ACM EXTENDED // REFERENCE
Glossary
Every advanced term used in this guide, in plain language. Anywhere a term appears underlined you can tap it to see this same definition without leaving the page.
01
All Terms
5 HT3 receptor
A serotonin switch in the brain and gut that triggers vomiting. Blocking it is how most antiemetics work.
Acetylcholine
The chemical messenger nerves use to tell muscles to contract. Block it and the muscle cannot move, however hard the nerve tries.
Acidosis
An increase in body acidity, which can develop with poor circulation or carbon dioxide retention. In the mod, worsening acidosis increases bleeding and reduces pressure support effects.
Acute severity
The currently active TBI burden, stored as severity in the game state. It can resolve toward zero under suitable conditions, unless past herniation imposes a recovery floor; it is separate from the lasting injury record.
Adenosine
A medication that briefly slows electrical conduction through the AV node. The mod uses a rapid delivered dose to attempt conversion of its SVT rhythm; it does not deliberately create asystole.
AED
Automated external defibrillator: a device that analyzes heart rhythm and can deliver a shock for suitable arrest rhythms.
Afterdepolarisation
A stray electrical twitch happening while the heart cell is still resetting. It is the trigger that starts torsades.
Afterload
The pressure and resistance the heart must overcome to push blood out. ACME changes vascular resistance and blood pressure, but the reviewed flow calculations do not use a separate afterload value.
Agonal respirations
Occasional gasping that does not provide normal effective breathing.
Agonist
A substance that activates a receptor and produces an effect.
Alpha 1 receptor
A target for chemical signals that can narrow blood vessels and increase resistance.
Alveolar
Related to the tiny air sacs in the lungs where gases pass between air and blood.
Alveolar oxygen pressure
The oxygen pressure inside the tiny air sacs of the lungs, before oxygen enters the blood.
Alveoli
Tiny air sacs in the lungs where oxygen enters the blood and carbon dioxide leaves it.
Amide anaesthetic
One of the two chemical families of local anaesthetic, which includes lidocaine. Allergy to one family does not mean allergy to the other.
Amiodarone
A medication used by the mod for selected abnormal heart rhythms. Its card lists the supported rhythms and dose related effects.
Analgesia
Pain relief. Worth separating from sedation, because a drug can make someone unresponsive while leaving them fully able to feel pain.
Anaphylaxis
A severe, whole body allergic reaction. Blood vessels dump their pressure and the airway swells shut, and it kills within minutes without adrenaline.
Anisocoria
Pupils of unequal size. In the mod, an asymmetric brain injury pupil state can produce this finding.
Antagonist
A substance that blocks or reduces another substance's effect.
Anterograde amnesia
Not forming new memories from the moment the drug takes effect. The casualty may be responsive at the time and remember none of it afterwards.
Antiarrhythmic
A drug that corrects an abnormal heart rhythm, usually by changing how electrical signals move through heart muscle.
Anticoagulation
Reduction of the blood's ability to form clots.
Antifibrinolytic
A medication that slows the breakdown of existing blood clots.
Anxiolysis
Taking the edge off fear and agitation without knocking someone out. A casualty who is calm rather than fighting you is easier and safer to treat.
Apnea
Not breathing. In a sedated or paralysed casualty this is expected and you breathe for them, and in anyone else it is an emergency.
ARDS
Acute respiratory distress syndrome. The lungs flood with fluid from inflammation rather than from a failing heart, so they stiffen and oxygen struggles to cross into the blood. It needs low volumes and real PEEP, and it is why a lung can look clear from the outside and still be almost impossible to ventilate.
Arrhythmia
An abnormal heart rhythm, which may be too fast, too slow, irregular or ineffective.
Arteriole
A small artery that helps control resistance and the amount of blood reaching nearby tissue.
Aspiration
Material such as vomit entering the airway or lungs.
Asystole
No effective electrical activity from the heart. The monitor shows a near flat trace and there is no pulse.
Atelectasis
Collapse or loss of air in part of the lung, reducing the area available for gas exchange.
Atrial fibrillation (AFib)
Disorganized activity in the upper heart chambers that produces an irregular heartbeat. RVR means the lower chambers are also beating rapidly.
Atrial kick
The extra filling supplied when the upper heart chambers squeeze before the lower chambers. The reviewed DO2 calculation does not track this separately.
Atrial tachycardia
A fast rhythm that begins in the upper chambers of the heart, outside the usual pacemaker.
Atrium
One of the heart's two upper chambers, which receives returning blood.
Atropine
A drug that speeds up a heart that is beating too slowly, by removing the brake the nervous system keeps on it.
