The Secondary Survey is a head to toe and systems examination with the aim of identifying all injuries that have not been detected in the Primary Survey.
The Secondary Survey is undertaken when the Primary Survey is completed and the Airway, Breathing and Circulation are stable. If the patient deteriorates during the Secondary Survey, then you should STOP immediately and repeat the Primary Survey.
Documentation is required for all procedures undertaken.
Take a brief history of the cause of injury and a relevant patient history.
Assessment[edit | edit source]
Conduct thorough examination of each the following systems.
Head Examination[edit | edit source]
Scalp and ocular abnormalities
External ear and tympanic membrane
Maxillofacial injuries
Neck Examination[edit | edit source]
Penetrating wounds
Subcutaneous emphysema
Tracheal deviation
Neck vein appearance
Pain / tenderness
Neurological Examination[edit | edit source]
Brain function assessment using the Glasgow Coma Scale (GCS)
Spinal cord motor activity
Sensation and reflex
Chest Examination[edit | edit source]
Clavicles and all ribs
Breath and heart sounds
Abdominal Examination[edit | edit source]
Penetrating wound of abdomen requiring surgical exploration
Signs of blunt trauma and hidden haemorrhage
Genital examination
Rectal and vaginal examination
Examination of Pelvis And Limbs[edit | edit source]
Fractures and pain
Peripheral pulses
Evidence of weakness, loss of function or sensory change
Spinal Examination[edit | edit source]
Log roll and check each vertebral level for injury
Rectal Examination[edit | edit source]
Perform rectal examination (if not already done)
Investigation[edit | edit source]
Relevant further investigation includes the following domains:
Imaging[edit | edit source]
Imaging
X-Ray chest, cervical spine and pelvis
Other X-rays as clinically indicated
Ultrasound (FAST)
CT Scan (If available)
Blood Tests[edit | edit source]
Any additional investigations
Other[edit | edit source]
ECG
Procedures[edit | edit source]
Relevant procedures include:
- Nasogastric tube for abdominal decompression
- Urinary Catheter for urine output