Trauma and Acute Care Surgery
Core concepts
Master the primary survey (airway, breathing, circulation, disability, exposure) and the secondary survey. Understand damage control resuscitation, massive transfusion protocols, and the lethal triad (hypothermia, acidosis, coagulopathy). Know the evaluation of blunt and penetrating trauma, FAST examination, and indications for CT. Understand traumatic brain injury basics, thoracic trauma (tension pneumothorax, hemothorax, cardiac tamponade), abdominal solid organ injury, and vascular injury. Know the principles of burn resuscitation and the management of the acute abdomen in the ICU.
Traps in questions
Questions often test when to intubate versus observe, and when FAST changes management. Distinguish tension pneumothorax (clinical diagnosis, immediate decompression) from simple pneumothorax. Another trap is the timing of laparotomy in solid organ injury; hemodynamic instability drives the decision. Watch for questions about the elderly trauma patient, who decompensates late. Be careful with the difference between permissive hypotension and hypotension in brain injury.
Worked rule of thumb
Ask: is the patient stable or unstable? Unstable with positive FAST goes to the operating room. Stable undergoes CT. In tension pneumothorax, decompress before imaging.
Exam strategy
Prioritize life threats in order. Airway before breathing, breathing before circulation, and never delay decompression for a chest radiograph.