling oxygen has a collapsed lung until you prove otherwise.
🎲 Where they come from
They are rolled with the hit, by damage class.
| Damage class | Collapsed lung (chest) | Blood around the heart (chest) | Airway (neck / head) | Broken pelvis (abdomen) |
|---|---|---|---|---|
| Gunshot | 35% | 12% | 30% (neck) | 15% |
| Stab / laceration | 30% | 15% | 25% (neck) | - |
| Vehicle collision | 15% | - | - | 30% |
| Blast injury | 30% | - | 20% (head burn) | 25% |
| Burn | - | - | 35% (head burn) | - |
| Fall | 10% | - | - | 20% |
| Blunt trauma | 6% | - | - | 4% |
| Drowning | - | - | Always (water) | - |
A broken rib adds +30% to the chance of a collapsed lung. A burn to the face only causes airway swelling when it is level 2 or worse.
🫁 Pneumothorax, collapsed lung
| Signs | Oxygen falls, breathing and heart rate go up. The patient feels they can't get enough air |
| Stethoscope | Breath sounds quiet on one side |
| Ultrasound | That lung is not sliding |
| Confirmed by | Ultrasound or CT |
| Open chest wound, not sealed | Turns into a tension pneumothorax in 4 minutes |
| No open wound, or sealed / sutured | Tension in 15 minutes |
| Tension | No breath sounds on one side, oxygen crashing, blood pressure dropping. Collapse after 2½ minutes, death 2 minutes after going down |
Fixing it
| Where | Treatment | Item | |
|---|---|---|---|
| Field | Chest Seal | chest_seal | Seals an open chest wound and controls bleeding up to level 2. Slows the slide into tension |
| Field | Needle Decompression | decompression_needle | Turns a tension back into a simple pneumothorax for 10 minutes. Then it builds again |
| Hospital | Chest Drain | - | Re-expands the lung. The drain stays in for 10 minutes. Played as a minigame |
The needle buys 10 minutes, nothing more. Decompress, load, drive. If the tension comes back on the way, decompress again.
A chest drain also lets out a small bleed into the chest (internal bleeding level 1, once it is known), no surgery needed for that one.
🫀 Cardiac tamponade, blood around the heart
| Signs | Heart rate climbs and blood pressure falls as the blood builds up. The patient feels pressure in the chest, racing heart |
| Stethoscope | Muffled heart sounds |
| Ultrasound | Fluid round the heart |
| Confirmed by | Ultrasound or CT |
| How fast | Builds up fully in 5 minutes. Collapse 1 minute later, death 2 minutes after going down |
Fixing it
| Where | Treatment | |
|---|---|---|
| Field | Nothing. | Transport now |
| Hospital | Pericardiocentesis | Drains the blood with a needle under the breastbone. Played as a minigame |
There is no field fix for a tamponade. About six minutes from the hit to collapse, the drive is the treatment.
😮💨 Airway obstruction
Three causes, two levels: partial (gurgling or stridor) and blocked.
| Cause | From | Sounds like |
|---|---|---|
| Water | Drowning. Staying under turns it into a full airway | Gurgling |
| Swelling | Smoke and heat in the face (head burn) | Stridor |
| Trauma | A gunshot or stab to the neck | Stridor |
Found with the Airway & Breathing check or the stethoscope. A blocked airway stops the patient breathing, oxygen crashes.
| How fast | |
|---|---|
| Water | Clears one level every 5 minutes once they breathe on their own |
| Swelling or trauma, not secured | Closes completely after 10 minutes |
| Blocked | Collapse after 2 minutes, death 2½ minutes after going down |
Fixing it
| Problem | Treatment | Item | |
|---|---|---|---|
| Water | Suction Airway | airway_kit | Clears one level per use |
| Swelling or trauma | Intubate | intubation_kit | Only on an unconscious or sedated patient. Played as a minigame |
A tube makes the airway safe straight away. Swelling or an injured airway heals 20 minutes after the tube went in, and the tube comes out on its own once the airway is clear and the patient is awake.
A conscious patient whose airway is closing has to be sedated before you can intubate them.
🦴 Pelvic fracture
A fracture on the abdomen is a broken pelvis. It bleeds inside.
| Found by | Palpating the abdomen (suspected), X-Ray or MRI (confirmed) |
| Bleeds | 120 ml a minute, 240 ml if it is open |
Pelvic Binder (pelvic_binder) | Stops 75% of that bleeding. Played as a minigame |
The binder holds the pelvis but does not heal it. Confirm it on the X-Ray, then plate it at the surgery table, see Surgery & Procedures.
⚡ They block a revive
A patient in cardiac arrest from a tension pneumothorax, a tamponade or a blocked airway will not get a pulse back until the cause is treated.
- CPR still keeps blood moving and buys time.
- A good shock gets a pulse that flickers and is lost.
- Help up and a first aid kit refuse until it is fixed.
See Cardiac Arrest.
A respawn, a hospital check-in, the AI medic and the revive kit clear the first three on their own, and put a binder on a broken pelvis.
Rank locks: needle decompression needs Chest decompression (rank 1), intubation Advanced airway (rank 1), chest drain and pericardiocentesis Chest procedures (rank 2). See Permissions.
⚙️ Settings
shared/config/trauma.lua → Config.Trauma. All times are in seconds.
| Setting | Default | |
|---|---|---|
enabled | true | false turns all four off |
pneumo | 240 / 900 / 600 / 600 | tensionOpen, tensionClosed, decompressionLasts, drainRemove |
tamponade.buildUp | 300 | Time to build up fully |
airway | 300 / 600 / 1200 | fluidClears, swellingWorsens, swellingHeals |
pelvis.binderReduces | 0.75 | Share of the pelvic bleeding a binder stops |
causes, ribFracturePneumo | table above, 30 | Chance per damage class, extra % from a broken rib |
Each threat also has its own collapseAfter, deathAfter and vitals effects.