Medical School MD + DO Mastery

A 4-year, board-aligned study system for medical school and licensing exams.

Walk the full Year 1–4 curriculum — foundational sciences, organ-system blocks, clinical clerkships and advanced practice — each with mastery checklists and linked learning resources, plus a dedicated review system for school exams, Shelf/COMAT, USMLE Step 1–3 and COMLEX-USA Levels 1–3.

EMERGENCY MEDICINE - TRAUMA + TOXICOLOGY + ENVIRONMENT

YEAR 3 | PAGE 32G - PRIMARY SURVEY -> TIME-CRITICAL ACTION ->

SECONDARY SURVEY -> REASSESS

In trauma and toxicology, the exam often tests whether you recognize the management sequence before a complete diagnostic label is available. Treat immediate threats as they are found; then widen the evaluation. For real patients, supervised local protocols, trauma systems, poison control and specialty consultation supersede any study resource.

G. TRAUMA: PRIMARY-SURVEY DECISION MAP

DomainWhat you are looking forExam logic / immediate priority
A - Airway + C-spineObstruction, facial/neck injury, expanding hematoma, inhalation injury, depressed consciousness.Secure a failing/at-risk airway while protecting the cervical spine; do not postpone airway management for complete imaging.
B - BreathingTension/open PTX, massive hemothorax, flail segment/contusion, ventilation failure.Some thoracic threats are clinical diagnoses and require immediate treatment before confirmatory imaging.
C - CirculationExternal/internal hemorrhage, pelvic/abdominal/chest bleeding, shock trajectory.Control hemorrhage, obtain access/blood as indicated, activate trauma resources; unstable patients may move to definitive hemorrhage control rather than CT.
D - DisabilityGCS/mental status, pupils, lateralizing deficit, glucose; traumatic brain injury.Prevent hypoxia/hypotension; identify herniation or expanding ICH patterns; reassess serially.
E - ExposureHidden wounds, burns, deformity, contamination; temperature loss.Fully expose for injury survey, then prevent hypothermia and proceed to secondary survey after immediate threats are controlled.

H. TOXICOLOGY: TOXIDROME -> ECG / ACID-BASE -> ANTIDOTE / SUPPORT

PatternCluesHigh-yield decision
OpioidCNS/respiratory depression, miosis (not universal).Ventilation is the immediate threat; naloxone is used to reverse clinically important opioid effect, with reassessment for recurrence.
SympathomimeticAgitation, diaphoresis, tachycardia, hypertension, hyperthermia, mydriasis.Control agitation/hyperthermia and complications; distinguish from anticholinergic pattern by sweating/bowel/bladder clues.
AnticholinergicDry/flushed, mydriasis, urinary retention, delirium, decreased bowel sounds.Supportive care + ECG/temperature; identify medication source and severe complications.
CholinergicSecretions, bronchorrhea, diarrhea/urination, miosis, weakness.Airway/secretions are immediate; recognize organophosphate/carbamate exposure and antidotal pathway.
TCA / sodium-channel blockadeAltered mental status, hypotension, wide QRS/arrhythmia after overdose.ECG drives urgency; sodium bicarbonate is a classic antidotal intervention for significant sodium-channel blockade.
Acetaminophen / salicylate / toxic alcoholEarly presentation may be deceptively benign; acid-base, anion/osmolar gap and time-from-ingestion matter.Use agent-specific levels/nomograms or toxicology pathways when valid; involve poison center/toxicology early for severe/uncertain ingestion.

H. TOXICOLOGY: TOXIDROME -> ECG / ACID-BASE -> ANTIDOTE / SUPPORT — I. ENVIRONMENTAL + EXPOSURE EMERGENCIES

  • Heat illness: distinguish heat exhaustion from heat stroke by CNS dysfunction; rapid cooling and organ-support priorities dominate severe hyperthermia.
  • Hypothermia: handle gently, monitor rhythm, rewarm according to severity; cold patients can have altered medication/electrical responses.
  • Burns/smoke: airway/inhalation injury and carbon monoxide/cyanide risk may be more urgent than burn size; estimate depth/TBSA only after stabilization.
  • Envenomation/decontamination: protect staff, remove ongoing exposure, identify syndrome and consult poison control/toxicology when indicated.

H. TOXICOLOGY: TOXIDROME -> ECG / ACID-BASE -> ANTIDOTE / SUPPORT — PROCEDURE / SIMULATION MASTERY CHECK

Practice under supervision: bag-mask ventilation, airway setup, defibrillation/cardioversion workflow, IV/IO access, wound anesthesia/irrigation/closure, splinting, bedside ultrasound orientation and trauma/team communication. Know indications, contraindications, complications and when to call for help.

CORE RESOURCES

SAEM - Trauma approach and primary survey SAEM - Chest Trauma Divine Intervention Episode 181 - Comprehensive NBME Emergency Medicine Shelf Review Series 1 2026/27 clerkship-expanded edition - verify school and official exam updates before testing