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S-Rank Guide by ChaosDragon13

Version: 1.11 | Updated: 06/16/2006

Trauma Center: Under the Knife

S Rank Guide

By Chaosdragon13

version 1.0 - well its been a few month since I first started but I finally
  found time to finish it (4/1/06)

version 1.1 - updated cutoff scores for mission 4, 11, 16, 17, 22, 24, 27
  thanks to Sam Lilley and updated the lowest time thanks to Erratum (6/7/06)

version 1.11 - updated cutoff score for mission 20 thanks to Drk Scyther

1. How things are set up
2. Required Skills
3. Missions
4. Final Words

1. How things are set up:

	The basics of what you need to know are all listed in the section
below titled ‘required skills’. After that is the section which goes through
each level individually. For the easier levels which lend themselves to much
more experimentation I will only list certain information such as how to get
a full special bonus and what is the base score for an S rank. All the other
aid for getting an S rank on those levels can be found in the ‘required
skills’ section. However for other levels there will be a more in depth
walkthrough describing the most efficient way to beat the level and get an
S rank.   

2. Required skills:

1. Getting ‘cool’ on most or all mini rankings during the mission.

- Scalpel: Disinfect the area first until it gives you the ‘okay’ message
  then proceed to cut from one end to the other. Your ability to follow the
  dotted line is what determines your mini ranking for this.

- Stitching: Go over the wound fairly evenly and make sure that you go
  completely from one end of the wound to the other. However, all that
  really matters is that you went completely from one end to the other. But
  using even spacing is a good habit since depending on the size of the wound
  it will require you to pass over it a given number of times.

- Bandaging: Disinfect the area first until it gives you the ‘okay’ message
  then cover the wound. Make sure to cover the whole wound without using an
  excessive amount of bandage.

- Forceps: When pulling glass out of wounds all that matters is how straight
  you pulled it out. The time it takes to pull it out or to get it to the pan
  doesn’t matter.

- Resuscitation: When massaging the hearth apply gel to the area until it
  has a good green color then proceed to follow the darker line up and down
  in rhythm with the hand tool selected. It’s not hard at all once you know
  what you are doing.

- Rubbing: After cutting something out, such as a tumor you will need to
  apply the patch, rub gel over it until given the ‘okay’ message, and then
  rub the patch with the hand tool. People tend to have trouble on this but
  it’s actually really easy. Simply rub over the patch in a wide circling
  motion. After it makes the rubbing sound 4-5 times it will be finished. 
  From what I have found this is how it works: When you put the patch on and
  disinfect it a pixel or spot on the patch is randomly selected and that
  spot must be touched with the hand tool before a new spot is generated.
  Each time you hit the spot it will make the rubbing noise and you will be
  one step closer to finishing the process and the faster you finish the 
  better your mini ranking. So while you don’t have to rub in a circle, it
  is the easiest way to cover every possible point on the patch. 

2. Finish the mission with speed to get a high time bonus

3. Get the full 2000pts for the special bonus (very important)
  - Don’t use Healing Touch (HT)
  - Don’t ‘miss’ (exception for Miracle at 9,800ft)
  - Each mission has a specific time that you can’t take longer than
  - Follow any mission specific rules

4. Injection/Gel vital stabilization (I/G). This is something you will
need to know how to do in order to beat X1, but not for much else. The
main thing you need to know for most levels is just that using the
gel will slightly raise your vitals.

How it works:
- Raise pt. vitals by using a few injections. 
- After that use antibiotic gel over the wounds. Use of the gel slows the
  decline of the vitals.
- If vitals are not at a suitable point use a few more injections to raise
  the vitals even higher. Because the gel is slowing the vital decline these
  injections will raise the vitals slightly faster than the first set.
- Apply gel over wounds again. You should always be sure that there is at
  least some amount of gel over the wounds to slow down the decline of the
- If at anytime you run out of injections, apply the gel until you are able
  to use them again. Applying the gel in this way holds the vitals steady
  while you wait for you injections to be useable again.
- Once the vitals are holding steady at a number that is safe (one that gives
  you enough leeway to do something other than raise the vitals and also one
  that doesn’t take too much time to get back up to, normally around 40)
  apply a fresh layer of gel and continue with the mission for a short time
  until you are required to raise the vitals back up.

5. Double stylus pens. Get into the habit of either using your thumb to
switch between the tools on left side of the screen or simply use two stylus
pens. It saves a lot of time on levels where you are constantly switching.

