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The Secondary Survey

Once a trauma patient has been stabilised following a primary survey, the secondary survey is then performed as a thorough assessment for any trauma-related pathology that may have been missed.

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

Inspect

Deformity, bruising, lacerations
Cervical Spine

Immobilise until radiologically cleared

Tenderness to palpation
Palpate

Tracheal deviation, crepitus

Chest

Life-Threatening Injuries

Open chest wound, tension PTX, massive haemopneumothorax, cardiac tamponade
Inspection

Bruising, symmetry, flail chest
Palpation

Chest wall tenderness, crepitus
Auscultation

Air entry, heart sounds

Abdomen

Inspection

Bruising, distension, wounds
Palpation

Tenderness, guarding, mass
Auscultation

Bowel Sounds
FAST Scan

Morrison's pouch, splenorenal recess, pericardium, pouch of Douglas
Nasogastric Tube

Contraindicated if base of skull fracture

Empty stomach contents, look for blood

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

Deformity

Obvious fracture / dislocation
Bruising

Grey-Turner's Sign
Tenderness

Spinal / paraspinal / ribs

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

Neurological Assessment

Conscious State

Glasgow coma scale
Eyes

Pupils, acuity, eye movement
Pupils

Size, light reflexes, accommodation
Visual Acuity

Snellen Chart or equivalent, one eye at a time
Eye Movement

Modified H pattern - ask about pain / diplopia
Facial Movement

Raise eyebrows, close eyes, show teeth, puff cheeks
Tongue

Deviation on protrusion of tongue
Motor Assessment

Tone, power, reflexes
Tone

Passive movement of joints
Power

0/5 no flicker, 3/5 vs. gravity, 5/5 normal

Movement against gravity & resistance, R vs. L
Reflexes

0 no response, 2+ normal, 3+ brisk, 4+ clonus

Biceps, triceps, supinator, patella, achilles, Babinski
Sensory Assessment

Tactile, pain, vibration, proprioception

On this page: Head Neck Chest Abdomen Pelvis Back Arms Legs Neurological Assessment

Read More...

Robert C. Schlant, Joel M. Felner, The arterial pulse- clinical manifestations, Current Problems in Cardiology, Volume 2, Issue 5, August 1977 Simon HB. Hyperthermia. N Engl J Med. 1993; 329: 483-487. Thomas PD. The Differential Diagnosis of Fixed Dilated Pupils: A Case Report and Review. Critical Care and Resuscitation. 2000; 2: 34-37. Wilhelm H. Pupil Examination and evaluation of pupillary disorders. Neuro-ophthalmology. 1994; 14(5): 283-295. Wood NK. Percussion of the Lungs. Journal of the American Medical Association. 1914; 63(16): 1378.

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