Medical Overhaul
Neurotrauma
Replaces Barotrauma's simple health bar with organ-by-organ physiology: bleeding, fractures, infection, combustion, drug interactions, and surgery up to organ transplants. Conditions must be diagnosed and treated correctly — the wrong drug, or too much of the right one, kills the patient.
Requires LuaCsForBarotrauma
Medical
Bots can't treat
Fork (actively maintained)
- What it is
- A total overhaul of human health. The actively-maintained fork (by "guns" & "Lukako"); original concept by Mannatu.
- Dependency
- LuaCsForBarotrauma required. In MP it runs server-side; client-side LuaCs is needed for single-player/sub editor. Many players also run BetterHealthUI for a usable health panel.
- Load position
- Low in the list, below Enhanced Reactors & Immersive Repairs. Incompatible with any non-patch mod that overwrites
Human.xml or vanilla medicine.
- Configure
- ESC menu → "Neurotrauma". There's an official training map (Mercy Hospital) and a community Trello "fork guide" to practise with.
- Big caveat
- Bots will not treat injuries. A human medic is mandatory in MP. You also can't open the health menu of someone lying on a bed (known base-game interaction).
Numbers caveat: exact drug strengths, skill thresholds and crafting recipes below come from community guides/wiki and may lag the current build. Use them as direction; the in-game medical fabricator and ESC config are authoritative. Anything I couldn't confirm is marked like this.
❖The core survival model (read this first)
Neurotrauma feels overwhelming until you understand that almost nothing kills directly. Two things do the actual killing, and everything else is either a symptom or an easy fix:
- "Neurotrauma" (the affliction) is the central kill-switch. It deals direct vitality damage and instantly kills at 200%. It's one of the only afflictions that does direct damage, so it is always fixed first. Treat with Mannitol + time, and fix its cause.
- Hypoxemia (low blood oxygen) is the most common driver of neurotrauma and is easy to fix. Fix the oxygen problem and neurotrauma stops climbing.
The death spiral to recognise
Low blood / low blood pressure / low O₂ → hypoxemia → cardiac arrest + unconsciousness → cardiac arrest worsens hypoxemia → neurotrauma climbs → death at 200%. CPR or an Autopulse breaks the cardiac-arrest end of the loop while you fix the underlying cause (oxygen + blood volume).
Blood pressure targets ~100%. Below ~80% is Hypotension; above ~150% is Hypertension. Read it with the health scanner or hematology analyzer. Don't panic — delay is what turns a survivable wound into total organ failure. A single gunshot is usually ~30 seconds of surgery.
◎Diagnosis workflow & avoiding over-medication
1
Stabilise
Bag a critical patient (Stasis Bag), get them to a surgery table, tourniquet any limb artery bleeds.2
Scan
Use the Health Scanner for afflictions, organ damage and blood pressure. If symptoms appear with no visible cause, it's usually a blood issue → use the Hematology Analyzer (acidosis / alkalosis / sepsis / blood type).3
Prioritise
Neurotrauma/hypoxemia first → stop bleeding → restore blood volume → restart heart/breathing → then chase organ damage and symptoms.4
Don't over-medicate
Antibiotics, mannitol and liquid oxygenite all damage organs; stimulants add neurotrauma/psychosis/addiction; opiates add overdose + addiction; mannitol does nothing below 70% blood pressure. Use the minimum effective dose, pair organ-damaging drugs with Thiamine, match blood type before transfusing, and remove the Autopulse once stable (it causes hypertension if left on).⚠Afflictions reference
Format: cause → how you detect it → how you treat it. "Open-and-close surgery" means the generic sequence Painkiller → Scalpel → Hemostat → Skin Retractors → (work) → Suture.