3. Missions:

mission number: mission name (my score, my time)
- the minimum number of points needed to get an S rank or an estimate if I
  can not figure it out exactly by experimenting. A ‘?’ indicates that I am
  not sure if the score written is the exact cut off for an S rank, but
  everything that I got which was above that score gave me an S.
- you must have at least this much time left on the mission clock in order
  to get the full special bonus. This will not appear for every mission as
  the later missions have a much larger time window which you will should
  not even come close to passing.
Special Bonus: Mission related things required to get the full 2000pts for
  the special bonus, not all missions have them and it’s possible that I may
  not have found out about some in my experimenting but it’s likely that all
  the major requirements will be listed.
Walkthrough: Mission walkthrough, not all missions have one.
General Tactics: Missions without a walkthrough may have this section giving
  general advice on things to do to make the mission go more smoothly.

01: Standard Procedure (5215, 4:31)
- 5200
- 4:30
General Tactics: Required skills 1-3 are all that count in this level.

02: Standard Procedure 2 (4515, 4:31)
- 4500
- 4:00
Special Bonus: if searching for the tumor with the sonogram you will lose
  points if you find the shadow of the tumor but it disappears because you
  were not close enough to it, its best to find where the tumor is and then
  on the next run through the level cut it open without using the sonogram.

03: A Farewell (4905, 4:08)
- 4500 
- 3:40
Special Bonus: if searching for the tumor with the sonogram you will lose 
  points if you find the shadow of the tumor but it disappears because you
  were not close enough to it, its best to find where the tumor is and then
  on the next run through the level cut it open without using the sonogram.

04: Singing the Blues (7440, 3:36)
- 7200
- 3:08
General Tactics: This mission is the first one that is a must for the double
  stylus skill. Tap a section with the laser until it is burned off then
  quickly switch to the gel with the other pen, rub it on, and switch back
  to the laser. Alternatively you can rub the gel over the area first and
  then laser the area while the gel is still there. This will normally heal
  the wound the moment it is made. Either way there is a lot of switching
  between gel and laser so a second stylus is a good choice.

05: A Real Doctor (4935, 3:33)
- 4800
- 3:00
Special Bonus: must have less than 2 ‘bad’ mini rankings, if searching for
  the tumor with the sonogram you will lose points if you find the shadow
  of the tumor but it disappears because you were not close enough to it, its
  best to find where the tumor is and then on the next run through the level
  cut it open without using the sonogram.
General Tactics: Cut out the tumors one at a time and apply the patches.
  However wait until all the patches are on then disinfect them all at once
  and rub them in one at a time. When you are asked to use the sonogram at
  the end of the mission all you have to do is use it 10 times so just click
  it anywhere on the screen as quickly as it will let you.

06: Life or Death (6355, 3:49)
- 6000?
- 3:30
General Tactics: Before using the gel for resuscitating the patient use it to
  heal the small wounds near the bottom of the screen, this way you don’t
  have to waste your time doing that once the mission clock has started
  running. After that stitch the wounds first then pull the glass. Through
  out the whole mission only pull one or two pieces of glass before switching
  over to the gel to heal up the small wounds. Also one or two injections may
  be needed when pulling the small glass pieces out of the heart.

07: Dormant Ability (6570, 4:20)
- 6200?
- 3:40
Walkthrough: Cut the patient open and zoom in. Sonogram the two thrombi at
  the bottom right and take them out at the same time. Then Sonogram the
  other three and take them out all at once. Afterwards quickly pass over
  anything that Angie has to say. There is a maximum number of thrombi you
  can have pass through the spleen before you lose points for your special
  bonus and if you leave her talking too long you will pass this number.
  Don’t do anything until Derek uses HT automatically, you don’t have to do
  anything at this point so there is no reason to try. Once he uses HT,
  sonogram the two thrombi that are closest to reaching the hole at the end
  of the spleen and take them out. Then sonogram the remaining three and take
  them out at the same time. Depending on how fast you were up to this point
  you may have to wait a second or two for the last two thrombi to appear,
  when they do sonogram the two of them and take them out at the same time.
  Then all that is left to do is just to stitch everything up.

08: Striving for Asclepius (2000, 99:99)
- 2000
- n/a
Walkthrough: Its not really much of a walkthrough, but all you have to do for
  this level is draw five stars. Depending on how good your draw the stars
  you will get a different amount of points for the special bonus (which is
  all that counts for this level). Drawing five good sized stars with sharp
  points will get you 2000 points and an S rank.