Auscultation
Listening to body sounds with a stethoscope, such as breath sounds in the chest.
Auto-PEEP
Pressure left in the lungs because the patient did not fully breathe out before the next breath.
Autonomic decompensation
Failure of the brain’s automatic vascular control as reserve is exhausted or herniation progresses. In the game, tone can become unstable before late failure favours vessel widening and falling resistance.
Autonomic integrity
How much of the brain’s automatic control of systemic blood vessel tone remains functional. In the mod it changes over time, separately from cerebral autoregulation, and also limits the compensatory ability of junctional vessels.
Autonomic tone
The TBI controller’s signed influence on systemic blood vessels, from −1 to +1. Positive favours tightening, zero is neutral, and negative favours widening; the value is an influence on resistance, not a blood pressure measurement.
AV node
The electrical relay between the upper and lower heart chambers. Slowing this relay can slow some fast rhythms.
Barometric pressure
The pressure of the surrounding air. It falls as altitude increases.
Barotrauma
Tissue damage caused by a pressure difference, including injury to the lungs during excessive pressure.
Benzodiazepine
A medication group that can calm, sedate and treat seizures.
Beta 1 receptor
A target for chemical signals that can increase heart rate and contraction strength.
Beta lactam
The largest family of antibiotics, including penicillins and cephalosporins. They kill bacteria by preventing them building a cell wall.
Bilateral
Present on both sides of the body.
Blast impulse
Pressure accumulated over the brief duration of a blast wave. The mod records an estimate; its main injury gates use effective peak pressure.
Bolus
A quick, measured amount of fluid or drug given all at once rather than dripped in.
Boyle's Law
For a fixed amount of gas at constant temperature, lower surrounding pressure permits a larger gas volume. Body structures and leaks can limit how trapped gas actually expands.
BPM
Beats per minute, the unit used for heart rate.
Bradycardia
A heart rate that is too slow. In a shocked casualty it usually means the body has run out of ability to compensate.
Bradypnea
Slow breathing.
Breacher’s syndrome
A term used for symptoms reported after repeated low level blast exposure, including headache, poor concentration, dizziness and sleep disturbance. It is not a single diagnostic test or a separate named disease state in the mod.
Broad spectrum
An antibiotic that covers many different bacteria rather than one specific type. The right choice when you do not know what is in the wound.
Bronchospasm
Tightening of the muscles around smaller airways, narrowing them and making airflow harder.
Buccal
Delivered against the inside of the cheek, where medication can be absorbed through the lining of the mouth.
BVM
Bag valve mask: a hand squeezed bag used to provide breaths. In the game, active bagging is a continuing provider action.
Cabin altitude
The effective altitude inside the aircraft. A helicopter has none, so the cabin is at whatever height it is flying.
Calcium chloride
A calcium containing medication. The mod uses delivered calcium to correct modeled calcium deficit and tracks excess exposure.
Calcium gluconate
A calcium containing medication with less elemental calcium per gram than calcium chloride. The mod accounts for this difference.
Cannulation
Getting a plastic tube into a vein so fluid and drugs can be given. Each failed attempt damages the vein and makes the next one harder.
Capillary refill
How long color takes to return after pressure is released from a fingertip or similar area. It is one clue about circulation.
Capnogram
The waveform drawn by a capnograph. It rises as carbon dioxide rich gas is exhaled and normally falls toward zero during inspiration.
Capnography
A continuous graph of carbon dioxide in breathing gas over time. Its height, baseline and shape help you assess exhalation, airflow and the measurement connection.
Cardiac arrest
Loss of effective circulation because the heart is not pumping useful blood flow.
Cardiac output
The amount of blood pumped over time. It depends on heart rate and the amount ejected with each effective beat.
Cardioselective
A drug that acts mainly on the heart and mostly leaves the lungs alone. It matters because non selective versions can close the airways of an asthmatic.
Cardioversion
An electrical shock timed to an organized heartbeat to treat an appropriate abnormal rhythm.
Catecholamine
A group of chemical messengers that includes epinephrine and norepinephrine. Their effects on the heart and blood vessels depend on the substance and dose.
Catheter
A small tube placed in the body. An IV catheter provides a route for fluid and medication into a vein.
CBRN
Chemical, biological, radiological and nuclear hazards.
Ceftriaxone
An antibiotic medication. Its card describes the routes and effects supported in the game.
Central pontine myelinolysis
Brain damage caused by correcting a sodium problem too quickly. It is the reason concentrated salt is given carefully rather than fast.
