ACM EXTENDED / QUICK REFERENCE

Printable quick reference

Medication, ventilator, access, rhythm and TBI charts for a second screen or a printed reference beside you.

Medication chart

All 33 medication entries, including the clearly marked unavailable legacy entry. Names link to their full cards.

ACM EXTENDED · ARMA 3 GAME REFERENCE

Cardiac & resuscitation

M1 / 3

IV intravenous · IO intraosseous · IM intramuscular · IN intranasal · INH inhaled · PO oral · BUC buccal
Reference amounts are game model amounts, not safe maxima. Weight examples use 83 kg. Check Hardcore push timing, breathing and pressure before repeating.

Medication	Use	Route	Stock / concentration	Game reference / action	Key cautions
Adenosine	Regular SVT with a pulse	IV IO	12 mg / 4 mL 3 mg/mL	6 mg (2 mL); deliver over 5 s for the modeled rapid push	Flush when required. Not for AFib, VT or a fast sinus rate.
Amiodarone	VF / pulseless VT support; AFib RVR, AT or SVT	IV IO	150 mg / 3 mL 50 mg/mL	150 mg reference; 150 mg / 10 min = 15 mg/min	Fast delivery lowers BP. Cumulative ≥2.2 g can contribute to torsades.
Atropine	Raise HR; sarin effect treatment	IV IO IM	1 mg / 1 mL 1 mg/mL	1 mg IV / IO; 2 mg IM reference	Sarin reversal depends on active effect. One reference dose may not reverse exposure.
Epinephrine	Arrest support; measured pressor support	IV IO IM	1 mg / 1 mL 1 mg/mL	1 mg IV / IO; 0.3 mg IM reference These are NOT push dose amounts.	Push dose action uses mcg. Monitor HR/BP and leakage; excess can trigger AT/SVT.
Epinephrine, cardiac vial	Arrest support; dilute mixture source	IV IO	1 mg / 10 mL 100 mcg/mL	Full vial = 1 mg. Mixing 1 mL + 9 mL saline makes 10 mcg/mL.	Do not confuse this with the 1 mg/mL vial: a tenfold concentration difference.
Esmolol	AFib RVR control; AT / SVT; HR reduction	IV IO	100 mg / 10 mL 10 mg/mL	0.5 mg/kg reference = 41.5 mg at 83 kg	Premix: 2.5 g / 250 mL, not a bolus. Accumulation can cause bradycardia / hypotension.
Lidocaine	VT with pulse; VF / pulseless VT support; local anesthesia	IV IO IM / local	100 mg / 5 mL 20 mg/mL	Cardiac: 1 mg/kg = 83 mg at 83 kg Separate IM/local reference: 100 mg	Shock and esmolol reduce clearance. Toxicity can cause seizures, apnea and arrest.
Magnesium sulfate	Torsades termination and suppression	IV infusion IO infusion	2 g / 50 mL 40 mg/mL	2 g reference; finite premixed bag	Reassess rhythm. Excessive delivery rate lowers HR/BP; leaking fluid injures tissue.
Norepinephrine	Titrated pressure support	IV infusion IO infusion	4 mg / 4 mL 1 mg/mL	Model start: 0.05–0.1 mcg/kg/min At 83 kg: 4.15–8.3 mcg/min	4 mg is a mixture amount, NOT a patient dose. Assess volume, pressure and line integrity.
Calcium chloride	Hypocalcemia; blood product resuscitation	IV IO	1 g / 10 mL 100 mg/mL	1 g (10 mL) reference 273 mg elemental calcium	Vesicant. Excess calcium or fast delivery can cause bradycardia, hypotension and arrest.
Calcium gluconate	Calcium replacement	IV IO	5 g / 50 mL 100 mg/mL	3 g (30 mL) reference 279 mg elemental calcium	Both salts add to the same calcium burden. Compare elemental amounts; watch the site.

