Trauma Center: Second Opinion/XS Score Requirements

The following guide will show you what Special Bonuses are required to get an XS rank. Remember that XS ranks can only be gained in Hard mode. For Normal and Easy, the highest rank possible is S. Requirements for an S in Normal and Easy are almost the same as an XS in Hard except for one detail. Any bonus that requires a numeric amount, such as 10 COOLs earned, will be less for Normal and Easy. Also, a lot of episodes have a time requirement for a Special Bonus. This bonus is listed in seconds. For example, the bonus "Completed with 240 left" means you completed the mission with 240 seconds left, or four minutes.

Important: Even if you get all of the special bonuses for an episode you still may not get an XS rank. There is a score cut off for each rank. While most missions you will get an XS rank if you do get all of the bonuses, it is not guaranteed. Remember that you get a score bonus depending on how high the patient's vitals are when you finish the procedure. If you have the time at the end of an episode, raise the patients vitals.

Episode 1-1: Standard Procedure

 * No mistakes
 * Vitals stayed above 75
 * Completed with 275 left, 4:35
 * 6 COOLs earned

Episode 1-2: Learning the Ropes

 * No mistakes
 * Completed with 260 left, 4:20
 * 3 COOLs earned

Episode 1-3: A Farewell

 * No mistakes
 * Completed with 240 left, 4:00
 * 3 COOLs earned

Episode 1-5: Singing the Blues

 * No mistakes
 * Fewer than 6 blood pools
 * Completed with 210 left, 3:30

Episode 1-6: A Real Doctor

 * No mistakes
 * Vitals stayed above 25
 * Completed with 210 left, 3:30
 * 3 COOLs earned

Episode 1-8: Life or Death

 * No mistakes
 * Completed with 240 left, 4:00
 * 3 COOLs earned

Episode 2-1: Dormant Ability

 * No mistakes
 * Less than 2 thrombi passed through
 * Completed with 240 left, 4:00
 * 3 COOLs earned

Episode 2-3: Striving for Asclepius

 * Healing Touch activated
 * 4 Skilled Healing Touches
 * 1 Passable Healing Touch

Episode 2-4: Awakening

 * Max CHAIN over 50
 * No aneurysms ruptured
 * Completed with 150 left, 2:30
 * No mistakes

Episode 2-6: Just Let Me Die

 * Max CHAIN over 20
 * Less than 1 hemorrhage
 * Wound did not reopen
 * 7 COOLs earned

Episode 2-9: Please Let Me Live

 * Max CHAIN over 50
 * Completed with 180 left, 3:00
 * Wound did not reopen
 * No mistakes

Episode 2-11: For the Greater Good

 * Max CHAIN over 14
 * Fibrillation occurred less than 3 times
 * Completed with 240 left, 4:00
 * No mistakes

Episode 3-2: GUILT

 * Max CHAIN over 50
 * Completed with 180 left, 3:00
 * No mistakes

Episode 3-4: Something Precious

 * Max CHAIN over 60
 * Completed with 150 left, 2:30
 * No mistakes

Episode 3-6: An Explosive Patient

 * No Healing Touch
 * Core reached faster than 80, 3:40
 * Did not approach MISS limit

Episode 3-8: Caduceus on a Plane

 * No mistakes
 * Completed operation before 5 jolts
 * Inflammation remained below 3
 * Completed with 210 left, 3:30

Episode 3-10: Pandora's Box

 * No Healing Touch
 * Less than 2 membranes multiplied
 * Completed with 210 left, 3:30
 * No mistakes

Episode 4-2: Race for the Cure

 * Max CHAIN over 12
 * Toxins formed fewer than 3 times
 * Completed with 140 left, 2:20
 * No mistakes

Episode 4-4: Stepping Up

 * Max CHAIN over 18
 * 3 or fewer diverticula formed
 * Completed with 120 left, 2:00
 * No mistakes