Cerebral
Related to the brain.
Cerebral autoregulation
The brain’s ability to adjust its vessels as blood pressure changes. Severe structural TBI reduces this reserve, making low pressure more damaging and excessive pressure more likely to add to ICP.
Chelate
To bind a substance chemically so less of it remains freely available.
Chronotropy
Anything affecting how fast the heart beats. Positive speeds it up, negative slows it down.
Citrate
A chemical used in stored blood to prevent clotting by binding calcium. Large transfusions can reduce the recipient's available calcium.
Clearance
How fast the body removes a drug. Poor circulation and other drugs can slow it, which makes a normal dose build up to a dangerous level.
Coagulation
The process of forming a blood clot.
Coagulopathy
Impaired blood clotting. It can make bleeding harder to control.
Colloid
A fluid with large molecules that stay inside blood vessels rather than leaking out. It holds volume better than salt water does.
Competitive antagonist
A drug that competes with something else for the same receptor and wins by outnumbering it. Give enough and it displaces whatever was there.
Compliance
How easily a lung expands. Lower compliance means less volume moves for the same pressure.
Contractility
How hard the heart squeezes on each beat, separate from how fast it beats or how full it is.
Contraindication
A reason a treatment should not be used or needs special caution.
Coronary
Related to the blood vessels that supply the heart muscle.
Coronary perfusion
Blood reaching the heart muscle itself. During CPR this is the thing chest compressions are trying to achieve, because a starved heart will not restart.
CPP
Cerebral perfusion pressure: effective pressure reaching the brain minus ICP. The game’s TBI recovery gate adds CPP minima of 55 mmHg for severe structural injury and 60 for critical injury; mild and moderate injury do not receive that added high CPP requirement.
CPR
Cardiopulmonary resuscitation: chest compressions and breathing support during cardiac arrest.
Crystalloid
A fluid containing dissolved small substances, such as salts. Saline and PlasmaLyte are examples; they add fluid without adding red blood cells.
Cumulative dose
The total amount given across repeated doses.
Curare cleft
A notch in the exhaled carbon dioxide plateau. In ACM Extended, the cleft shape is linked to spontaneous effort while the ventilator is connected; read it with the patient's breathing and support settings.
Cushing response
A raised ICP response that can support blood pressure while slowing the pulse and disturbing breathing. In ACM Extended, exhausted autonomic control can affect vascular resistance before the full vital sign pattern appears, and late failure can replace the initial pressure rise with collapse.
Cyanosis
A blue or dusky appearance of skin or visible tissue.
Dalton's Law
The pressure driving oxygen into the blood falls as you climb, even though the air is still 21 percent oxygen. A casualty who was borderline at ground level becomes hypoxic in the air.
Dead space
Air that is moved with breathing but does not take part in gas exchange.
Defibrillation
An electrical shock used to stop a shockable cardiac arrest rhythm.
Diaphoretic
Sweaty.
Diastole
The part of the heartbeat when the heart relaxes and fills with blood.
Diastolic pressure
The lower number in a blood pressure reading, measured between heartbeats.
Dimercaprol
A medication used for the mod's lewisite chemical exposure treatment.
Dissociation
A state where someone is disconnected from what is happening to them rather than asleep. Their eyes may be open and they keep breathing, but they are not present.
Dissociation curve
The S shaped relationship between oxygen pressure and how loaded the blood is. Its shape means a healthy person can lose a lot of pressure safely and a sick one cannot.
Distributive shock
Poor circulation caused partly by blood vessels losing their normal tone and distributing blood ineffectively.
Diuresis
Making someone produce a lot of urine. It removes water from the whole body, which is unhelpful if they are already short of volume.
Dyssynchrony
A mismatch between the patient’s breathing effort and the breaths delivered by the ventilator.
ECG
Electrocardiogram: a recording of the heart's electrical activity. It shows rhythm but does not confirm a pulse.
Ectopy
Extra heartbeats fired from the wrong place. A few are harmless, and a run of them can turn into a lethal rhythm.
Elemental calcium
The actual calcium contained in a calcium salt. Equal masses of different calcium salts do not contain equal amounts of calcium.
Emesis
Vomiting. In a casualty with a poor airway it is far more dangerous than it sounds, because what comes up can go down into the lungs.
Endobronchial
Inside one of the main branches of the windpipe. A tube placed too deeply can ventilate mainly one lung.
Epinephrine
A medication with heart rate and pressure effects. The mod has separate reference amounts and delivery rules for standard and measured push doses.
Ertapenem
An antibiotic medication with route specific timing in the game.