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Analgesia, sedation & paralysis

M2 / 3

Medication	Use	Route	Stock / concentration	Game reference / action	Key cautions
Fentanyl	Analgesia; adjunct to a sedative	IV IO IM	500 mcg / 10 mL 50 mcg/mL	1 mcg/kg reference = 83 mcg at 83 kg	Respiratory depression. Opioids add together; pain relief is not adequate hypnosis.
Morphine	Analgesia; adjunct to a sedative	IV IO IM	10 mg / 2 mL 5 mg/mL	0.1 mg/kg reference = 8.3 mg at 83 kg	Reduced breathing, HR and BP. Poor perfusion reduces IM effect; allow for timing.
Ketamine	Analgesia; dose dependent hypnosis	IV IO IM	500 mg / 10 mL 50 mg/mL	Analgesia: 0.2 mg/kg IV or 0.75 mg/kg IM Induction at full effect: ~1.75 mg/kg IV or 4.375 mg/kg IM	Default induction model, not an instant response. Nystagmus supports sedation assessment; monitor breathing/BP.
Midazolam	Sedation; lidocaine toxicity seizure suppression	IV IO IM	5 mg / 5 mL 1 mg/mL	5 mg IV / IO; 10 mg IM reference	More may be needed as lidocaine burden rises. Stacking depresses breathing and BP.
Propofol	Hypnosis and maintenance sedation	IV IO	500 mg / 50 mL 10 mg/mL	100 mg reference at 83 kg; scales with weight	No analgesia. Monitor ventilation and BP, especially with opioids or depleted reserve.
Rocuronium	Neuromuscular blockade	IV IO	100 mg / 10 mL 10 mg/mL	1 mg/kg reference = 83 mg at 83 kg	Paralysis provides NO sedation or analgesia. Support ventilation; assess hypnosis before and during paralysis.
Sugammadex	Reverse rocuronium blockade	IV IO	500 mg / 5 mL 100 mg/mL	Binding calibration: 16 mg/kg for up to 1.2 mg/kg available rocuronium	100 mg is a model unit, not a complete reversal dose. Smaller amounts give proportionate binding capacity.
Esketamine	Analgesia without vascular access	IN	50 mg atomizer	One atomizer = one fixed product dose	Adds to shared sedation. Nausea; combined ketamine-family exposure can depress breathing.
Fentanyl lozenge	Analgesia in an awake patient	BUC	Fixed product	One lozenge treatment action	Patient sitting or lying. Adds opioid burden; monitor breathing and nausea.
Penthrox	Brief analgesia in an awake patient	INH	Inhaler product	One treatment use; reassess before repeating	Repeated uses add exposure. Satisfactory pain relief does not prove ventilation is adequate.
Paracetamol / acetaminophen	Milder pain with a suitable oral route	PO	Pack / tablet product	One available pack/tablet treatment use	Fixed game product units, not an injectable mg reference. Treat the underlying injury.

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Adjuncts, osmotherapy & local rescue

M3 / 3

Medication	Use	Route	Stock / concentration	Game reference / action	Key cautions
Ammonia inhalant	Wake-up attempt with stable vitals	INH, head	Inhalant product	One treatment use	No extra wake-up roll within 10 s. Correct the cause of unconsciousness.
Naloxone	Opioid effect / overdose reversal	IN	4 mg / 0.1 mL	One nasal spray treatment action	Support breathing. Other sedatives remain active; a new opioid dose can cause renewed effects.
Ondansetron	Medication related nausea	IV IO IM	4 mg / 2 mL 2 mg/mL	4 mg (2 mL) reference	Does not remove aspiration risk, airway obstruction or drug toxicity.
Tranexamic acid (TXA)	Clot stability; external / internal bleeding control	IV IO	1 g / 10 mL 100 mg/mL	1 g (10 mL) reference	Continue pressure, dressings, packing and volume treatment. No separate TXA toxicity cutoff is defined here.
Ceftriaxone	Antibiotic effect family	IV IO IM	1 g / 10 mL 100 mg/mL	1 g (10 mL) reference	Uses the ertapenem effect family in the reviewed game data.
Ertapenem	Antibiotic care	IV IO IM	1 g / 3.2 mL 312.5 mg/mL	1 g reference	No separate drug-specific adverse syndrome in the reviewed path.
Hyaluronidase	Local rescue for eligible irritant extravasation	Local infiltration	150 units / 1 mL	150 units full reference; smaller amounts add within 90 s	For calcium, amiodarone, magnesium, esmolol, HTS or mannitol injury. Use the affected site.
Phentolamine	Local rescue for pressor extravasation	Local infiltration	5 mg / 1 mL 5 mg/mL	5 mg full reference; smaller amounts add within 90 s	For epinephrine/norepinephrine injury. Systemic syringe delivery has different effects and can lower BP.
Hypertonic saline 3%	Raised ICP with modeled TBI	IV infusion IO infusion	250 mL bag 30 mg/mL; 7.5 g total	250 mL reference	Raises sodium; benefit limited by sodium ceiling. Bag and dedicated push effects differ.
Mannitol	Raised ICP with modeled TBI	IV infusion IO infusion	20%, 500 mL bag 200 mg/mL; 100 g total	500 mL reference	Adds no sodium, but shares the sodium ceiling gate. Watch local leakage and perfusion.
DimercaprolNOT IN GAME	NOT IN GAME	Unavailable	Legacy artwork only	No usable in-game dose	UNAVAILABLE. Do not select it as part of a treatment plan.

