90 Gruesome Injuries

d20+ crushing injuries, d20+ piercing injuries, d20+ slashing injuries, and a lightweight wound system to support them.

I like violence in my games to be ugly – if someone’s going to get murdered, I want it to be gross. Unfortunately I’m not great at coming up with gruesome injuries (or much else) on the spot. This injury system is meant to solve that problem for me.

This is the first draft, and I expect significant revisions – especially to the tables – after more playtesting. 90 entries was a bit exhausting and I’m just happy to take a break from it for a while.

Getting Injured

If your character ends a fight with 0 or less HP you have been injured. Someone must perform first aid by rolling their Medicine skill and expending medical supplies. If you perform first aid on yourself, roll with disadvantage.

Next make an Injury roll: a d20 minus your current HP on the most relevant Injury Table (slashing, piercing, or crushing). If first aid was a failure, roll with disadvantage.

Gain the effects of the listed injury.

“✚” denotes that surgery is required to prevent imminent death. Another Medicine roll must be made and more medical supplies must be expended. On a success the character survivers. On a failure the character dies.

Injury Tables


d20 Piercing Injury Other Effects
1 Bleeding cut in forearm.
2 Bleeding laceration across muscles in upper arm.
3 Deep cut on the shin.
4 Puncture to the side of the stomach. No internal damage.
5 Hole in chest dampens clothes with blood.
6 Diagonal cut across the face.
7 Hole in forearm gushes blood.
8 Ugly cut in arm passes through muscle.
9 Thigh punctured to the bone.
10 Strike to the lower back grazes kidney.
11 Chest is punctured and trickles blood. Lung narrowly missed.
12 Throat is pierced. Victim gasps. Blood trickles.
13 Muscles are torn into a bloody mess. -1 Strength
14 Forearm bleeds. Fingers tingle - nerve is damaged. -1 Agility
15 Hit to thigh damages a major nerve and artery. -1 Agility
16 Hit to lower back just misses spine, piercing a kidney. -1 Will
17 Chest is punctured - blood flows freely. Muscle torn. -1 Strength
18 Eye is punctured and destroyed. -1 Eye
19 Forearm is splayed open revealing bone. ✚, -2 Strength
20 Quick strike severed a thumb. ✚, -1 Thumb, -1 Agility
21 Ankle is mangled, tendon and nerves cut. ✚, -2 Agility
22 Blow passes entirely through torso - significant bleeding. ✚, -2 Will
23 Deep chest wound pools blood. Victim coughs blood. ✚, -2 Will
24 Teeth shattered and roof of mouth penetrated. ✚, -2 Intellect
25 Deep hole mangles upper arm, rendering it useless. ✚, Lamed Arm
26 Ugly gash just below shoulder. Amputation required. ✚, -1 Arm
27 Hole through thigh gushes blood. Leg hangs uselessly. ✚, Lamed Leg
28 Stomach torn open, contents strewn across the ground. Death
29 Blow punctures heart. Victim coughs blood before dying. Death
30 Hit punctures straight through skull, exposing brain. Death


d20 Slashing Injury Other Effects
1 Slash down the arm.
2 Deep cut across the shoulder.
3 Cut across the calf.
4 Slash across the stomach.
5 Long cut on the chest.
6 Cut to the side of the head. Hair and face runs with blood.
7 Ragged cut to the arm.
8 Cut severed a finger.
9 Deep slash into thigh.
10 Long cut to belly bleeds profusely.
11 Deep chest gash soaks clothing in blood.
12 Chunk of flesh removed from throat. Victim gasping.
13 Forearm streams blood. Radius is broken. -1 Strength
14 Forearm streams blood and hand is numb. -1 Strength
15 Blood covers the shin. The tibia is fractured. -1 Agility
16 Cut penetrates deep into abdomen. Stomach leaks. -1 Will
17 Slash across the back. Spinal ligaments cut. -1 Agility
18 Chunk of skull slashed off. Profuse blood. -1 Intellect
19 Triceps are gushing blood. Humerus is fractured. ✚, -2 Strength
20 Hand is severed. Wrist spews blood. ✚, -1 Hand
21 Leg is severed below knee. Magnificent blood loss. ✚, -1 Leg
22 Intestines spill out a slashed belly. ✚, -2 Will
23 Broken ribs clearly visible through slash. Blood pooling. ✚, -2 Will
24 Skull split open at the forehead. Face covered in blood. ✚, -2 Intellect
25 Arm lopped off near elbow. Gushing blood. ✚, -1 Arm
26 Arm severed near shoulder. Fountain of blood. ✚, -1 Arm
27 Leg detached above knee. Terrifying blood loss. ✚, -1 Leg
28 Total disembowelment. Stomach contents everywhere. Death
29 Chest split wide open. Heart pumps into chest cavity. Death
30 Skull hacked in two. Brain destroyed. Death


d20 Crushing Injury Other Effects
1 Bruise on forearm. Uncomfortable but inconsquential.
2 Large bruise near shoulder hurts enough to be a fracture.
3 Hit above knee breaks skin and leaves a bruise.
4 Huge bruise across abdomen.
5 Blow to the chest left a bruise and nearly broke ribs.
6 Hit to the face broke nose. Blood streaming.
7 Hit to forearm fractured radius.
8 Hit to upper arm fractured humerus.
9 Several toes have been crushed.
10 Hit to lower back has bruised kidney.
11 Hit square in the chest cracks a rib.
12 Hit to the head leaves victim reeling and confused.
13 Wrist has been snapped by a deft blow. -1 Strength
14 Blood pours from forearm. Radius is fractured. -1 Strength
15 Tibia is clearly fractured from a crushing blow. -1 Agility
16 Lower back is badly bruised and a vertebrae is fractured. -1 Agility
17 Heavy blow to the chest cracks several ribs. -1 Will
18 Hit to back of head cracks skull and concusses victim. -1 Intellect
19 Wrist is left a broken mess. Tendons have been cut. ✚, -2 Strength
20 Forearm is crushed. Bone protrudes at an odd angle. ✚, -2 Agility
21 Hip is fractured. Leg hangs uselessly. ✚, -2 Agility
22 Covered in bloody vomit after a vicious stomach hit. ✚, -2 Will
23 Ribcage is crushed inwards with massive bleeding. ✚, -2 Will
24 Skull is crushed and bits of bone are pushed into brain. ✚, -2 Intellect
25 Elbow is crushed and amputation is required. ✚, -1 Forearm
26 Humerus is split in two. Amputation is required. ✚, -1 Arm
27 Femur is snapped. Amputation is required. ✚, -1 Leg
28 Pelvis and lumbar spine are shattered. Massive bleeding. Death
29 Chest is completely collapsed into a bloody crater. Death
30 Face is caved in - a bloody, unrecognizable mess. Death


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Contact: jason@anywhither.com