Esketamine
A ketamine related medication supplied as a nasal product in the game.
Esmolol
A medication that slows heart rate. The mod also models reduced pressure and dose related toxicity.
EtCO2
Carbon dioxide measured at the end of an exhaled breath. It is influenced by breathing, circulation and measurement conditions.
ETT
Endotracheal tube. The breathing tube that goes through the vocal cords into the windpipe. It is the most secure airway there is.
Expired tidal volume (VTe)
The volume of gas measured coming back out during one breath. A leak can make this lower than VTi even when the ventilator's set volume looks adequate.
External jugular (EJ)
A vein near the surface of the side of the neck. The mod provides a separate IV placement site here.
Extravasation
A drug leaking out of the vein into surrounding tissue. Harmless with some drugs and destructive with others.
Fentanyl
An opioid pain medication available in injectable and lozenge forms. The mod handles their doses and onset differently.
Fibrin
Protein strands that form the supporting mesh of a blood clot.
Fibrinolysis
The process that breaks down blood clots.
FiO2
The fraction of oxygen in the air being delivered, as a percentage. Room air is 21 percent, and this ventilator can enrich up to 95.
Fowler's position
Sitting with the upper body raised.
Frank Starling
The relationship between heart filling and the force of contraction, within limits. The mod uses a simplified volume based relationship to estimate stroke volume.
GABA A agonist
A drug that boosts the brain's main calming signal. The result is sedation, and at higher doses unconsciousness. Most sedatives work this way.
Gauge
The thickness of a needle or cannula. Confusingly, a lower number means a wider tube, and wider means faster flow.
Haemoglobin
The protein in red blood cells that carries oxygen. Lose blood and you lose carriers, so you can be fully saturated and still delivering almost nothing.
Half-life
The time it takes for half the drug to leave the body. Short means it wears off fast and needs repeating, long means a mistake stays with you.
Heart rate
The number of heartbeats per minute. A monitor may show electrical activity even when there is no effective pulse.
Hematocrit
The fraction of blood volume occupied by red blood cells.
Hemodilution
A lower concentration of blood cells after fluid is added to the circulation.
Hemorrhage
Bleeding, either outside the body or into an internal space.
Hemostasis
Stopping bleeding through vessel response, clot formation or treatment.
Hemothorax
Blood collecting in the space around a lung, usually from a torn vessel rather than the lung itself. It presses the lung down from below, so the casualty cannot fill it however hard the machine pushes, and the fix is to drain it rather than to raise the pressure.
Henry's Law
Gas dissolved in liquid comes out of solution as pressure falls, like opening a fizzy drink. It matters for anyone who has been diving recently.
Herniation
Brain tissue displaced by pressure inside the skull. The game tracks current and maximum stages; past progression can impose an acute recovery floor even after pressure improves.
Histamine release
Some drugs make the body dump histamine, which widens blood vessels and drops blood pressure. It is why morphine is a poor choice in someone who is bleeding.
Hyaluronidase
A local treatment for selected medication leak injuries in the mod. It is applied around the affected tissue.
Hypercapnia
Too much carbon dioxide in the blood, commonly from inadequate breathing.
Hyperkalaemia
An elevated potassium level in the blood. Large changes can disrupt the heart's electrical activity.
Hypernatraemia
Too much sodium in the blood. A risk when giving concentrated salt solutions, and correcting it too fast causes its own harm.
Hypertension
High blood pressure.
Hyperthermia
An abnormally high body temperature.
Hypertonic saline
A salt solution more concentrated than ordinary saline. The mod uses 3% saline for its brain pressure treatment system.
Hyperventilation
Breathing that removes carbon dioxide faster than the body produces it.
Hypnosis
Medication induced reduction in awareness or consciousness. It does not by itself describe pain relief or muscle paralysis.
Hypocalcaemia
A low level of available calcium. Calcium is needed for clotting, muscle contraction and other cell functions.
Hypocapnia
Less carbon dioxide in the blood than normal, often from breathing more than needed.
Hypoglycemia
Low blood sugar.
Hypokalemia
Low potassium in the blood. Potassium helps heart and muscle cells work electrically.
Hypoperfusion
Too little blood flow reaching the tissues.
Hypotension
Blood pressure that is low. Interpret it together with pulse, mental status, bleeding and other signs of blood flow.
Hypothermia
An abnormally low body temperature. In the mod, severe cooling affects clotting, circulation and medication response.
Hypoventilation
Breathing too little, so carbon dioxide builds up. Slow, shallow, or not often enough, and the casualty becomes acidic.