Episode 4-6: The First Step

 * Max CHAIN over 17
 * No mistakes
 * Finished 10 of Victor's orders

Episode 4-7: Medical Research

 * Finished faster than 5

Episode 4-8: The Next Step

 * Max CHAIN over 70
 * No mistakes
 * Completed with 210 left, 3:30

Episode 4-9: Progress

 * Finished faster than 15

Episode 4-10: Prolonged Struggle

 * Max CHAIN over 100
 * Completed with 140 left, 2:20
 * No mistakes

Episode 5-2: Under the Knife

 * Max CHAIN over 200
 * All 5 operations were completed
 * 5 patients saved
 * No mistakes

Episode 5-3: Shifting GUILT

 * No Healing Touch
 * Less than 3 membranes multiplied
 * Completed with 190, 3:10 left
 * No mistakes

Episode 5-4: GUILT Evolves

 * Max CHAIN over 30
 * 3 or fewer diverticula formed
 * Completed with 180 left, 3:00
 * No mistakes

Episode 5-6: Infection

 * Max CHAIN over 50
 * Paraskevi moved 1 or less times
 * Completed with 120 left, 2:00
 * No mistakes

Episode 5-8: A Devil

 * Max CHAIN over 70
 * Blue GUILT body did not appear
 * Completed with 230 left, 3:50
 * No mistakes

Episode 5-9: Death Awaits All

 * Completed with 240 left, 4:00
 * No mistakes
 * Max CHAIN over 120
 * 25 COOLs earned

Episode Z-1: From Overseas

 * Max CHAIN over 28
 * No mistakes
 * Completed with 225 left, 3:45
 * 3 COOLs earned

Episode Z-2: Miracle

 * Tumors did not regenerate
 * Max CHAIN over 100
 * No mistakes
 * Completed with 180 left, 3:00

Episode Z-3: Pursuit

 * Flash used 1 time or less
 * Max CHAIN over 35
 * No mistakes
 * Completed with 200 left, 3:20

Episode Z-4: Transplant

 * Tumors did not regenerate
 * Finished before vasoconstrictor expired
 * No mistakes
 * Completed with 230 left, 3:50

Episode Z-5: Sayanora

 * Captured 3 GUILT bodies
 * Max CHAIN over 50
 * No mistakes
 * Completed with 140 left, 2:20

Episode 6-3: Relapse

 * Max CHAIN over 10
 * Completed with 210 left, 3:30
 * 1 or fewer diverticula formed

Episode 6-4: Second Opinion

 * Max CHAIN over 60
 * No mistakes
 * Completed with 120 left, 2:00
 * 30 COOLs earned

Episode 6-6: The Future of GUILT

 * Max CHAIN over 90
 * Completed with 140 left, 2:20
 * No mistakes

Episode 6-7: Fallen Heroes

 * Max CHAIN over 150
 * No mistakes
 * Completed with 200 left, 3:20
 * Less than 5 membranes multiplied

Episode 6-8: Vulnerability

 * Max CHAIN over 180
 * No mistakes
 * Completed with 150 left, 2:30
 * 20 COOLs earned

Episode X-1: Kyriaki
The requirements for all of the X Episodes are the same for Dr. Stiles and Dr. Weaver.


 * No Healing Touch
 * Completed with 90 left, 1:30
 * No mistakes
 * Max CHAIN over 60

Episode X-2: Deftera

 * No Healing Touch
 * Completed with 90 left, 1:30
 * No mistakes
 * Max CHAIN over 70

Episode X-3: Triti

 * No Healing Touch
 * Completed with 180 left, 3:00
 * No mistakes
 * Less than 6 membranes multiplied

Episode X-4: Tetarti

 * No Healing Touch
 * Completed with 60 left, 1:00
 * Max CHAIN over 20

Remember for this episode you can make mistakes and still get XS. It's the Max CHAIN over 20 that will be the most difficult part.

Episode X-5: Pempti

 * No Healing Touch
 * Completed with 120 left, 2:00
 * No mistakes
 * Max CHAIN over 100

Episode X-6: Paraskevi

 * No Healing Touch
 * Completed with 90 left, 1:30
 * No mistakes
 * Max CHAIN over 50

It is ok if the Paraskevi burrows into other organs in this episode. Just makes sure it doesn't burrow if you get as far as the heart.

Episode X-7: Savato

 * Completed with 90 left, 1:30
 * No mistakes
 * Max CHAIN over 200