Brain & neurological
| Affliction | Cause | Treatment |
|---|
| Neurotrauma | Stroke, liver/kidney damage, sepsis, skull fracture, hypoxemia, a tourniquet on the head, toxins (lead, meth). Death at 200%. | Mannitol + time; fix the cause (usually hypoxemia). Mannitol has no effect below 70% BP and overuse damages organs. NT Surgery Plus adds "Mannitol Plus" that heals neurotrauma directly. |
| Brain Damage | Sepsis, organ damage, stroke, traumatic shock, meth/hyperzine, cyanide, head tourniquet | Mannitol (mind the BP floor and organ-damage risk) |
| Stroke | Circulatory failure | Surgery: Scalpel → Hemostat → Skin Retractors → Suture (community-sourced sequence) |
| Concussion | Head impact (wear a helmet) | Cannot be cured normally; rest in bed / monitor. Combat Stimulant reportedly clears it. |
| Coma | Cardiac arrest (a failed Naloxone dose can induce it) | Above ~40% it causes cardiac arrest — keep an Autopulse on and wait; otherwise monitor |
| Psychosis | Alien blood, meth/steroids/hyperzine, anaparalyzant, hallucinogens | Haloperidol |
Blood & circulatory
| Affliction | Cause / detection | Treatment |
|---|
| Bloodloss / Hypovolemia | Open wounds, artery/internal bleeds | Stop the leak first (sutures/tourniquet/surgery), then restore volume: Blood Pack (best) > Saline > Ringer's. Rule of thumb: ~30% bloodloss per blood pack; under 30% loss is survivable. Deusizine & Combat Stimulant also cure some. |
| Hypotension (low BP) | Below ~80%. Hyperventilation, hypoxemia, headache, pale skin, confusion, rising heart rate | Ringer's / Saline / Blood Pack to raise volume; Adrenaline slows cardiac-arrest onset; Deusizine. A climbing heart rate is the warning that arrest is coming. |
| Hypertension (high BP) | Above ~150%. Often from over-transfusing or leaving the Autopulse on | Usually self-resolves — remove the Autopulse. For extreme cases: Sodium Nitroprusside or Nitroglycerin; or draw blood. |
| Artery Bleeding | Fast, lethal blood loss | Tourniquet (limbs only, never head/torso) → Morphine → Scalpel → Hemostat → Skin Retractors → Suture. Move fast. |
| Internal Bleeding | Trauma, liver failure | Often auto-fixed by open-and-close surgery. Deusizine treats "internal damage". |
| Aortic Rupture | Unconsciousness, irregular heartbeat, cyanosis, vomiting blood, respiratory arrest | Scalpel → Endovascular Balloon → Medical Stent → Suture (or plain open/close, slower) |
| Hemotransfusion Shock | Giving an incompatible blood type (wrong plasma type = half-strength version) | Streptokinase heals it; Thiamine for the organ damage. Read blood type with the hematology analyzer first (O− universal red-cell donor, AB universal plasma donor). |
| Heart Attack | Causes heart damage | Streptokinase + Nitroglycerin (50%) |
Cardiac rhythm
| Affliction | Treatment |
|---|
| Increased Heart Rate | Harmless symptom unless it escalates; usually means low blood pressure |
| Irregular Heartbeat (Fibrillation) | Defibrillator / Autopulse / CPR. Often caused by acidosis (e.g. post-surgery) |
| Cardiac Arrest / Asystole | Defibrillator / Autopulse / CPR, plus Adrenaline (slows onset) and Nitroglycerin (cures arrest) |
| Cardiac Tamponade | Open-and-close surgery auto-fixes it. Some players add Drainage during the procedure. |
Thoracic & respiratory
| Affliction | Treatment |
|---|
| Pneumothorax | From fractured ribs. Morphine → Scalpel → Hemostat → Skin Retractors → Drainage → Suture |
| Respiratory Arrest | Ambu Bag (with an oxygen / Liquid Oxygenite source), or place the patient on/near a surgery table (provides artificial respiration) |
| Hypoxemia | Restore circulation/oxygen (CPR/Autopulse + breathing); Deusizine or Liquid Oxygenite cure it directly (Liquid Oxygenite also damages organs and removes the need to breathe — a stopgap when the heart is at 100% damage) |
| Hyperventilation / Hypoventilation | Symptoms. Hypoventilation (from analgesia / neck fracture) leads to acidosis — reduce analgesia with Naloxone |
Acid–base
| Affliction | Treatment |
|---|
| Acidosis | Common after surgery; causes fibrillation. Ignorable at low severity. Transfuse neutral blood, or induce alkalosis (Adrenaline causes hyperventilation, or Raptor Bane Extract makes them vomit) |
| Alkalosis | Uncommon; shows as "palpitations" on the hematology analyzer. Cancelled by acidosis / neutral blood |
Organ damage & failure
Organs accumulate damage; at 100% the organ fails. Damage is mostly survivable; failure of a vital organ is lethal and needs a transplant. Thiamine speeds passive organ healing with no downside — it's the standard organ-damage drug. Note that the very drugs that save lives (antibiotics, mannitol, liquid oxygenite) and conditions (sepsis, hypoxemia, radiation, hemotransfusion shock) cause organ damage — this is the "don't over-medicate" mechanic.