Hypovolaemia
Not enough blood or fluid in the circulation. Usually from bleeding, and it is the reason most trauma casualties are unstable.
Hypovolemic shock
Poor circulation caused by too little circulating fluid or blood.
Hypoxemia
Too little oxygen in the arterial blood. This differs from poor tissue oxygen delivery caused by inadequate blood flow.
Hypoxia
Not enough oxygen reaching tissue. Organs start failing, and the brain is the first to complain and the first to be permanently damaged.
I:E ratio
How long the machine spends pushing a breath in compared with letting it out. 1:2 means expiration lasts twice as long as inspiration. Too little expiratory time and the next breath starts before the last one has finished leaving, which stacks pressure in the chest.
Iatrogenic
Caused by the treatment rather than the injury. A pneumothorax you made with a needle is iatrogenic.
ICP
Intracranial pressure: pressure inside the skull. In ACM Extended it returns toward a normal baseline, usually 10 mmHg, as acute TBI resolves; recovery does not mean a target ICP of zero.
IM
Intramuscular: medication delivered into a muscle. It must be absorbed before reaching the bloodstream.
Infiltration
Fluid leaking from an IV into nearby tissue instead of entering the bloodstream.
Inhaled
Breathed into the lungs.
Inspired tidal volume (VTi)
The volume of gas delivered into the airway during one breath. On the ventilator, compare it with the expired volume, VTe, to see whether delivered gas is returning.
Intranasal
Delivered through the nose, usually as a spray or mist.
Intrathoracic pressure
The pressure inside the chest cavity. Raising it, which is what any ventilator does, makes it harder for blood to flow back into the heart.
Intubation
Placing a breathing tube into the windpipe to provide an airway for ventilation.
IO
Intraosseous. A needle drilled into bone marrow when a vein cannot be found. It works as fast as a vein and is far more reliable in shock.
Ionised calcium
The freely available form of calcium in blood, used in processes including clotting and muscle contraction.
Ischemia
Insufficient blood supply to a tissue, reducing the oxygen and nutrients it receives.
IV
Intravenous. Into a vein, which is the usual route for fluids and drugs when you can find one.
Jaundice
Yellow discoloration of skin or the whites of the eyes.
Ketamine
A medication used in the mod for pain relief and sedation, with different effects depending on dose and route.
Laminar flow
Smooth flow in layers. Poiseuille's relationship assumes this type of flow.
Laryngoscopy
Using a scope to see the opening of the windpipe during breathing tube placement.
Laryngospasm
A sudden tightening at the voice box that can block airflow.
Lateral recumbent
Lying on one side.
Lethal triad
Hypothermia, acidosis and impaired clotting occurring together in severe injury. The mod also tracks calcium deficit as a contributor to worsening bleeding and circulation.
Lidocaine
A medication used in the mod for selected ventricular rhythms and local pain treatment. Its effect depends on route and dose.
Local anesthetic
A medication that reduces sensation in a particular area.
Lumen
The hollow inside of a tube, catheter or blood vessel.
Magnesium sulfate
A medication used by the mod to treat torsades. The infusion effect develops as the medication is delivered.
Mannitol
A medication used to draw water out of swollen tissue. In the game its brain pressure effect depends on the delivery action and amount.
MAP
Mean arterial pressure: the average pressure in the arteries across a heartbeat. The game uses it in organ perfusion, but adequate MAP alone does not prove adequate oxygen delivery; TBI recovery requirements also depend on structural injury and ICP.
Mechanism of action
How a drug actually produces its effect at the level of the body's machinery, rather than what it is used for.
Metabolic
Related to chemical processes in the body's cells, such as using energy and producing waste.
Midazolam
A medication used for sedation and selected seizure treatments in the mod. It can reduce breathing and blood pressure.
Minute ventilation (MV)
The volume of air moved in one minute, usually expressed in L/min: breath volume multiplied by breathing rate. In this wiki, MV adequacy is a game support ratio rather than a volume in L/min.
Miosis
Small or narrowed pupils.
Morphine
An opioid pain medication. The mod also models reduced breathing and other dose related effects.
Mottled
Patchy changes in skin color, often seen when circulation is poor.
Mu opioid receptor
A cell target through which opioid medications produce effects including pain relief, sedation and reduced breathing.
Mydriasis
Large or widened pupils.
Myocardial
Related to the heart muscle.
Myocardial depression
Reduced strength of heart muscle contraction.
Naloxone
A medication that reverses opioid effects. Other causes of sedation or unconsciousness can remain.