Dedicated osmotherapy pushes: 23.4% HTS, 30 mL: about 0.96 mmHg ICP reduction and +0.36 mEq/L sodium. Mannitol 20%, 50 g push item: about 0.8 mmHg ICP reduction, no sodium rise. Both complete in 6 s and share the sodium ceiling gate; these are game action results, not the full-bag response.

Ventilator chart

Six common situations with starting references and what to reassess.

ACM EXTENDED · ARMA 3 GAME REFERENCE

Ventilator settings & reassessment

V1 / 1

Starting references from Ventilator Settings & Tips. Select settings by the modeled injury and reassess the actual response.

Pattern	Mode / priority	PEEP cmH2O	FiO2	Volume / timing	Why / reassess
Healthy lung needing support	SIMV VC PS	5	21–40%	VTi 6–8 mL/kg I:E 1:2	Supports reduced drive. Follow delivered VTe, MV and patient effort.
Pulmonary edema	SIMV VC PS; supported spontaneous path may use CPAP	10–15	40–60%	VTi 6–8 mL/kg I:E 1:2 to 1:1.5	PEEP recruits lung units. Watch perfusion, PIP and VTe; treat the fluid problem.
Blast lung / ARDS	SIMV PC starting option	5–8	60–95%	VTe 5–6 mL/kg reference I:E 1:1.5	Adjust PInsp to delivered volume. Healing depends on support, FiO2 and pressure, not the mode name alone.
Pneumothorax	Chest assessment / drainage first; then support as indicated	5 reference after effective drainage	As needed	VTi 6 mL/kg reference I:E 1:2	PEEP cannot remove pleural air. Positive pressure can increase leakage; follow chest findings and perfusion.
Hemothorax	Assess drainage AND circulating volume	5 reference	As needed	VTi 6 mL/kg reference I:E 1:2	Pleural blood and lost blood volume are separate problems. PEEP does not drain the chest.
Active CPR	IMV VC (CPR)	0	Per available support	10 breaths/min VTi 6 mL/kg, bounded 300–500 mL	Triggering off; unsynchronized breaths. These are configurable defaults. Reassess after ROSC.

Read delivered ventilation

VTi = inspiratory tidal-volume target; VTe = delivered exhaled volume. MV = minute ventilation. Example: 0.5 L × 12 breaths/min = 6 L/min before delivery limitations.

Sedation before paralysis

Ketamine-associated nystagmus supports the sedation assessment. Rocuronium prevents movement but provides no hypnosis or analgesia. Reassess sedation during ventilation.

SpO2 is only part of the picture

A high saturation does not prove adequate oxygen delivery during blood loss. Falling peripheral perfusion also makes the reading less dependable. Assess pulse, pressure, chest, EtCO2 and volume.

IV / IO chart

Gauge choice, site selection, vesicants and a compact delivery check.