09: Awakening (5626, 2:21 )
- 5600
Walkthrough: Open up the patient. Zoom in on the first aneurism and remove
  it: inject, cut remove, siphon blood, put together, and stitch. Zoom out
  and zoom back in on the second one and remove it. At this point two will
  appear at once, zoom in so that both are on the screen. Draw up a full
  syringe and inject both of them until they are at the point where you can
  make the cut. The reason for filling the syringe is so you can inject both
  of them without having to fill it up again. Cut both of them, then one by
  one remove them the rest of the way until you get to the part where you are
  supposed to make the stitch. Wait until both of them are at this point
  before you stitch either of them. This is because once you stitch one of
  them a trigger is set off and the second pair will appear.
     After stitching the first pair the second pair will appear, treat them
  the same way. Zoom out and then back in so both are on the screen, inject
  them at the same time, cut them at the same time, and then remove them one
  at a time. This time however, once you get them both to the part where they
  need to be stitched raise you vitals first and then make the stitches. This
  way you shouldn’t have to worry about your vitals during any other time of
  the mission.
     Now comes the part people find hard but it’s actually really easy. Your
  screen should be set up from the last pair so that three of the five
  aneurisms that appear will be accessible to the syringe and a fourth will
  be at the bottom but will get covered up by the syringe bottles. Fill up
  the syringe all the way and inject and cut but do not remove the pair on
  the left of the screen. Then fill up the syringe again and inject and cut
  the third one on the screen, again do not remove anything yet. After
  cutting the third quickly zoom out and back in so that the remaining two
  are on screen. The lower of the two should be just about ready to burst
  and the higher is slightly behind it. Fill the syringe and inject half of
  it into the bottom aneurism and the other half into the top one. This will
  lower them enough so that neither of them will burst. From here continue to
  inject half a syringe into one and half into the other until you can make
  the cuts for each of them.
     Now that you have everything cut you can start removing them one by one,
  all the while using injections for vitals as needed. Once you are all done
  sew up the patient like normal. If you are having trouble getting the score
  needed for an S rank, then take a little time at the end, before you
  bandage everything, to raise the vitals so you get a higher vital bonus.
  The mission can be finished with around 2:40 left on the clock and my time
  with an S rank score was 2:21, so there is plenty of time to raise your
  vitals to get a higher score.

10: Just Let Me Die (5030, 2:18)
- 4900
General Tactics: Start by stitching up all the small wounds first to slow the
  rate of vital decline and then move on to the larger wounds. Raise your
  vitals at the end of the mission to get a higher score.

11: Please Let Me Live (6635, 3:13)
- 6600
Walkthrough: Open up the patient and start by stitching up the normal wounds,
  then move on to the larger wounds. Before you stitch up the last one use
  two injections to bring your vitals up. When you are able to switch to the
  sonogram, find the kyriaki, cut it out and laser it. When the second set
  appears don’t cut the out right away. First stitch up all the wounds that
  are on the screen along with any other wounds that they make while you are
  taking care of the ones that are already there. The reason you don’t want
  to cut them out right away in this level is because you need the extra
  wounds for more points. After the wounds are all sewn up find both kyriakis
  and kill them at the same time. Stitch up all the wounds but one, raise you
  vitals, then stitch up the last wound.
     When the mother kyriaki appears, first stitch up the three large cuts
  and any others it make sin the process, then proceed to cut it out and
  laser it three times. The reason for not cutting it out right away, again,
  is because you need the extra points.
     After the mother kyriaki is dead stitch up any wounds, sew up the
  patient like normal, and bring the vitals up to around 80 before you apply
  the bandage.

12: For Everyone’s Sake (5355, 4:20)
- 5100?
Walkthrough: Open the patient and select the knife. This will set off a short
  dialogue leading into resuscitating the patient. After that is done quickly
  disinfect and cut open the heart. Zoom in and drain the blood. Select the
  knife and make all three sets of cuts. Finally, take out the heart valve.
  At this point you have to pause because the area is about to fill up with
  blood again and if you try to do anything you will miss. Once it fills up
  and you siphon it off you have to pause again because one of two things
  will happen. If the vital line on the top of the screen goes back to its
  green color then proceed to place the new valve in and finish up the
  mission like normal. However, if it doesn’t go back then you are going to
  have to wait until you resuscitate the patient again before you continue
  with the procedure. Either way you will get enough points to get an S rank
  although if you get the second path you will get a higher score like the
  one I have.

13: GUILT (7105, 3:05)
- 7000?
Walkthrough: Open patient, stitch up normal wounds, heal all but one of the
  large wounds, raise vitals then heal up the final one. Find, cut out, and
  kill both kyriakis at one time, when the second wave comes find, cut out,
  and kill all three at the same time. Use I/G methods to slow your vitals if
  you need to. Once they are dead stitch up all but one wound, raise you
  vitals and stitch the final wound.
     When the mother appears start by stitching up two of the large wounds
  she makes at the start. After that, go straight to killing her. Once you
  are done finish everything like normal but raise your vitals to around 80
  before bandaging.