| Organ | Effects / warning signs | Treatment |
|---|
| Heart | Not lethal below 100%; at failure the heart stops | Thiamine; Liquid Oxygenite as a stopgap, then transplant |
| Lungs | Needed to breathe away from a surgery table; damaged by an Ambu Bag run with a welding/fuel/paint source | Thiamine; transplant at failure |
| Liver | Leg swelling, hypertension, brain damage, bloating; jaundice (turning yellow) = liver dying; failure causes internal bleeding & is fatal | Thiamine; transplant at failure |
| Kidneys | Leg swelling, acidosis, hypertension, nausea/vomiting, bone & brain damage; least urgent | Thiamine; transplant (can wait until stable) |
| Brain | Neurotrauma etc. | Mannitol |
Bone Death (100% bone damage, from neglected kidney failure, radiation or sepsis): surgery + Osteosynthesis Implants on every limb (incl. head/torso) until the "Enhanced Growth" condition shows.
Bones & fractures
| Injury | Treatment |
|---|
| Dislocation | Wrench |
| Arm/Leg Fracture | Bandage → Gypsum (cast). Don't waste osteosynthesis implants on extremity fractures. |
| Skull / Neck / Rib Fracture | Surgery: Scalpel → Hemostat → Skin Retractors → Surgical Drill → Osteosynthesis Implants → Suture. Bandages temporarily suppress the effects (neurotrauma from skull, pneumothorax from ribs) but surgery is the real fix. |
| Spinal Injury | Causes analgesia 200% (drops the patient) → acidosis. Surgery on the fractured neck → Surgical Drill → Spinal Cord Implants |
Infection & sepsis
| Affliction | Treatment |
|---|
| Inflammation | From foreign bodies (also causes artery bleeding + sepsis) or infected wounds. Antibiotic spray/ointment for inflammation; surgery + Tweezers to remove foreign bodies (yanking them through an open wound causes traumatic shock) |
| Sepsis | From festering infected wounds (or unsterilized surgery if the NT Sepsis addon is installed). Fever, fast heart rate, abdominal pain; does "everything bad". One dose Broad-Spectrum Antibiotics + Thiamine for the organ damage. Confirm on the blood scanner if unsure. |
| Gangrene | From untreated traumatic amputation or sepsis. At 15% it's irreversible — amputate the limb or it kills the body. |
| Husk Infection | Calyxanide (pill ingredient cures 50%); Broad-Spectrum Antibiotics slow it. The Calyxanide + Antibiotics pill combo ("Antihusk") gives −70 husk infection + 500 resistance. |
Drug, chemical & radiation
| Affliction | Treatment |
|---|
| Opiate Overdose | From too much opium/morphine/fentanyl (each dose = analgesia + overdose + addiction). Naloxone cures analgesia, overdose, withdrawal. |
| Withdrawal (opiate / chemical / alcohol) | Cured respectively by opiates, stimulants/Combat Stimulant, and Haloperidol |
| Mass Analgesia + Hypoventilation | From a "fent trip" or neck fracture → acidosis. Naloxone, then fix acidosis. |
| Radiation Sickness | Antirad → Thiamine for the organ damage |
| Poisons | Matching Antidote (50%), or broad-spectrum Stabilozine (15% all) / Carbon (7% all) |
| Allergic reaction | Not confirmed as a distinct NT affliction in the sources reviewed — may be vanilla/addon only. |
Burns / combustion
- First-degree: Antibiotic Ointment.
- Second-degree: Antibiotic Ointment ×2.
- Third-degree: surgery — Scalpel → Hemostat → Skin Retractors → Plastiseal → Suture.
