Keep Him Alive is the challenge mode of Trauma Lab: 10 real emergencies that you treat using the Medicine tab only — no weapons, no powers, just drugs, tools and surgery. This guide covers the win and lose rules, all 10 cases with the in-game tips, and the full medicine list you have to work with. Press H in the game to open the mode.
How you win and how you lose
The mode uses exactly the same physiology as the sandbox: bleeding, drugs, heart and lungs behave the same way, so everything you know about the patient's body applies here. You win once the patient has been stable for 15 seconds in a row — bleeding controlled, blood pressure and oxygen holding. You lose if he dies, or if his systolic pressure stays under 60 mmHg for 6 seconds. That six-second clock is what makes low pressure so dangerous: even if the patient looks alive, a quiet slide under 60 mmHg ends the run.
The general priority order is: stop arterial bleeding first (bright red, pulsing blood), then replace lost blood, then deal with pain or poison. Keep an eye on systolic pressure throughout — falling under 60 mmHg is the fastest way to fail.
All 10 emergencies
1. Gunshot · thigh — Soldier, 24
A 9 mm round went through the left thigh and tore the femoral artery, with blood loss up to roughly a litre per minute. In-game tip: tourniquet high on the thigh, pack the hole with gauze, then give blood. TXA (tranexamic acid) helps reduce bleeding deaths. The tourniquet comes first because nothing else matters while an artery is open — every second of delay is blood pressure you will have to buy back later.
2. Sword cut · arm — Squire, 19
The brachial artery is cut in the inner upper arm. Tip: tourniquet above the cut, then suture or clamp the vessel in Surgery, and replace lost blood. Unlike case 1, the tourniquet here is a bridge — the permanent fix is closing the vessel, so move to the surgery tools as soon as the bleeding is held.
3. Open fracture · shin — Motorcyclist, 31
The tibia is through the skin, the shin artery is torn, and the patient is in severe pain. Tip: tourniquet above the knee, gauze and bandage the wound, fit a bone plate (Ortho), and give morphine or ketamine for pain. Severe pain is part of this case, so the painkiller is part of the tip, not an optional extra.
4. Heart attack · cardiac arrest — Man, 72
A blocked coronary artery has collapsed his rhythm into VF. Tip: defibrillate — VF is shockable. Adrenaline every few minutes, and amiodarone after the 3rd shock keeps the rhythm stable. The sequence matters: the defibrillator converts the rhythm, adrenaline supports the heart between shocks, and amiodarone stops it slipping back.
5. Heart wall rupture · needs surgery — Woman, 78
Dead heart muscle has torn and blood is leaking around the heart. Tip: fluids and blood to buy time, then chest surgery to repair the heart. Defibrillate if it fibrillates. No drug fixes a torn wall — the fluids only keep her pressure alive long enough for you to operate.
6. Opioid overdose — Man, 29, found unresponsive
Fentanyl has stopped his breathing; his pupils are pinpoints. Tip: naloxone reverses it within a minute — but it wears off sooner than fentanyl, so watch for him going under again. The trap in this case is relaxing after the first dose: set up, then keep watching the monitor.
7. Sleeping pills + alcohol — Woman, 45
A benzodiazepine overdose on top of alcohol. Tip: flumazenil reverses the benzodiazepine — though it can trigger seizures in long-term users — while alcohol has no antidote: wait it out. Treat the half you can treat, then hold her stable until the rest clears on its own.
8. House fire · cyanide — Firefighter, 38
Hydrogen cyanide from burning plastics: SpO₂ looks fine, but his cells can't use oxygen. Tip: cyanide antidote (hydroxocobalamin), plus fluids for blood pressure. This is the case where the monitor lies to you — trust the situation, not the oxygen number.
9. Snake bite — Ranger, 34
Viper venom stops clotting and attacks vessels. Tip: antivenom — but one dose too many can trigger anaphylaxis, so keep adrenaline ready. The cure is itself a risk, so dose carefully and have the response to an overdose already in hand.
10. Bee sting · anaphylaxis — Hiker, 26
His airway is swelling shut and his vessels are dilating. Tip: adrenaline, then fluids for the pressure. Adrenaline is the whole answer here — it opens the airway and tightens the vessels — with fluids holding pressure while it works.
The Medicine tab: every drug and its dose
The Medicine tab includes these drugs, with doses as shown in the game: Adrenaline 1 mg, Amiodarone 300 mg, Atropine 1 mg, Fentanyl 100 mcg, Flumazenil 0.5 mg, Ketamine 50 mg, Midazolam 5 mg, Morphine 10 mg, Naloxone 0.4 mg, Paracetamol 1 g and Tranexamic acid 1 g — alongside tools like tourniquets, gauze, bandages, a defibrillator, fluids and blood. Surgery comes in Simple or Complex modes, with stitches, bone plates, suction and blood top-ups.
Serums and the Inhibitor (Sandbox)
- Super serum — heals everything still inside the body (organs, brainstem, bones, wounds) and closes torn skin and muscle. It does not revive him and does not regrow limbs, as the developer confirmed in the comments.
- Ultra serum — revives and regrows: lost limbs and organs grow back, and organs that fell out are drawn back in.
- Super-soldier serum — also available in Sandbox.
- Inhibitor — stops everything: every drug, serum and poison.
The serums are listed here as Sandbox items; experimenting in Sandbox is a good way to get familiar with the patient before you take on the emergencies. And if you want the patient to sleep while you practise, the developer's answer is ketamine.
Medical disclaimer: this is a game. The tips on this page describe in-game mechanics and are not medical advice.
Content warning: Trauma Lab contains graphic injury, blood and medical detail and is intended for players 18+.
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