14: Something Precious (5625, 2:54)
- 5000?
General Tactics: You can use the gel to kind of control how the two things
  move, but its more just about getting lucky and having the right pairs
  bump into each other. This strain of guilt is pretty straight forward, make
  sure not to let too many of those dots to accumulate otherwise your vitals
  drop too fast, and when you get the point where you need to cut them out
  do it as fast as possible since they produce those dots quite rapidly at
  this point. There isnt much else to say because each time you play the
  mission things can be pretty different.

15: An Explosive Patient (3100, 0:03)
- 3100
Walkthrough: Start by zooming in on the water tanks. Siphon up water form
  the tank on the right. To place it in the tank on the left tap the left
  tank so that the tube with the water appears and then run the stylus from
  top to bottom of the tube(instead of bottom to top). Once the tube is
  empty you will have to move on to the next part. 
     Zoom out and back in on the section in the bottom left. Use the forceps
  to pull out all of the pins that are marked with arrows. After you pull out
  two of them you get a message saying that a trigger was set off and that if
  the temperature gets too high the bomb will go off, and that you can use
  the gel to cool it down. You don’t need to worry about this tough. Just
  zoom out and then back in on the section in the top left, the board with
  chips on it. There are four chips in the top row and five chips in the
  bottom row. From left to right, burn, with the laser, the third and fourth
  chips in the top row and the first, third, and fourth chips in the bottom
     At this point it will zoom in on the timer. Take out the scalpel and
  cut all the red wires without cutting the white ones. As long as you don’t
  ‘miss’ during any part of the mission you will get an S rank.

16: Miracle at 9,800ft (5770, 3:03)
- 5200
Special Bonus: 5 misses are allowed. 
Walkthrough: Follow this to get no misses. Open up patient and drain two
  areas of fluid. If you get lucky and find some fluid really quickly you
  may be able to drain three before turbulence hits and you can’t do
  anything. So after getting two, maybe three wait for the turbulence to pass
  and then do the same by draining two or three more depending on how fast
  you find them. Again wait for turbulence to pass and repeat. Once you drain
  eight area of fluid the mission is over and you just have to stitch
  everything up.

17: Forbidden Knowledge (5945, 4:21)
- 5700
Walkthrough: It is hard to eplain so just go to gamefaqs.com and look up my
  Triti guide under the "FAQs & Guides" section of Trauma Center. Follow the
  picture and directions without using HT and you will easily get an S.

18: Race for the Cure (4080, 2:26)
- 3900?
- 2:00
General Tactics: To speed things up a little, when you cut tetarti out use
  the gel to heal the wound while tetarti is blinking. You can’t inject it
  with anything while its blinking so you might as well make good use of your

19: Stepping Up (7340, 3:49)
- 7200
General Tactics: When you start there are three things you need to inject
  with the correct color and then cut out. The top one is yellow, the bottom
  left is purple, and the bottom right is green. Inject two of them to the
  cutting stage and then cut them together. Then inject and cut the third.
  Remove them and replace with the patch one at a time but disinfect and rub
  them together. You know what to do on the rest of the mission, just don’t
  miss and get through each set of three on the first try.

20: Taking a First Step (4465, 3:45)
- 4450
Special Bonus: You have to let the vitals drop below 70 before you inject 
  the first dose of the white vial.
Walkthrough: Open up the patient and follow what the guy tells you to do.
  First use the scalpel then the laser then the gel. Then he will start with
  the injections, just use them in the order he tells you to. If you are
  having trouble with the injections, there is a pattern that pempti follows.
  First it will flash on screen in one spot, and then it will flash a second
  time as it starts to move off in a random direction from that spot. If you
  place the injection slightly in front of pempti on the path that it is
  moving in during the second flash on screen you shouldn’t miss as long as
  you saw the course correctly and it wasn’t actually turning when you
  thought it was going straight. Then, before you inject the white vial for
  the first time, wait until your vitals have dropped below 70. This is a key
  part of getting the full special and S ranking this mission. Once the
  vitals have dropped below 70 just continue the mission like normal and
  don’t miss. If you don’t get the full special bonus then you won’t get an
  S rank.

