5E Critical Wounds Chart

In my opinion, 5E is too forgiving for wounds.  For small nicks and cuts, it's great, but for grievous blows that lay heroes low, where are the scars, the peg legs, the hobbled veterans?  Where is the hero, bandaged and not at his best, waging back into the fray?

A lot of systems have critical hit charts, but often they are very specific (lose 1d3 fingers, etc).  While Pathfinder or Dungeon Crawl Classics the like have specific wounds, the elegance of D&D is the non-specificity of injuries.  Looking at the Exhaustion table is great inspiration for effects that are generic, leaving it to the imagination what has actually befallen the beloved player character.  I may have backslid here and there, but I tried to draw on either the advantage/disadvantage mechanic, or saving throws where possible.  I also kept it vague where possible so you don't (usually) end up with a severed hand from a fireball spell, or the like.

To handle these horrific wounds, I put together three categories -- detriments, impairments, and injuries.  Each one being more permanent or severe than the prior one.  Also, by setting the triggers for detriments as 'attacker's option' it's easy for the DM to not have the heroes permanently crippled by a band of kobolds (the anti-paladin, on the other hand, is happy to maim for dark purposes).

It's gone over well in my game, and I'd invite you to enjoy the same!

(NB - This blog post is pretty close to ' viral', still averaging about 100 hits a day and I wrote it years ago ... drop me an email at archadethered@gmail.com, tell me how you found this, if you like this house rule in your game, and if there's anything else you'd like to see for your 5E game ...)

PERSISTENT WOUNDS

     While many wounds are superficial and fade quickly, sometimes a grievous blow will have lasting effects -- whenever a target takes significant damage, there is a chance of a persistent wound, as detailed below:

Detriment

     Whenever a creature is struck by a critical hit, at the attacker’s option instead of the extra die of damage, the target may suffer a detrimental effect.

    Every non-permanent detriment can be automatically removed with the lesser restoration spell, or a short rest.

D20	Detriment
1	Bleeding -- lose 1 hp per turn (DC 15 Constitution Save at the end of each turn to stop effect, or receive 1+ hit points of healing)
2	Disoriented -- disadvantage to Intelligence-based checks/saves/attacks (DC 15 Intelligence Save at the end of each turn to stop effect)
3	Fumble -- drop weapon or held object.
4	Hobbled -- speed reduced by 10 feet (DC 15 Dexterity Save at the end of each round to stop effect).
5	Knocked Down -- rendered prone.
6	Knocked Out -- rendered unconscious (DC 15 Constitution Save at the end of each turn to end effect, or DC 15 Wisdom (Medicine) check by an ally to wake you up).
7	Minor Wound - Disadvantage to Strength-based checks/saves/attacks (DC 15 Strength save at the end of each round to end the effect).
8	Minor Scar - the scar doesn't have any adverse effect.  Any magical healing of more than 20 hp removes the scar.
9	Off-Balance -- pushed back 5 feet, and attacks against target have advantage before their next turn.
10	Out of Breath -- can't speak (DC 15 Constitution save at the end of each round to end the effect).
11	Painful Blow -- disadvantage to all Wisdom-Based checks/saves/attacks (DC 15 Wisdom Save at the end of each turn to end the effect).
12	Ringing Blow -- deafened (DC 15 Wisdom save at the end of each round to end the effect).
13	Strained Limb -- disadvantage to Dexterity-based checks/saves/attacks (DC 15 Dexterity save at the end of each round to end the effect).
14	Stunned -- gain the stunned condition and miss the next turn.
15	Traumatic Blow -- disadvantage to Charisma-based checks/saves/attacks (DC 15 Charisma save at the end of each turn to end the effect).
16	Vision Obscured -- everything has light cover (+2 to AC, DC 15 Wisdom save at the end of each round to end the effect).
17	Wide Open -- target is vulnerable to the next attack before their next turn.
18	Winded -- disadvantage to Constitution-based checks/saves/attacks (DC 15 Constitution save at the end of each round to remove the effect).
19	Gain level of exhaustion
20	Gain impairment (re-roll on the chart below).

Impairment

     If a character rolls a 20 on the detriment table above, or fails one or more death saves by 5 or more, they will discover an impairment upon regaining consciousness.

     Every non-permanent impairment can be removed with the lesser restoration spell, or a week of bed rest, unless the description says otherwise.

