Massive damage
From Tomb of the Serpent Kings
Characters that suffer a catastrophic amount of damage at once could die from the trauma. These characters have to undergo a system shock roll.
How much damage is enough damage? If you take damage in one attack or effect that is equal or greater than 20 + 2 HP per level, you have to roll system shock. For example, a level 3 character's massive damage trigger would be 26 HP.
This is damage from ONE attack or effect; if multiple attacks in the same turn or effects add up to that much damage in total, it doesn't count.