On a successful hit from a bow, the target must succeed on a DC 20 Fort save or instantly die. Like all specialty arrows, it is consumed on use whether the attack (or saving throw) was successful or not.
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Worn on the wrist of a monk when making flurry of blows attacks, what would normally be armor becomes an offensive weapon. The token is placed in one of the monk’s combat sliders but both sliders are still used per normal open handed combat. If this weapon is used to score a natural 20, the monster will immediately perish if the 8🖐🏿 on the damage wheel is facing the damage dot indicator on the combat board.