21: Medical Research (2000, 99:99)
- 2000
- n/a
Special Bonus: Although there is not a specific time designated by the
  mission clock there is still a clock that runs in the background. If you
  don’t finish within 30 seconds then your points will be deducted.
Walkthrough: For those who want to try the puzzle on their own, take note
  that there is a picture of the shape you are supposed to make on the top
  screen. For others:
   X     X          X: Blank space
R     R     O       R, O, B, G: Red, Orange, Blue, Green pieces respectfully 
   R     O
G     B     O
   R     B
G     X     B
   G     B

22: The Next Step (4475, 3:44)
- 4200
General Tactics: This one is not hard, its just annoying like mission 20 was.
  Pretty much all you have to do is finish the mission without missing.
  Although the injections in this mission are a little harder to get off than
  they were in mission 20 because it seems that you have a shorter time span
  as pempti shrinks after consecutive injections. In order to make things a
  little easier, only fill the syringe half way. You don’t need a full
  syringe to do the injection, only around a half of one, however high the
  fill the syringe the longer you have to wait until the whole thing empties
  before it counts. So the less you fill it the less time you have to wait
  and the less chance you have of missing due pempti disappearing before the
  injections completes.

23: New Laser Technology (2000, 99:99)
- 2000
- n/a
Special Bonus: Again there is no requirement based on the mission clock but
  there is one based on a clock that runs in the background. For this mission
  you have to finish the two puzzles in about 40-50 seconds.
Walkthrough: For those who want to try the puzzle on their own, take note
  that there is a picture of the shape you are supposed to make on the top
  screen. For others:
     Puzzle #1               Puzzle #2
   R     R     B           Y     Y     Y       X: Blank space
L     R     P     B     G     Y     B     O
   L     R     X           G     Y     B       R, B, L, P, G, O, Y: Red, Blue,
L     R     P     B     G     Y     R     O    Light Blue, Purple, Green,
   X     P     P           P     X     O       Orange, Yellow respectfully
L     G     O     O     P     P     R     O
   G     G     O           P     R     R

24: Doctor’s Struggle (4805, 3:00)
- 4400
General Tactics: Start by injecting pempti the normal way with half fill
  syringes and then proceed to go through the three stages of attacks. 
 Attack 1: Pempti sends out smaller cells that pause for a moment and then
  shoot out creating a cut. When it does this attack laser the cells before
  they make the cuts. This is possible to do on all pempti missions although
  the cells pause for less and less time each mission so by X5 you have to
  work really fast.
 Attack 2: Pempti send out a line of small cells that pause for a moment
  then move up to the top of the screen and back down producing a few small
  cell growths that will need to be lasered off and healed with gel. When
  the row first appears laser all of them that you can before they start to
  move, which is normally two or three of them. After they are back near the
  bottom of the screen finish up the last ones that are left over. Then work
  on the small growths between attacks.
 Attack 3: This is the easiest one. All pempti does is send out a few small
  cells to circle around it. Simply place the laser in one spot so that all
  the cells pass under it and leave it there until they are all gone.
     After you go through one of each of the attacks pempti will start using
  them at random, and at times pempti itself will also be vulnerable to the
  laser. Take care of the attacks as needed and laser pempti six times
  whenever it’s vulnerable. Just do things with speed and this mission is an
  easy S.

25: Under the Knife (9999, 0:14)
- 9999
- >0:00
Special Bonus: You can’t have any misses and you must finish all the patients
  with time left on the clock. Otherwise even if you max out your score you
  will not get an S rank.
General Tactics: The main thing is that you have to be familiar with how to
  deal with kyriaki. I will not go into it in detail here because the mission
  is long and it would be pointless because you just repeat the same
  strategy. Basically during the first two small waves cut all of them out
  at the same time and laser them all together then stitch everything but one
  wound, raise you vitals and go on to the mother. If there is a small
  kyriaki during the mother fight then focus on it before going after the
  mother. When you are finishing a patient up don’t worry about how high or
  low their vitals are because it won’t affect the vitals of the next patient
  and it doesn’t really affect your overall score. If you beat the mission
  without missing and with time left on the clock you will max out your score
  so you don’t have to worry about that. Your main concern should be speed
  and accuracy because once you miss you have to start all over again. 
   Note: You only have to be on the third patient when time runs out to clear
         the mission normally.

26: Shifting GUILT (5839, 3:43)
- 5700?
Walkthrough: It is hard to eplain so just go to gamefaqs.com and look up my
  Triti guide under the "FAQs & Guides" section of Trauma Center. Follow the
  picture and directions without using HT and you will easily get an S.

27: GUILT Evolves (7265, 3:35)
- 7000
General Tactics: When you start there are three things you need to inject
  with the correct color and then cut out. The top one is green yellow, the
  middle is purple, and the bottom yellow. Inject two of them to the cutting
  stage and then cut them together. Then inject and cut the third. Remove
  them and replace with the patch one at a time but disinfect and rub them
  together. You know what to do on the rest of the mission, just don’t miss
  and get through each set of three on the first try.