ACM EXTENDED · ARMA 3 GAME REFERENCE

Vascular access & delivery

A1 / 1

Critical patient: establish IO early for urgent medication access. Preserve useful IV sites for independently attached bags. Only one bag can use a site at a time.

Access	Base capacity / margin	Choose when	Important limitation
14G IV	375 mL/min · 0.65× target	High flow is needed and a large, usable vein supports it.	Tightest insertion margin; oversized attempts add penalties.
16G IV	250 mL/min · 0.85× target	Substantial fluid capacity with a suitable vein.	Still needs vein size; oversized for the modeled popliteal target.
18G IV	125 mL/min · 1.15× target	A more forgiving target and moderate flow meet the need.	Half the configured 16G flow before other limits.
20G IV	87.5 mL/min · 1.35× target	Successful placement in a small/difficult vein is the priority.	Lowest IV capacity. Repeated attempts must not delay IO in a critical patient.
IO	Urgent medication route	Poor peripheral access; critical patient; reserve IVs for fluid.	Avoids the peripheral IV leak model, but not systemic drug effects or every cause of stopped delivery.

Choose the site

Palpate a usable vein. Low pressure narrows peripheral targets. After a missed or removed IV, move above the damaged site, use another limb, or choose IO. The same tier alone does not prove safe placement.

Vesicants change the plan

Pressors, calcium and other irritants can damage tissue if they leak. IO is useful for urgent pushes. Upper IVs and EJ are not immune. Reassess pain, bruising and delivery at the exact site.

Check what reaches the patient

Remove the constricting band. Select the correct site and open the clamp. Flush when required. Bag loss can exceed admitted volume; watch the patient, not just the bag counter.

Drip calculation: mL/min = gtt/min ÷ gtt/mL. Drug/min = concentration × actual admitted mL/min. Example: 30 gtt/min ÷ 60 gtt/mL = 0.5 mL/min. At 10 mcg/mL, this is 5 mcg/min before delivery losses.

Cardiac rhythm chart

All 13 monitor examples alongside the treatment category.

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Rhythm recognition & pulse check

R1 / 1

Check the pulse: a monitor trace cannot prove perfusion. These are six-second game examples, not calibrated ECG recordings. SYNC = synchronized cardioversion.

Sinus rhythm

ECG example75 BPM example

Regular P waves, narrow QRS complexes and T waves. Confirm perfusion with a pulse check. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Confirm a pulse; assess perfusion and cause.

Sinus bradycardia

ECG example45 BPM example

The same sinus morphology with more time between beats. Check the pulse and pressure. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Slow sinus rate. Assess perfusion and reversible causes.

Sinus tachycardia

ECG example130 BPM example

The game compresses the sinus complex at this rate. The underlying cause still determines perfusion. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Treat the cause; do not equate all fast rates with SVT.

Atrial fibrillation

ECG example90 BPM nominal example

Uneven beat spacing and a fibrillatory baseline. The rate is a nominal example; individual intervals vary. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Irregular rhythm. Assess rate, stability and perfusion.

AFib with RVR

ECG example150 BPM nominal example

Fast, uneven beat spacing with a fibrillatory baseline. Assess whether the patient remains perfusing. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Assess stability; rate control or appropriate synchronized treatment.

Atrial tachycardia

ECG example185 BPM example

Regular narrow complexes with a small atrial deflection before the main spike. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Organized tachyarrhythmia. Confirm pulse; assess SYNC treatment.

SVT

ECG example190 BPM example

Regular, rapid narrow complexes. The trace does not determine whether pressure is adequate. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Regular fast rhythm. Adenosine targets this with a pulse.

VT with a pulse

ECG example230 BPM example

Broad ventricular complexes. This example has a pulse; pulse assessment determines the treatment path. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Pulse separates this from arrest. Assess SYNC treatment.

Pulseless VT

ECG example230 BPM electrical example

The same broad waveform can occur without a pulse. This example is cardiac arrest. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Shockable arrest: CPR, ventilation, defibrillation; SYNC off.

Ventricular fibrillation

ECG exampleNo organized rate

Chaotic activity without consistent QRS complexes. A displayed electrical number would not be a pulse. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Shockable arrest: CPR, ventilation, defibrillation; SYNC off.

