Secondary Survey

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

Conduct thorough examination of each the following systems.

Head Examination

Scalp and ocular abnormalities

External ear and tympanic membrane

Maxillofacial injuries

Neck Examination

Penetrating wounds

Subcutaneous emphysema

Tracheal deviation

Neck vein appearance

Pain / tenderness

Neurological Examination

Brain function assessment using the Glasgow Coma Scale (GCS)

Spinal cord motor activity

Sensation and reflex

Chest Examination

Clavicles and all ribs

Breath and heart sounds

Abdominal Examination

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

Fractures and pain

Peripheral pulses

Evidence of weakness, loss of function or sensory change

Spinal Examination

Log roll and check each vertebral level for injury

Rectal Examination

Perform rectal examination (if not already done)

Investigation

Relevant further investigation includes the following domains:

Imaging

Imaging

X-Ray chest, cervical spine and pelvis

Other X-rays as clinically indicated

Ultrasound (FAST)

CT Scan (If available)

Blood Tests

Any additional investigations

Other

ECG

Procedures

Relevant procedures include:

• Nasogastric tube for abdominal decompression
• Urinary Catheter for urine output