28: Infection (9475, 1:55)
- 9400?
- 1:30?
Special Bonus: The time portion of this mission is something that needs to
  be watched out for. I am not sure exactly what it is though. I am guessing
  it is 1:30 but it could also be 1:20. I do however know it is not lower
  than that. Also you must finish the mission before any worms make it to
  the next part of the body.
Walkthrough: This strain of GUILT is the hardest out of all of them. In fact
  I didn’t even attempt to S rank them until I had S ranked everything else
  except for X7. In order to S rank this mission you need to be able to use
  two styli because you need all the extra time you can get. Also it will
  help very much in switching to the laser quickly when the worms start to
     Okay once you open up the patient there is a set of cuts. Stitch them
  all up and then use an injection to raise the vitals while the worm is
  coming out. After that switch to the laser and freeze the worm as soon as
  you can. Cut it in half and use an injection to raise you vitals up while
  the two halves are flashing. By the time you are done with the injection
  the halves will be done blinking and you have to freeze them again.
  Afterwards stitch up the two wounds (one may only need the gel if it is
  small enough). At this point use another injection if needed to raise you
  vitals up all the way and then wait until the two halves unfreeze. At which
  point freeze them again. You want to wait to refreeze them at this point so
  you have the longest time to work while they are frozen.
     Now, with the two halves frozen, cut one of the halves and use an
  injection afterwards while they are blinking. Then freeze the two quarters
  and proceed to cut one of them down to the smallest size. So cut one
  quarter into eighths and then cut all the eights into sixteenths. Each time
  you make the cuts, you want to get all of them at same time and while they
  are flashing you want to use an injection to raise your vitals. Also, all
  the while you want to keep the other half and quarter piece from moving as
  little as possible, so while you are working on the cutting the other
  pieces you also have to keep and eye on them and laser them whenever they
  start to move. Once you have gotten down to the smallest sized worms,
  freeze them and pull them out. Then rub the gel over the wounds quickly and
  start to stitch them up. After they are stitched bring your vitals back up
  a little over 50. Remember to always keep an eye on the other pieces and
  make sure they don’t move too much.
     Now with all the wounds healed and your vitals slightly above 50, start
  cutting up the other quarter in the same fashion as you did for the first
  quarter. Once you have pulled all of the pieces out, again you want to rub
  on the gel real quick to slow the vital decline a little and to be able to
  see where exactly the wounds are. And then stitch up the wounds and bring
  your vitals above 50.
     After that you will only have the one half left. Simply take care of it
  the same way you did with the last half. Cut it in half and then deal with
  those pieces one at a time in the same fashion as before.
     Once you have cleared out all of the worm, stitch up all the wounds
  and finish off the mission. You may also want to raise the vitals a little
  bit before you finish everything off in order to get a few more points.
  Just be sure not to get under 1:30 on the game clock otherwise your hopes
  for an S rank will be gone since you will get the 300 point deduction for

29: Devil (4725, 4:00)
- 4700
Special Bonus: You can not let any grey bug form
General Tactics: When you stitch all but one wound in the beginning a few
  bugs will come out of the last wound. So be prepared and get them with the
  laser as quickly as possible. Now for the next part the best thing to do is
  to memorize where the cuts form and on which side of the cut the bugs come
  out of. When the cut does form place the laser on the side that the bugs
  come out of before they appear and you should get an instant kill for about
  half of the bugs that come out of the cut. Then just clean up the last few
  that are left over and get ready for the next cut to appear. As for the
  S rank base score, I really don’t think it is that high, and although this
  level is short it is annoying to play over and over. The base score is
  probably closer to 4500 but I haven’t tested it, but basically though, as
  long as you don’t have a grey bug form you should get an S rank.

30: Death Awaits All (6786, 4:08)
- 6700?
Specail Bonus: I believe there is a certain of grey bugs that you can't go
  over, but the level is too long to test different numbers of bugs.
General Tactics: First thing is that because of the possible special bonus
  requirement I suggest taking care of the blue bugs when they form. Much
  like the previous mission, it helps if you position the laser where the
  web or cut is going to be before it appears so that half of the bugs get
  killed off before they get a chance to do anything. I don't know if it
  matters but it is what I did when I got my S rank. Also, cut the web as 
  quick as possible. Everytime the scalpel is available, use it even if you
  have to stop lasering the bugs for a second.
     During the second part of Savato just play like normal, only try to
  avoid touching Savato with anything but the laser or scalpel. There have
  been suggestions in the past to tap Savato with other tools to stop him
  from making cuts but during X7 this seems to have the opposite effect and
  actaully causes it to make more cuts. So its better to get used to this
  on an easier level.
     Right after the game automatically uses HT is the point that really
  matters when going for an S rank. At his point don't use your own HT,
  first just continue to stitch up the wounds Savato makes until your
  score gets around 3000-35000 points. Of course stablize your health as
  needed. Also at this point you can repeatedly tap Savato with other tools
  in order to delay it from making cuts. Once your score gets up to where
  it should be just use your own HT and finish the mission like normal. With
  the 2000 points from the special bonus and points from time bonus you will
  have enough to get an S rank.