⚒Medical equipment & items
Diagnosis tools
| Item | What it does / when to use |
|---|
| Health Scanner | Reads most afflictions, organ damage, blood pressure. Scan every patient first. |
| Hematology / Blood Analyzer | Reads blood pressure, blood type, acidosis/alkalosis/sepsis. Use for "symptoms with no visible cause" and before transfusing. |
| Pill Analyzer | Identifies a pill's composition. Niche. |
Resuscitation & circulation
| Item | What it does / when to use |
|---|
| Defibrillator | Restarts heart / corrects fibrillation & cardiac arrest |
| Autopulse | Mechanical CPR; restarts heart and slowly clears hypoxemia (if lungs work). Remove once stable (causes hypertension). |
| CPR (health-menu button) | Manual compressions; works underwater/at pressure. Non-medics fracture the patient's ribs — pre-bandage. |
| Ambu Bag (manual resuscitator) | Manual ventilation; needs a gas source. With a Liquid Oxygenite tank it oxygenates; with welding/fuel/paint it damages lungs. |
| Surgery Table | Provides artificial respiration, reduces traumatic shock, and is the required location for surgery. |
| Stasis Bag | Halts deterioration / prevents death. Stabilise a critical patient while you prep. You cannot operate on a bagged patient. |
Surgical tools & consumables
| Tool | Role in surgery |
|---|
| Scalpel | Make the incision (start of nearly every surgery) |
| Hemostat | Clamp / control bleeding after the incision |
| Skin Retractors | Hold the incision open for access |
| Tweezers | Remove foreign bodies (bullets, shrapnel) |
| Surgical Saw | Amputation / limb reattachment |
| Surgical Drill | Bone surgery (skull/neck/rib, implants) |
| Organ Procurement / Multipurpose Scalpel | Remove a failed organ for transplant |
| Drainage | Relieve pneumothorax during chest surgery |
| Endovascular Balloon + Medical Stent | Repair aortic rupture |
| Suture | Close the incision (end of nearly every surgery; restores some vitality) |
| Osteosynthesis / Spinal Cord Implants | Fix fractures, bone death, spinal injury |
| Plastiseal | Third-degree burns |
| Replacement organs | Heart / lungs / liver / kidney for transplant |
Plus: Tourniquet (limb arteries only), Splint/Gypsum (cast fractures), Bandages (stop bleeding / temporarily suppress fracture effects), Wrench (dislocations), Antibiotic Spray/Ointment (inflammation/burns).
Drugs & pills
Drugs are crafted at the ChemMaster 2000 (craftable from 1 FPGA circuit + 1 plastic + 1 steel + 1 aluminium + 1 titanium-aluminium alloy). A pill = a base (sets capacity) + a binder + up to two fillers + active ingredients + optional dye; a failed craft gives weaker effects. Bases: Alien Blood (cap 3, +psychosis, skill 60), Saline/Ringer's (cap 1, skill 10), Blood Pack (cap 2, skill 40). Binders: Ethanol (skill 20), Mannitol. Fillers: Sodium (+potency, explodes with Saline/Ringer), Silicon (2× yield), Magnesium (2× potency).
Skill values are community-sourced and may be dated.
| Drug | Effect | Risk / note |
|---|
| Opium / Morphine / Fentanyl | Analgesia for surgery; cures opiate withdrawal | Each dose adds overdose + addiction |
| Naloxone | Cures analgesia, opiate overdose, withdrawal | A failed dose can cause coma |
| Broad-Spectrum Antibiotics | Cures sepsis; husk resistance | Damages kidneys, liver, heart, lungs — pair with Thiamine |
| Thiamine | Accelerates organ healing | No downside — the standard organ-damage drug |
| Adrenaline | Slows cardiac-arrest onset, counters slows | — |
| Liquid Oxygenite | Cures hypoxemia; removes need to breathe (stopgap) | Damages all four organs |
| Deusizine | Cures bloodloss, internal damage, organ damage, hypoxemia | Causes burns |
| Streptokinase | Heals heart attacks & hemotransfusion shock | — |
| Nitroglycerin | Cures cardiac arrest; heals heart attack 50% | — |
| Azathioprine | Immunosuppressant so transplants aren't rejected | Failure can cause sepsis; take before transplants |
| Mannitol | Reduces brain damage / neurotrauma | No effect below 70% BP; overuse damages organs |
| Calyxanide | Cures 50% husk infection | — |
| Haloperidol | Cures psychosis & alcohol withdrawal | — |
| Propofol | Anesthesia (knock-out for surgery) | — |
| Combat Stimulant | Slowly heals internal damage, bleeding, burns, bloodloss, withdrawal | Chemical addiction |
| Stabilozine / Carbon | Heal all poisons 15% / 7% | — |
| Meth / Anabolic Steroids / Hyperzine | Haste/vigor buffs | Inflict organ damage, neurotrauma, psychosis, addiction |
| Sodium Nitroprusside | Lowers extreme blood pressure | Severe hypertension only |
| Antirad | Treats radiation sickness | Follow with Thiamine |
Fluids: Blood Pack (best volume restoration), Saline (weaker, often enough), Ringer's Solution (raises blood pressure, prevents collapse).