Torsades

ECG example220 BPM electrical example

Established torsades after its entry transition: complexes change shape, amplitude and polarity. The patient is pulseless throughout the entry stage too. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Game shockable arrest path; magnesium and reversible causes.

PEA

ECG example80 BPM electrical example

Organized abnormal complexes with no mechanical pulse. PEA can have several appearances; the monitor alone cannot diagnose perfusion. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Electrical activity without a pulse. CPR; no defibrillation.

Asystole

ECG example0 BPM

Low baseline noise without organized complexes. Reassess the patient and monitor connection. Hover, tap or enter a time to inspect. Vertical scale is relative, without mV calibration.

Nonshockable arrest. CPR, ventilation and correct causes.

Before choosing a treatment

Pulse first. Then stability and rhythm. Motion/CPR artifact and a brief post-shock trace can mislead. Reassess after the transient clears.

TBI chart

Structural injury, recovery gates and the link between autonomic failure and hemorrhage.

ACM EXTENDED · ARMA 3 GAME REFERENCE

TBI recovery & autonomic response

T1 / 1

Structural severity: lasting injury history that sets available reserve. Acute severity: active burden that can improve. Stable mild/moderate injury can resolve its acute burden to zero; history can remain without continuing to drive ICP. ICP returns toward its normal 10 mmHg baseline, not zero. Prior herniation can impose a lasting acute severity floor.

Structural grade (S)	Direct hypotension floor	Recovery MAP minimum	Recovery CPP minimum
Mild · S ≤ 0.35	60 mmHg	65 mmHg	No added minimum
Moderate · 0.35 < S ≤ 0.60	60–65 mmHg	65 mmHg	No added minimum
Severe · 0.60 < S ≤ 0.80	65–75 mmHg	65–75 mmHg	55 mmHg
Critical · 0.80 < S ≤ 1.00	75–85 mmHg	75–85 mmHg	60 mmHg

Read the ranges: thresholds rise continuously with structural severity inside each band. Recovery MAP minimum = the greater of 65 and the hypotension floor. Below the recovery gate, low CPP can still add injury. Brain CPP = effective brain MAP − ICP. Head elevation subtracts 6 mmHg from MAP in this check; the debug CPP display uses unadjusted MAP. These are game defaults, not universal MAP 85 / CPP 70 requirements.

Recovery needs every gate

Meet the grade’s MAP and CPP gates, ICP ≤ 25 mmHg, SpO2 ≥ 90%, ventilation ratio ≥ 0.9, and no active oxygen-delivery deficit. New insults can still add burden; Perfusion OK alone does not prove recovery.

Normal SpO2 is not enough

The modeled oxygen-delivery deficit starts below 70% and clears at 78% or higher. Hemorrhage can prevent brain recovery despite normal saturation. Restore delivery and assess volume, pressure and ventilation together.

Reserve still matters

Mild autoregulation is essentially preserved; moderate impairment is small. Severe/critical injury keeps less reserve. Low CPP becomes more damaging; excessive CPP can add ICP as autoregulation fails. A higher number is not always better.

Autonomic state	Systemic effect	Custom junctional bleeding connection
Stable injury	TBI tone near neutral.	No fixed TBI bleeding multiplier. Treat the wound and assess delivery.
Rising ICP / compensation	Positive tone supports vasoconstriction, resistance and MAP.	Higher peripheral resistance reduces junctional flow, other factors equal.
Reserve failing	Tone becomes labile; constriction and dilation can alternate.	Compensatory vessel spasm weakens as autonomic integrity falls. Full Cushing vitals are not required.
Advanced / terminal failure	Negative tone and dominant vasodilation can lower resistance and MAP.	Lower resistance permits more junctional flow; reassess bleeding and perfusion together.

Autoreg = cerebral autoregulation. Auto = systemic autonomic integrity / signed tone (−1 to +1). Junctional compensation ability = 25% + 75% × integrity. This scales available compensation, not bleeding directly. Signed tone already acts through systemic resistance and is not applied again inside the junctional equation.