31: First Sin (7790, 1:58)
- 7700? the actual cut off might be around 7500
General Tactics: Its really not hard, just play it like you did all the
  other kyriaki missions. When you get to the set of small waves find and
  cut them all out at once. Between the small waves and the final wave heal
  all but one wound then bring your vitals up and finally heal the last
  wound. Then for the final wave focus on the little kyriaki first then work
  on the mother. Also you may need to use the I/G stabilization method, or
  at least try it out on this level to get a feel for how to use it.
     Another small tip. During the second and final wave, before you go to
  cut out the kyriakis first quickly stitch up one or two wounds. This way
  when they make the wounds when you cut them out your vitals wont be
  dropping too fast. Then you may also want to stitch one wound up after
  you cut them out depending on whether or not you passed the wound limit.
     I dont think I explained it before, but the kyriaki mission have a
  cartain number of wounds for which they will not pass. Once they reach
  the wound limit the only time a new wound will be made is if you either
  stitch up a current wound thus bringing the number of wounds below the
  limit, or if you cut a kyriaki out. Once the number of wounds goes above
  the limit your vitals will start to drop too fast for you injections to
  keep up with. So always make sure you are at the limit, this way the
  kyriaki aren't making a lot of new cuts and dropping you vitals 5 points
  per cut they make on top of your vitals droping, and your vitals won't
  be dropping at an insane speed like when you are over the limit.

32: Second Sin (5175, 1:26)
- 5100?
General Tactics: This one is like the other deftera missions, there isnt
  much I can say about it since each time you play it things can turn out
  differently. Just work the mission like normal, don't let the dots build
  up and cut them out as soon as possible when you are at that point. 
     The only different thing about this level is that you have to know that
  you are able to use the gel in order to kind of direct the motion of the
  tumors. This is because the second part of the level starts where pairs of
  the same color tumors are on paths to hit each other, which you know
  produces a large number of those dots. So you have to use the gel right
  when you start the second part in order to separate them.

33: Third Sin (5860, 3:47)
- 5600?
Walkthrough: It is hard to eplain so just go to gamefaqs.com and look up my
  Triti guide under the "FAQs & Guides" section of Trauma Center. Follow the
  picture and directions without using HT and you will easily get an S.

34: Fourth Sin (7295, 3:37)
- 7200?
General Tactics: This mission is the same as the others of the same type.
  These are the easiest missions as long as you have the accuracy to not
  miss when they start moving fast. Basically just get every wave on the
  first try and you will get and S rank.
     Also when you start the mission, the top growth is yellow, the middle
  side growth is purple, and the bottom is green. So cut these out quickly
  like in the other missions.

35: Fifth Sin (4970, 1:18)
- 4900?
General Tactics: Really its just the same as before only faster. Definitly
  for this mission you should be using two sylui. Also like other pempti
  missions there is a luck factor in getting an S rank, the more of attack
  type 3 it uses the easier the mission is.

36: Sixth Sin (9820, 2:16)
- 9800? it is probably much lower, but its a long mission to test out
General Tactics: Simply follow the same walkthrough as Infection. Nothing
  really changes with this strain of GUILT other than the fact that the
  patient's vitals start to drop a little faster each time so you just need
  to bring up your speed a little bit.

37: Final Sin (7885, 3:20)
- 7800?
General Tactics: Do everything the same as you did for Death Awaits All. The
  only difference in tactics is that I think they increased the number of
  grey bugs you can have appear before your special bonus decreases. But
  still just to be sure I think you should worry about the bugs while you are
  taking care of everything else. I did when I got my S rank so I know it is
  possible to take care of the bugs and every else.
     Also, like the last Savato mission, before you use your own HT bring
  your score up to around 3500+ points before you end the mission to be sure
  that you have enough points to get an S rank.

