Obtunded states
Recognize partial impairment, identify its cause and distinguish recovery from a brief response to stimulation.
What the player experiences
An obtunded player remains awake in the medical state system but has reduced awareness. Effects include fluctuating blur, dimming at the edge of vision, brief eyelid closures, muffled sound and altered speech when supported. Short lucid intervals can temporarily improve the effects.
The current state allows normal movement and weapon inputs. Starting a sprint while moving can cause a brief fall, with a default 35% chance per eligible sprint attempt. Simply entering the state does not force a particular posture. Actual medical unconsciousness takes over if the patient deteriorates.
Automatic entry and recovery
These checks apply to living players when physiological obtundation is enabled. The master option is off by default under Addon Options > ACM Extended: Trauma > 2. Obtundation. Either oxygenation or perfusion can trigger entry; recovery requires both to improve.
| Condition | Default behavior |
|---|---|
SpO2 from 70% to below 88% | Starts the entry timer |
MAP from 55 to below 65 mmHg | Starts the entry timer |
Continuous time in an entry band | 8 seconds; leaving the band resets the timer |
SpO2 below 83% or MAP below 59 mmHg | Immediate entry at the next evaluation, provided the patient has not crossed into unconsciousness or the critical range |
SpO2 at least 92% and MAP at least 70 mmHg | Allows recovery; an active treatment can delay this transition |
After recovery | 45-second recovery window. Ordinary re-entry needs 20 continuous seconds; the profound trigger can still act |
SpO2 below 70%, MAP below 55 mmHg, cardiac arrest or actual unconsciousness | Obtundation releases control to the underlying medical systems. These thresholds do not describe every cause of unconsciousness |
Zeus induced obtundation | Manual state is excluded from automatic physiological recovery; use the module again to clear it |
Assessment and treatment
- Check response, airway, breathing, pulse, blood pressure and SpO2. Look for hemorrhage and head injury.
- Correct the cause: control bleeding and restore perfusion, or correct airway and breathing problems.
- Reassess after treatment. A lucid interval, clearer speech or a brief wake-up response does not prove that oxygenation and circulation have recovered.
- Use the head injury reference for abnormal pupils or a worsening neurological examination.
Resolved concussion versus renewed impairment
Stable mild or moderate TBI can resolve its acute burden while structural injury remains in the history. That history alone no longer keeps producing unconsciousness or deterioration. Renewed impairment still needs reassessment for poor perfusion, oxygen delivery, ventilation, rising ICP or a new injury.
Sources and revision
TBI behavior checked at ACM Extended dev revision 98d18bb: acute recovery and structural history.
Ammonia and fracture pressure awakening
A new ammonia inhalant use can rapidly end obtundation when vital signs are stable and no condition forces unconsciousness. It gives a default 20-second stimulus grace period. Persistent hypoxia or shock can still cause deterioration later.
Applying direct pressure over a fractured limb can immediately wake an eligible lightly unconscious or obtunded patient. The action adds severe pain, then checks stable vital signs and the same forced unconsciousness gate used by ACM wake-up actions. The probability scales with SpO2. It does not override deep sedation or another forced unconscious state.
The fracture stimulus has an 8-second per limb cooldown and an 8-second wake stimulus grace period by default. It adds pain without generating artificial fracture damage or bleeding. A woken patient remains lying until the appropriate get up action. Use pressure for bleeding control and account for this pain response when a fracture is present.
Sources and revision
Game mechanics checked against ACM Extended source 4848f63. Values below are game defaults and can change with mission settings. Entry and recovery · Player effects · Fracture stimulus
Sources and revision
Game mechanics checked against ACM Extended source 4848f63. Values below are game defaults and can change with mission settings. Configured entry bands