NCD
Needle chest decompression. Putting a needle through the chest wall to let trapped air escape and relieve a tension pneumothorax.
Neuromuscular blocker
A drug that paralyses muscles. It does nothing for pain or awareness, so a casualty given one without sedation is awake and unable to move or tell you.
Neuromuscular junction
The connection where a motor nerve signals a muscle to contract. Blocking this signal can stop movement without reducing awareness.
Newtonian fluid
A fluid whose viscosity stays constant as its rate of flow changes. This is one assumption in the ideal Poiseuille equation.
NMDA antagonist
A substance that blocks a brain receptor involved in pain and awareness. Ketamine acts through this pathway; breathing can still be impaired, particularly with other medications.
Norepinephrine
A medication used to support blood pressure, mainly through increased vascular resistance in the reviewed game model.
Nystagmus
Rapid involuntary eye movements. In ACM Extended, pupil assessment can add this finding during ketamine dominant deep sedation under specific conditions.
Obstructive shock
Poor circulation caused by a physical obstacle to blood flow, such as pressure from a tension pneumothorax.
Obtundation
Reduced alertness while still awake. The game can apply visual, hearing and speech effects while the player retains movement.
Occlusion
A blockage that prevents normal flow.
Ondansetron
A medication used to reduce nausea and vomiting.
Opioid
A medication group used for pain relief that can also reduce breathing and alertness.
Oral
Taken by mouth and swallowed.
Osmotherapy
Using a concentrated fluid to pull water out of swollen brain tissue, which lowers pressure inside the skull.
Osmotic gradient
Water moving toward whatever is more concentrated. Put concentrated fluid in the blood and water is pulled out of swollen tissue into it.
OTFC
Oral transmucosal fentanyl citrate. A fentanyl lozenge absorbed through the cheek, used when there is no line. Slower and harder to control than an injection.
Overpressure
Pressure above the surrounding air pressure during a blast. The mod estimates it from charge, distance and nearby geometry.
Oxygen delivery
Oxygen reaching the tissues through the circulation. It is cardiac output multiplied by arterial oxygen content, so normal saturation alone does not establish adequate delivery.
P wave
The ECG wave representing electrical activation of the upper heart chambers.
PaCO2
The pressure of carbon dioxide in arterial blood. ACME tracks retained carbon dioxide separately from the exhaled EtCO2 reading.
Palpation
Checking by touch, such as feeling for a pulse or vein.
PaO2
The pressure of oxygen dissolved in arterial blood. It is different from the percentage of hemoglobin carrying oxygen.
Paracetamol
A pain medication delivered through a fixed product treatment action in the game.
Paralysis
Loss of muscle movement. A paralytic can stop breathing without providing pain relief or unconsciousness.
Partial pressure
The contribution of one gas, such as oxygen, to the total pressure of a gas mixture.
Patency
How open a passage is. An open airway permits airflow; an open IV line permits fluid flow.
PEEP
Positive end expiratory pressure: pressure maintained in the lungs between breaths. It can help keep air sacs open but can also reduce blood returning to the heart.
Penthrox
An inhaled pain relief product supplied through a treatment action in the game.
Perfusion
Blood actually reaching tissue and delivering oxygen to it. A casualty can have a pulse and still be perfusing badly.
Peripheral resistance
The resistance opposing blood flow through the body. The game combines several effects into a resistance value used to calculate blood pressure; its scale is not a clinical SVR measurement.
Permissive hypotension
Accepting a lower pressure while hemorrhage is uncontrolled to reduce pressure driven loss. In the game, this must be weighed against oxygen delivery and severity specific brain perfusion requirements, particularly the reduced reserve of severe or critical TBI.
PERRL
Pupils equal, round and reactive to light.
PFC
Prolonged field care: continued casualty care when evacuation is delayed.
Phentolamine
A local treatment for selected vasopressor leak injuries in the mod.
PIP
Peak inspiratory pressure. The highest pressure reached while pushing a breath in. A rising number means the lungs are getting stiffer.
Plasmin
The enzyme that dissolves clots. Useful for clearing old clot, and unhelpful when it dismantles the clot holding a wound shut.
Plasminogen
The inactive form of the clot dissolving enzyme, sitting in blood waiting to be switched on. Blocking that switch protects clot you have already made.
Plateau
The steady level a drug settles at when what you are giving matches what the body is removing. Raise the rate or slow the clearance and the plateau climbs.
Platelet
A small blood component that helps form a plug at an injured vessel.
Pleural
Related to the thin lining around the lung and the space between the lung and chest wall.
