Secondary survey Nicole Smith Clinical Nurse Unit Manager

Nepean Hospital Sydney, Australia

What we will cover:

�  Mechanism of injury and types of injury

�  Purpose of the secondary survey

�  Patient history and events leading up to the event

�  Anterior / posterior secondary survey

�  Maintaining C-spine precautions and the log roll procedure

�  Common further examinations

Mechanism of injury

Identifying the mechanism of injury is vital to predicting actual and associated injuries

Obtain full history of events if possible

Two most common forms of injury are blunt trauma and penetrating trauma

Blunt trauma – compression injury

Blunt trauma – shearing injury

Penetrating injury – projectile injury with a small or large open wound

Penetrating wound - gunshot

Secondary survey purpose

The primary survey is completed and all life threatening complications have been identified and corrected

�  During the secondary survey the focus is now to detect all injuries

�  Head to toe assessment

�  Guide investigations and interventions

Involves:

�  Gathering information, history and mechanism of injury

�  Reviewing vital signs

�  Full thorough head to toe examination – anterior / posterior with SPINAL PRECAUTIONS

�  Pain control

�  Reassure and talk with family / friends

Basics of trauma assessment to begin with:

L – Laboratory work up

I - IDC

N - naso / orogastric tube

E - ECG

S – Sa02

A – Allergies

M – Medications

P – Past medical history

L – Last eaten

E – Events leading up to now

Head to Toe Assessment

Head and Face

Identify: Wounds

Deformities & depressions of skull

Drainage from ears / nose

Check pupils = PEARL

Palpate for tenderness

Neck C-Spine precautions if uncleared

Identify:

Wounds

Deformities

Distended neck veins

Tracheal deviation

Tenderness

Neck range of motion if C-spine is clear

Chest

Identify:

Breathing rate, depth, use of accessary muscles

Listen to breath sounds & heart

Feel for tenderness

Inspect for wounds or bony deformities

Look for equal chest rise & fall

Accessory muscles

Abdomen

Identify:

Wounds

Feel for tenderness – note rigid or distended

Pain – targeted or generalised

Listen for bowel sounds

Bruising

Abdomen quadrants

Pelvis and perineum

Identify:

Wounds

Deformities

Palpate pelvis

Bleeding from urethra / or urine

Incontinence

In males – priapism

Extremities

Identify:

Movement

Wounds

Deformities – bone, dislocation of joints

Feel pulses, temperature, sensation and for tenderness

Color

Ecchymosis – bruising

Extremity range of motion

Posterior assessment

Log roll and maintain C-spine stabilisation

Log roll procedure

�  video

Posterior view

Identify:

Wounds

Deformities – bony fractures or dislocations

Flank bruising

Palpate downward on the entire spine – noting if any tenderness, bulging and/or deformities

Check anal sphincter tone

Common radiological examinations following trauma

Dependent on mechanism of injury, presentation and symptoms

X-ray: chest / pelvis / obvious extremity deformity

CT scan: C-spine / head / chest / abdomen / pelvis

Points to remember:

�  Primary survey is to identify life threatening injuries

�  Secondary survey is to identify all injuries from a head to toe assessment; guides investigations and to commence interventions for example, surgeons or radiographers

�  Identify mechanism of injury and get a detailed history of events

�  Provide comfort and analgesia to the patient

�  Information for the patient and family / NOK

References:

Newberry, L. (2003). Sheehy’s Emergency Nursing. Principles and Practice.5thedn. Mosby:USA

The College of Nursing. Emergency Nursing. 2004

Trauma – emergency Medicine Education. Retrieved from: emergencyeducation.net/trauma.html

TRAUMA.ORG: Critical Care: Initial Trauma Assessment

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