SURGERY - TRAUMA + ACUTE ABDOMEN + OPERATIVE DECISIONS

YEAR 3 | PAGE 29G - STABILIZE -> LOCALIZE -> SOURCE CONTROL / DEFINITIVE CARE

Step	Core question	Exam / clinical logic
1. Primary survey	Is there an immediate airway, breathing, circulation, disability or exposure threat?	Treat life threats during the survey; do not delay lifesaving intervention for a perfect diagnosis.
2. Hemodynamic status	Stable, transient responder or persistently unstable?	Stability determines how much diagnostic imaging the patient can safely tolerate before definitive control.
3. Identify bleeding / injury source	Chest? abdomen/pelvis? long bone? external? retroperitoneal? neurologic injury?	Use bedside exam and focused testing to localize the dangerous branch of the differential.
4. FAST / CT / OR / IR	What test or destination will change management now?	A stable patient can often undergo definitive imaging; an unstable patient with a clear operative source may need immediate control.
5. Secondary survey + reassessment	What injuries were missed and is the patient responding as expected?	Recheck after every intervention; deterioration is new diagnostic information.

Syndrome	Clues to prioritize	Decision direction
Obstruction	Pain/distention, vomiting, obstipation; prior surgery, hernia, malignancy.	Resuscitate/decompress when appropriate; distinguish uncomplicated obstruction from strangulation/ischemia or perforation.
Perforation	Sudden severe pain, peritonitis, free air or contaminated viscus.	Antibiotics/resuscitation plus urgent source control when perforation is confirmed or strongly suspected.
Ischemia	Pain out of proportion, vascular risk, shock or rising metabolic concern.	Time-sensitive vascular/surgical evaluation; do not be reassured by an early benign exam when risk is high.
Inflammation / infection	Appendix, gallbladder, diverticulum, pancreas, abscess or postoperative collection.	Ask whether treatment is antibiotics/supportive care, drainage, interval strategy or operation.
Hemorrhage	GI, solid-organ, vascular or postoperative bleeding.	Stabilize first; identify when endoscopy, IR, surgery or observation is the definitive path.
Hernia / closed-loop process	Painful irreducible hernia, obstructive features, skin/systemic signs.	Differentiate reducible/elective disease from incarceration/strangulation requiring urgent operative evaluation.

Operate / control the source when delay risks irreversible harm - e.g., uncontrolled hemorrhage, perforation/peritonitis, ischemic/strangulated bowel or other immediately correctable surgical catastrophe.
Drain / decompress / endoscope / IR when a less invasive source-control route is the appropriate definitive or bridging treatment.
Observe / treat nonoperatively only when the patient is stable, the disease supports that strategy and there is a clear reassessment / failure threshold.
Never let a test delay treatment when the clinical state already determines the next lifesaving step. Direct video repair Trauma Surgery: Initial Survey and Management - Lecturio Acute Abdomen: General Principles - General Surgery | Lecturio 2026/27 clerkship-expanded edition - verify school and official exam updates before testing