The Secondary Survey

Head injury, raised ICP, airway obstruction

Lacerations, haematomas

Depressed fracture, signs of base of skull fracture

Deformity, lacerations, swelling, bruising

Bleeding, avulsed teeth, jaw alignment & mobility

Orbits, pupils, visual acuity, eye movement

Septal haematoma, epistaxis, CSF leak

Haemotympanum, CSF leak

Deformity, bruising, lacerations

Immobilise until radiologically cleared

Tenderness to palpation

Tracheal deviation, crepitus

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

Bruising, symmetry, flail chest

Chest wall tenderness, crepitus

Air entry, heart sounds

Bruising, distension, wounds

Tenderness, guarding, mass

Bowel Sounds

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

Contraindicated if base of skull fracture

Empty stomach contents, look for blood

Pelvic fracture, urethral injury

Deformity, urethral blood, priapism

Laterally and anterior-posteriorly

Blood, pelvic fracture, prostate position, anal tone

Pelvic fracture, vaginal bleeding

Contraindicated if urethral trauma suspected

Monitor urine output

Obvious fracture / dislocation

Grey-Turner's Sign

Spinal / paraspinal / ribs

Amputation, vascular injury, humeral fracture, severe crush injury

Pallor, cyanosis

Over muscles, bones or joints

Obvious fracture / dislocation

Compress the nail, normal if refill in <2 seconds

Elicit subjective pain on palpation

Pain, crepitus, limited ROM

Amputation, vascular injury, long bone fracture, severe crush injury

Pallor, cyanosis

Over muscles, bones or joints

Obvious fracture / dislocation

Pain, crepitus, limited ROM

Femoral, popliteal, posterior tibial, dorsalis pedis

Glasgow coma scale

Raise eyebrows, close eyes, show teeth, puff cheeks

Deviation on protrusion of tongue

Tactile, pain, vibration, proprioception