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The Secondary Survey

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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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