✂Surgery, step by step
Prerequisites: enough Medicine skill (low skill turns the scalpel into a "Nasty laceration" — a failed skill check, confirmed by the dev), the patient anesthetized or unconscious (Morphine analgesia or Propofol), and you at/near a surgery table. With the NT Sepsis addon you must also sterilise tools (Autoclave) and dress the patient in surgical drapes.
- Generic open-and-close: Morphine → Scalpel → Hemostat → Skin Retractors → (work) → Suture. Many internal problems (internal bleeding, cardiac tamponade) are auto-fixed just by opening and closing.
- Organ transplant (heart/lungs/liver/kidney, all the same): Azathioprine → Scalpel → Hemostat → Skin Retractors → Organ-Procurement Scalpel (remove failed organ) → insert replacement → Suture → restart circulation (CPR/Autopulse/Defib). Give Liquid Oxygenite first if the heart is failing. Known dev-acknowledged bug: transplants sometimes fail to register the new organ.
- Amputation: Morphine → Antibiotic Ointment → Scalpel → Hemostat → Skin Retractors → Surgical Saw → Suture. Amputate any limb at gangrene ≥15%; watch bloodloss after.
- Bone surgery: Scalpel → Hemostat → Skin Retractors → Surgical Drill → Osteosynthesis Implants → Suture (Spinal Cord Implants for spine).
- Foreign body: Scalpel → Hemostat → Skin Retractors → Tweezers → Suture.
- Aortic rupture: Scalpel → Endovascular Balloon → Medical Stent → Suture.
⚑Emergency playbooks
Shot / heavily bleeding
Stasis bag → surgery table → tourniquet limb arteries → suture wounds → open/close for internal bleed/tamponade/pneumothorax (Drainage for pneumo; Balloon+Stent for aortic) → restore volume with type-matched Blood Packs → restart heart/breathing → watch neurotrauma.
Cardiac arrest
Autopulse or Defibrillator (CPR underwater) + Adrenaline/Nitroglycerin → fix the underlying hypoxemia/BP cause → remove the Autopulse once stable.
Infection / sepsis
Fever or blood-scanner confirm → one dose Broad-Spectrum Antibiotics + Thiamine → remove foreign bodies (surgery + tweezers), treat inflammation (antibiotic spray) → amputate any limb at ≥15% gangrene.
Hypoxia / drowning
Restore oxygen (Ambu Bag with O₂/Liquid Oxygenite, or surgery-table respiration) → Autopulse/Defib for arrest → Liquid Oxygenite/Deusizine to clear hypoxemia → Mannitol for resulting neurotrauma.
Broken limb
Bandage → Gypsum cast. Dislocation → Wrench. No implants on limbs.
Opiate OD
Naloxone (watch for the rare coma from a failed dose); manage resulting analgesia / hypoventilation / acidosis.
★Medic talents & addons
The fork lists "rework of medic talents to work properly with the mod" as a completed item, so vanilla Medical Doctor talents are adjusted to interact with the new system. There is no published, itemised list of exactly which talents NT changes — inspect them in-game. A separate community mod, "Medic Talent Rework," tweaks vanilla medic talents but is not part of NT.
Neurotrauma has a family of addons that change behaviour — know which content is base vs addon: NT Sepsis/Infections (adds sterilisation/autoclave requirements), NT Surgery Plus (Mannitol Plus), NT Cybernetics (cybernetic organs/limbs), plus NT Pharmacy, NT Metabolism, NT Symbiote, NT Grafting, and the Mercy Hospital training map.
▤Sources
- Neurotrauma — Steam Workshop (description, requirements, surgery-skill confirmation, transplant bug)
- GitHub — OlegBSTU/Neurotrauma (fork structure, addons)
- Steam Guide — "How to Neurotrauma" (per-affliction treatment sequences)
- Steam Guide — "A Mostly Exhaustive Neurotrauma Guide" (survival model, diagnosis)
- Steam Guide — "Neurotrauma Pharmacy guide" (drug effects, ChemMaster, pill crafting)
- Neurotrauma Wiki (Fandom) — Organ Damage, Blood Pressure, Hemotransfusion Shock, etc.
- Community "Neurotrauma fork guide" Trello (canonical; JS-heavy — open in a browser)