Pneumothorax
Air in the space between the lung and chest wall, which reduces lung expansion. Its effect depends on the amount of air and whether pressure is building.
Poiseuille’s law
An ideal laminar flow relationship: flow increases with pressure difference and the fourth power of internal radius, and decreases with viscosity and length. The assumptions limit direct application to living vessels and ventilator circuits.
Potassium channel
A gate in heart cells that controls how quickly the cell resets between beats. Blocking it lengthens the reset, which is how some rhythm drugs work.
PPV
Positive pressure ventilation: delivering breaths by pushing air into the lungs. In the mod, active support adds a filling penalty when circulating volume is low.
Precipitate
Two compatible looking fluids reacting in the line and forming solid particles. It blocks the line and can send solid material into the casualty.
Preload
The heart's filling and stretch before a contraction. ACME estimates its contribution from circulating volume and applies an additional penalty during positive pressure ventilation when volume is low.
Pressor
A drug that raises blood pressure, usually by tightening blood vessels. It moves the number without fixing why the number was low.
Pressure passive
A state in which cerebral blood flow and pressure follow systemic pressure more directly because local regulation is impaired. In severe TBI, more CPP is therefore not always protective: excessive pressure can add to ICP.
Prone
Lying face down.
Prophylaxis
Treatment intended to prevent a problem.
Propofol
A sedative that reduces awareness. The mod also models effects on breathing and blood pressure.
Pulsatile
Changing in pulses with each heartbeat.
Pulse pressure
The difference between systolic and diastolic pressure. For 120/80, pulse pressure is 40 mmHg.
Pulseless electrical activity (PEA)
Electrical activity appears on the monitor, but the heart is not producing an effective pulse. The game treats true PEA as having no mechanical cardiac output.
Pupillary
Related to the pupils, the openings in the eyes that change size in response to light.
QRS complex
The main spike on an ECG. It represents electrical activation of the lower pumping chambers.
QT interval
A measurement on the ECG of how long the heart takes to reset between beats. Stretch it too far and the heart becomes prone to a lethal rhythm called torsades.
R-R interval
The time between successive main ECG spikes. A shorter interval means a faster electrical rate.
Receptor
A target on or inside a cell that responds to a chemical signal or medication.
Refractory
Resistant to improvement, or temporarily less responsive to a new trigger, depending on context.
Refractory period
The brief time after electrical activation when heart cells cannot activate again normally.
Reperfusion
Restoring blood flow to tissue that previously received too little.
Repolarisation
The heart cell resetting electrically after a beat so it is ready for the next one. Slow it too much and the rhythm becomes unstable.
Respiratory depression
Breathing that becomes slower or less effective, sometimes because of medication.
Respiratory drive
The body's signal to take breaths. Sedatives, opioids and injury can change it.
Respiratory rate
The number of breaths taken or delivered in one minute.
Rocuronium
A medication that blocks muscle movement, including breathing. It provides neither pain relief nor unconsciousness.
ROSC
Return of spontaneous circulation. The heart starting to beat on its own again after cardiac arrest, which is the goal of everything you do during CPR.
RSI
Rapid sequence intubation. Giving a sedative and a paralytic together to place a breathing tube quickly and safely.
RVR
Rapid ventricular response. The lower chambers of the heart beating too fast because the upper chambers are firing chaotically. The heart pumps poorly at that rate.
Scleral icterus
Yellow discoloration of the whites of the eyes.
Secondary insult
An additional burden on the injured brain after the original trauma, such as inadequate oxygen delivery, poor perfusion or retained carbon dioxide. Preventing these insults allows the game’s acute TBI burden to recover when its other gates are met.
Sedation
Medication induced reduction in alertness, ranging from drowsiness to unconsciousness. Pain relief and paralysis are separate effects.
Semi-Fowler's position
Lying with the head and upper body partly raised.
Sepsis
A harmful body wide response to infection that can impair organ function.
Serum level
The concentration of a substance in the liquid portion of blood. The wiki's medication graphs show a relative game effect envelope, not a measured blood concentration.
Shunt
Blood flowing past parts of the lung that are not working, so it comes back still unoxygenated. Giving more oxygen barely helps, because the blood never meets it.
Simple pneumothorax
Air between the lung and chest wall that reduces lung expansion without the pressure effects of tension pneumothorax.
Sinus rhythm
A rhythm started by the heart's normal pacemaker. It can still be too fast or too slow for the patient's condition.
Sodium channel
The gate that starts each heartbeat's electrical signal. Blocking it slows conduction, which suppresses extra beats coming from damaged muscle.
