Surgery: Assessment, Resuscitation, and Decision-Making
Core concepts to master
Surgical items test prioritisation under uncertainty. Expect trauma (primary survey ABCDE, tension pneumothorax, haemorrhagic shock), acute abdomen (appendicitis, cholecystitis, perforation, obstruction, mesenteric ischaemia), wound and burn assessment, and perioperative care (VTE prophylaxis, antibiotic timing, fluid management). Understand the difference between a resuscitative and a diagnostic step, and know when imaging is contraindicated or must be delayed until the patient is stabilised.
Common traps
Classic distractors include choosing CT before resuscitation in an unstable patient, or ordering imaging when the diagnosis is clinical and requires immediate decompression. In tension pneumothorax, the answer is immediate needle decompression - never a chest X-ray first. In burns, calculate fluid resuscitation from the time of injury, not from arrival, and remember that circumferential full-thickness burns may need escharotomy. For suspected appendicitis in pregnancy or the elderly, presentations are atypical; do not exclude the diagnosis on the basis of normal inflammatory markers alone. Postoperative fever timing (wind, water, wound, walk) is a frequent question but avoid over-reliance on rigid day-based rules.
Worked rule of thumb
A young man with a stab wound has absent breath sounds, distended neck veins, hypotension, and tracheal deviation. This is tension pneumothorax: immediate needle decompression in the second intercostal space, mid-clavicular line, followed by chest drain. The rule: in an unstable patient, treat before you image. Apply the same logic to FAST scanning in blunt abdominal trauma with haemodynamic instability.