This is part 3 of a 3-part sequence. See here for Part 1.
Pull the switch to send the elevator down.
Once the elevator moves down below floor level, run over the top of it and grab the ladder on the inside of the elevator shaft.
Climb almost to the top. Then backflip to land in the opening behind.
Here you'll find a large medi pack and 4 boxes of shotgun shells. (The pickup by Lara's foot is actually 2 boxes.)
Walk away from the elevator shaft to the other side of this little room. Turn around, drop and hang from the edge. Then climb down the ladder and drop into the blue-tiled hallway below.
At this point, you can move out onto the open roof to fight the monster. Just watch out for the broken glass hazard in the doorway. Or, if you prefer, try this:
Use the switch again to bring the elevator up.
As you wait for the elevator to arrive, safety drop into the shaft to avoid the monster's pummeling fists.
But as soon as the top of the elevator reaches the opening, step off.
Then hop back into the elevator when the doors open. You can shoot the monster from inside the elevator, and it won't be able to reach Lara. When the monster falls, that's the end of the level and the game.
[Part 2 | Return to the Nightmare in Vegas Walkthrough]
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