D20	Impairment
1	Bloodloss -- target's maximum hit points are reduced by 2d6 (recover 1 hit point per long rest until condition removed).
2	Arm Injury -- limb rendered useless (DC 20 Constitution save at the end of each long rest to remove).
3	Blurred Vision -- everything is lightly obscured (DC 20 Wisdom save at the end of each long rest to remove).
4	Broken/Fractured Bones -- disadvantage to Dexterity-based checks/saves/attacks (DC 20 Dexterity save at the end of each long rest to remove).
5	Chronic Injury -- reduce maximum hit points by 2d6 (DC 20 Medicine check to remove, or receive 50+ hit points healing).
6	Comatose -- incapacitated (DC 20 Wisdom save at the end of each short rest to remove).
7	Concussion -- disadvantage to Charisma-based checks/saves/attacks (DC 20 Charisma save at the end of each long rest to remove).
8	Excruciating Wound -- disadvantage to Wisdom-based checks/saves/attacks (DC 20 Wisdom save at the end of each long rest to remove).
9	In Shock -- disadvantage to Intelligence-based checks/saves/attacks (DC 20 Intelligence save at the end of each long rest to remove), and make a DC 10 Intelligence check to take an Action each round.
10	Internal Injuries -- gain two levels of exhaustion
11	Leg Injury -- speed reduced by 10 feet (DC 20 Dexterity save at the end of each long rest to remove).
12	Lingering Injury -- disadvantage to Constitution-based checks/saves/attacks (DC 20 Constitution save at the end of each long rest to remove).
13	Memory Loss -- short term memory loss and disorientation, to full amnesia, depending on the wound.
14	Serious Wound -- disadvantage to Strength-based checks/saves/attacks (DC 20 Strength save at the end of each long rest to remove).
15	Thrown Back -- carrying capacity halved (DC 20 Strength save at the end of each long rest to remove).
16	Horrible Scar -- You are disfigured to the extent that the wound cannot be easily concealed.  You have disadvantage on Charisma (Persuasion) checks and advantage on Charisma (Intimidation) checks.  Magical healing of 40+ hit points or more removes the scarring.
17	Festering Impairment -- every time you take a strenuous Action, suffer 1d3 hit points damage.   This impairment can be removed with 20+ hit points of magical healing or an hour of surgery with a successful DC 15 Wisdom (Medicine) check.
18	Debilitating Impairment -- lose 1d3 hit points each round until 20+ hit points of magical healing are received or a successful DC 15 Wisdom (Medicine) check.
19	Staggered -- Gain the stunned condition.  Each round the target may attempt a DC 15 Consitution check to remove the effect.
20	Gain injury (roll on the chart below)

Injury

     If a character rolls a 20 on the impairment table above, or takes more than its total hit points in a single blow, or rolls a 1 on a death save, they will gain an injury upon regaining consciousness.

D20	Injury
1	Lose an Eye -- You have disadvantage on Wisdom (Perception) checks that rely on sight and on ranged attack rolls.  Magic such as regenerate can restore the lost eye.  If you have no eyes left after sustaining this injury, you're blinded.
2	Lose Both Eyes -- You are blinded.  Magic such as regenerate can restore the lost eyes.
3	Lose Fingers -- You lose 1d3 fingers on one hand (roll randomly), and you have disadvantage on any item held by that hand.  Magic such as regenerate can restore the fingers.
4	Lose Hand - You lose a hand (roll randomly).  You can no longer hold anything with two hands, and you can only hold a single object at a time.  Magic such as regenerate can restore the hand.
5	Lose Arm - You lose an arm (roll randomly).  You can no longer hold anything with two hands, can only hold a single object at a time, and you have disadvantage on any Strength (Athletics) checks.  Magic such as regenerate can restore the arm.
6	Lame -- Your speed is reduced by 5 feet.  You must make a DC 10 Dexterity saving throw after using the Dash action, or fail prone.  Magical healing of 20+ hit points or more removes the injury.
7	Severe Limp - Your speed is reduced by 10 feet.  You must make a DC 15 Dexterity saving throw after using the Dash action or fall prone.  Magical healing of 40+ hit points or more removes the injury.
8	Lose a Foot -- Your speed on foot is halved, and you must use a cane or crutch to move unless you have a peg leg or prothesis.  You fall prone after making the Dash action.  You have disadvantage on Dexterity checks to balance.  Magic such as regenerate can restore the foot.
9	Lose a Leg -- Your speed is halved, and you must use a cane or crutch to move unless you have a peg leg or prothesis.  You fall prone after making the Dash action.  You have disadvantage on all Dexterity checks.  Magic such as regenerate can restore the leg.
10	Chronic Injury -- your hit point maximum is reduced by 1d3 every 24 hours the injury persists. If your hit point maximum reaches 0, you die.  The injury heals if you receive magical healing of 40+ hit points, or someone can tend to the wound with surgery taking at least 4 hours and a successful DC 20 Wisdom (Medicine) check.
11	Crippled -- Reduce Strength by 1d3 points.  A greater restoration spell will remove this effect.
12	Mutilated -- Reduce Dexterity by 1d3 points.  A greater restoration spell will remove this effect.
13	Maimed -- Reduce Constitution by 1d3 points.  A greater restoration spell will remove this effect.
14	Brain Injury – Reduce Charisma by 1d3 points.  A greater restoration spell will remove this effect.
15	Deep Coma -- incapacitated (DC 20 Wisdom save at the end of each long rest to remove).
16	Bodily Strain – gain 1d6 levels of exhaustion, that cannot be removed normally --- a greater restoration will remove one level of exhaustion from this effect.
17	Emotional Trauma – gain one form of permanent insanity (DMG).
18	Roll again on both the injury table and the impairment table.
19	Roll again on both the injury table, and twice on the impairment table.
20	Roll again on both the injury table, and three times on the impairment table.