38: X1: Kyriaki (7840, 0:27)
- 7800?
General Tactics: First, I think that the only real requrement for this level
  is that you have to just beat the mission with any score, no misses, and
  no HT. Really as long as you do so you should end up with a high enough
     People tend to have a lot of trouble on this mission, but it plays just
  like First Sin. The only difference is that there are a few more small
  kyriakis and the vitals drop faster. Still you have to cut out all the
  small kyriakis at once, or if they are not close enough together get two
  at once and then the other one soon after. Also during this mission you
  are pretty much required to use I/G stabilization. And again, for the
  waves after the first one, try to stitch up one or two wounds before you go
  and cut out the kyriakis so as not to go too far over the wound limit.
     Basically the best thing to do is to practice. Start by practicing on
  First Sin and get all the basic tactics down, then move on to X1 and just
  keep playing the mission until you get used to it. It really isnt too hard
  once you know what you have to do, but it still isnt too easy.

39: X2: Deftera (5570, 2:19)
- 5500?
General Tactics: I don't know why but this level is much much easier than
  Second Sin. It is probably because the tumor pairs aren't set up to hit
  similar colors like they were in Second Sin. So really this one shouldn't
  be too hard, in fact I got an S on my first try but thay may have just
  been luck. Simply play the mission like you did for past deftera missions
  and you should be fine being that you already beat Second Sin which is the
  hardest version of this GUILT strain.

40: X3: Triti (5415, 2:11)
- 5400?
Walkthrough: It is hard to eplain so just go to gamefaqs.com and look up my
  Triti guide under the "FAQs & Guides" section of Trauma Center. Follow the
  picture and directions without using HT and you will easily get an S.

41: X4: Tetarti (7325, 3:32)
- 7300?
General Tactics: Just like the other X missions the tactics for this mission
  are no different from the other mission with the same GUILT strain. As long
  as you are fast enough to clear each wave on the first try without missing
  you will get an S rank.
     Also the top left starting groth is yellow, top right is green, and
  bottom center is purple, so knowing the colors cut them out fast in the
  as fashion as you did for the other tetarti missions.

42: X5: Pempti (4980, 2:09)
- 4900?
General Tactics: There are only two main things you can do for this mission.
  The first thing is to get really good at using two styli and get amazing
  speed. And the second is to play the level enough times so that eventually
  you get lucky and get a run though where pempti almost always uses its
  third type of attack(which is explained under the first pempti mission).
  When I got my S rank on this mission I used a combination of the two above
  tactics. Although I prbably used the second tactic more than the first.
  I know it isnt much to go on, but do your best, there isnt much else I can
  say since at this point in the game it is more about skills and/or luck
  than just following a simple pattern like during the earlier missions.

43: X6: Paraskevi (9550, 0:55)
- 9500?
General Tactics: Score doesnt matter too much on this mission because as long
  as you finish the mission with no misses and a full special bonus you
  should have enough points to get an S rank with.
     Also, just like Sixth Sin, follow the walkthough from Infection. It
  works for all paraskevi missions since the only real difference between the
  missions is that the patient's vitals drop faster. Its an intense mission
  but as long you already S ranked the other paraskevi missions it shouldn't
  be too hard to get this one with a little practice.

44: X7: Savato (8380, 2:03)
- 8380?
General Tactics: Well here it is, the final level. For the most part it plays
  like the other Savato missions, only this mission is much more based on
  luck than any of the others.
     First off, for this mission you can finally just ignor the blue bugs
  during the first part of the mission. If you try to take care of the bugs
  like in the previous level then you are almost never going to get past
  the web. Instead just use injections between scalpeling the web.
     Once you make it to the second part, play it like the other missions
  only more intense. You have to be very quick with everything and there is
  also a lot of luck involved. Also remember not to touch Savato with
  anything but the laser or scalpel when needed because it seems to cause him
  to make a lot of cuts all at once. Just do your best.
     Now for the most important part. Like in the other missions when the
  game uses HT on its own dont use you own HT until your score is high
  enough. You don't want to play this mission a second time so plan on
  getting an S rank the first time through. The score I got before I used my
  own HT was around 5500 I think. Anything around that score before you use
  your own HT should be enough to get you and S rank score with the time and
  special bonus. Good luck.

4. Final Words
   Well that is all of them, even the X missions. I am sorry there isnt more
I can say about the X missions but they really arent too different from the
other mission with the same GUILT strains. For the most part it just requires
better skills. Hope it helps.

All names and such are trademark of their respective companies.

Special Thanks:
t002 tyrant: who helped push me to get S ranks since having
  them going after the same goal made it more like a competition.
Sam Lilley: for revising a number of cutoff scores.
Erratum: for revising the cutoff time for mission 04.
Dark Scyther: for correcting the cutoff score for mission 20.

Any question you have or changes that need to be made can be sent to me at
superurbie@hotmail.com. This guide is intended for gamefaqs only so dont
ask to host it on your own site. 

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