SpO2
An estimate of the percentage of hemoglobin carrying oxygen. It does not measure the amount of hemoglobin present or the blood flow reaching tissues.
Stroke volume
The amount of blood pushed out by a lower heart chamber with each effective beat. The game uses simplified filling based estimates in its pressure and oxygen delivery calculations.
Structural severity
The lasting record of brain injury severity, used to set remaining reserve and pressure requirements. It can stay elevated after acute symptoms resolve, without itself continuing to produce raised ICP or unconsciousness.
Sugammadex
A medication that binds available rocuronium and reduces its paralytic effect. In the mod, reversal depends on the amounts and active effects of both drugs.
Supine
Lying flat on the back, face up.
Supraventricular tachycardia (SVT)
A fast rhythm that starts above the lower pumping chambers of the heart. In this guide, SVT means the mod's specific regular fast rhythm.
Sympathetic outflow
Nerve signals that help the body respond to stress, including changes in heart rate and blood vessel tone.
Sympathomimetic
A drug that mimics the fight or flight response. Raises heart rate, blood pressure and alertness.
SYNC
Synchronization mode: times a shock to a detected heartbeat. The game uses it for cardioversion of suitable organized fast rhythms.
Systemic
Affecting the body through the circulation, rather than only the place where treatment was applied.
Systemic vascular resistance
Resistance to blood flow through the systemic circulation. Arteriolar narrowing increases it; a maintained blood pressure can coexist with reduced cardiac output.
Systole
The part of the heartbeat when the heart contracts and pushes blood out.
Systolic pressure
The upper number in a blood pressure reading, measured during the pumping part of the heartbeat.
T wave
The ECG wave showing the lower heart chambers resetting electrically after a beat.
Tachyarrhythmia
An abnormal heart rhythm that is fast.
Tachycardia
A heart rate that is too fast. Often the first sign of blood loss, because the body speeds up to make up for smaller beats.
Tachyphylaxis
A decreasing response to repeated doses over a short period. The same dose can produce less effect.
Tachypnea
Fast breathing.
TBI
Traumatic brain injury: injury to the brain caused by trauma. ACM Extended separates lasting structural severity from active acute burden, which can improve when pressure, oxygen delivery and ventilation are adequate.
TCCC
Tactical Combat Casualty Care: a framework for treating casualties in a tactical setting.
Tension pneumothorax
Air building up in the chest with no way out, squashing the lung and the heart. It is rapidly fatal and is fixed with a needle or a tube.
TFC
Tactical field care: casualty treatment during the tactical phase after immediate fire related danger is addressed.
Therapeutic window
The range between a useful medication exposure and one likely to cause harmful effects.
Thoracostomy
An opening through the chest wall into the space around the lung, used to release trapped air or fluid.
Tidal volume
The size of one breath, measured in millilitres. Too small and they build up carbon dioxide, too big and you tear the lung.
Titrate
Adjust a medication dose or delivery rate in steps while reassessing its effect.
Torsades de pointes
A specific lethal rhythm where the ECG trace twists around the baseline. It is caused by a stretched QT interval, and magnesium is the treatment.
Toxicity
Harmful effects caused by a substance or medication.
Tranexamic acid (TXA)
A medication that reduces clot breakdown. It supports bleeding treatment but does not close a wound or replace lost blood.
Trendelenburg
A position with the head lower than the legs.
Turbulent flow
Flow with irregular mixing and swirls. It does not follow the simple laminar flow relationship.
Tympanic injury
Injury involving the eardrum. The mod records this at a configured blast pressure threshold.
Unilateral
Present on one side of the body.
Vasoconstriction
Narrowing of blood vessels as their smooth muscle contracts. Arteriolar constriction raises resistance; venous constriction can support venous return.
Vasodilation
Blood vessels widening. The pipes get bigger, so pressure falls even though the amount of blood has not changed.
Venous return
Blood flowing back to the heart through the veins.
Ventricle
One of the heart's two lower pumping chambers. The right sends blood to the lungs; the left sends it to the body.
Ventricular fibrillation (VF)
Chaotic electrical activity in the lower heart chambers that prevents effective pumping. This is a shockable cardiac arrest rhythm in the game.
Ventricular tachycardia (VT)
A fast rhythm starting in the heart's lower pumping chambers. A patient may have a pulse or may be in cardiac arrest, so check directly.
Vesicant
A drug that damages tissue if it leaks out of the vein. The injury develops over hours, so a bad line causes a problem you find out about later.
Viscosity
How strongly a fluid resists flowing. A more viscous fluid needs more pressure to move through the same tube.