The Secondary Survey
Head
Life-Threatening Injuries
Head injury, raised ICP, airway obstruction
Scalp
Lacerations, haematomas
Skull
Depressed fracture, signs of base of skull fracture
Face
Deformity, lacerations, swelling, bruising
Oral Cavity
Bleeding, avulsed teeth, jaw alignment & mobility
Eyes
Orbits, pupils, visual acuity, eye movement
Nose
Septal haematoma, epistaxis, CSF leak
Ears
Haemotympanum, CSF leak
Neck
Chest
Abdomen
Pelvis
Life-Threatening Injuries
Pelvic fracture, urethral injury
Inspection
Deformity, urethral blood, priapism
Pelvic Springing
Laterally and anterior-posteriorly
Digital Rectal Examination
Blood, pelvic fracture, prostate position, anal tone
Per Vaginal Examination
Pelvic fracture, vaginal bleeding
Urethral Catheter Insertion
Contraindicated if urethral trauma suspected
Monitor urine output
Back
Arms
Life-Threatening Injuries
Amputation, vascular injury, humeral fracture, severe crush injury
Colour
Pallor, cyanosis
Swelling
Over muscles, bones or joints
Deformity
Obvious fracture / dislocation
Capillary Refill
Compress the nail, normal if refill in <2 seconds
Tenderness
Elicit subjective pain on palpation
Joint Movement
Pain, crepitus, limited ROM
Legs
Life-Threatening Injuries
Amputation, vascular injury, long bone fracture, severe crush injury
Skin Colour
Pallor, cyanosis
Swelling
Over muscles, bones or joints
Deformity
Obvious fracture / dislocation
Joint Movement
Pain, crepitus, limited ROM
Peripheral Pulses
Femoral, popliteal, posterior tibial, dorsalis pedis