,USMLE Step 3 – Surgical Mastery Pack
(2025/2026): Emergency Protocols, Trauma
Scenarios & High-Yield Clinical Triggers.
best methods to maintain airway
orotrach intub. if trauma with cerv spine injury, orotech intub with manual cerv immobil using flex
bronchoscope. if extensive trauma and bleeding to the airway (listen to gurgling sounds),
cricothy.otomy. (percuta triostomy is also acceptable)
eval B in trauma
obtain ABG. deter cause of hypoxia with hist.
n range of pco2
35-45
n range of bicarb
20-28
both tension ptho and peri tampo may cause
dist neck veins and incr central venous press
peri tampo findings
enlarged heart on cxr, elect alter on ekg, puls para.
peri tamp immediate next step
peri.cent. if unsucc, pericardial window
tension ptho pres
resp dist, trach dev, absent breath sounds, hyperreso ot percussion
tension ptho rx
immediately place a largo bore needle or iv cath into the 2nd intercostal, then place a chest tube. so not
wait for cxr
hemodyn measurements in hemorr shock
pulm cap wedge pres is decr, CO is decr, sys vasc resis is incr, mixed venous sao2 is decr
bleeding site control
direct local pres (no blind clamping or tourniquet)
, prep for immediate explo laparotomy
2 large gauge iv lines, fluids and blood, type and screen, foley, admins iv abx
initial bolus fluid for children
20 kg/ml ringer lactate
anaphyl shock, immediate step
im epinephrine, fluids and observe
vasomotor shock, warm or cold
warm ad flushed
vasomotor shock, causes
meds (eg penicilin), spinal anesthesia, expo to allergen (eg bee sting)
asymp head injury with a closed skull fracture, next step
clean any lacerations, no surg interv
asymp head injury with a comminuted or depressed skull fracture, next step
repair or craniotomy. send patient to OR
currently asymp but head injury plus loss of consci, next step
head ct wo contrast. if normal may go home but if there is someone to observe (wake himup freq to see
if any mental changes)
head trauma, who gets tetanus toxoid and prophyl abx
all with open skull frac
basal skull frac manage
order ct of the neck and head (no xr). csf leak will stop. no prophyl abx. facial palsy may occur 2-3 days
later
epidural hema detected on ct, next step
emergency craniotomy
epidural hema, finding on ct
lens shaped hematoma
subdural hema pres
trauma with fluctuatin consciousness
subdural hema rx
(2025/2026): Emergency Protocols, Trauma
Scenarios & High-Yield Clinical Triggers.
best methods to maintain airway
orotrach intub. if trauma with cerv spine injury, orotech intub with manual cerv immobil using flex
bronchoscope. if extensive trauma and bleeding to the airway (listen to gurgling sounds),
cricothy.otomy. (percuta triostomy is also acceptable)
eval B in trauma
obtain ABG. deter cause of hypoxia with hist.
n range of pco2
35-45
n range of bicarb
20-28
both tension ptho and peri tampo may cause
dist neck veins and incr central venous press
peri tampo findings
enlarged heart on cxr, elect alter on ekg, puls para.
peri tamp immediate next step
peri.cent. if unsucc, pericardial window
tension ptho pres
resp dist, trach dev, absent breath sounds, hyperreso ot percussion
tension ptho rx
immediately place a largo bore needle or iv cath into the 2nd intercostal, then place a chest tube. so not
wait for cxr
hemodyn measurements in hemorr shock
pulm cap wedge pres is decr, CO is decr, sys vasc resis is incr, mixed venous sao2 is decr
bleeding site control
direct local pres (no blind clamping or tourniquet)
, prep for immediate explo laparotomy
2 large gauge iv lines, fluids and blood, type and screen, foley, admins iv abx
initial bolus fluid for children
20 kg/ml ringer lactate
anaphyl shock, immediate step
im epinephrine, fluids and observe
vasomotor shock, warm or cold
warm ad flushed
vasomotor shock, causes
meds (eg penicilin), spinal anesthesia, expo to allergen (eg bee sting)
asymp head injury with a closed skull fracture, next step
clean any lacerations, no surg interv
asymp head injury with a comminuted or depressed skull fracture, next step
repair or craniotomy. send patient to OR
currently asymp but head injury plus loss of consci, next step
head ct wo contrast. if normal may go home but if there is someone to observe (wake himup freq to see
if any mental changes)
head trauma, who gets tetanus toxoid and prophyl abx
all with open skull frac
basal skull frac manage
order ct of the neck and head (no xr). csf leak will stop. no prophyl abx. facial palsy may occur 2-3 days
later
epidural hema detected on ct, next step
emergency craniotomy
epidural hema, finding on ct
lens shaped hematoma
subdural hema pres
trauma with fluctuatin consciousness
subdural hema rx
