Inspect whether there is any bruising related to a seatbelt. Evaluate whether breath sounds are symmetrical and heart sounds are normal and not muffled. Assess any respiratory effort and work of breathing. The area over the sternum and clavicles require special attention as fractures involving these bones may suggest significant force and need for further evaluation of other intrathoracic injuries. Palpate the entire chest wall for crepitus (subcutaneous emphysema) and tenderness. Also evaluate whether there is a neck swelling or pulsatile neck mass. C-spine can be cleared either clinically by applying decision rules, or by obtaining imaging studies, such as plain radiographs or a CT scan. Assume an injury to cervical spine with blunt trauma until proven otherwise. Beware that injuries under the hard collar may not be readily apparent. Inadequate immobilization increases morbidity. ![]() ![]() The neck should be carefully inspected and palpated while it is carefully immobilized. The ocular examination should also include ocular mobility/entrapment, or periorbital ecchymosis (Raccoon eyes). The pupillary size and response, as well as eye movements should be assessed. Beware that facial fractures may be subtle. The presence of blood or clear drainage from the ear canal indicates basilar skull fracture with cerebrospinal fluid (CSF) leak. Also, ears should be evaluated for hemotympanum or retro-auricular ecchymosis (Battle's sign). Palpate the entire facial bony margins including orbit, the maxilla, the nose and jaw.Ī nasogastric (NG) tube should not be inserted if there is facial trauma or evidence of basilar skull fracture. The scalp should be palpated, since scalp lacerations or bony step-offs may be identified only by careful palpation. In elderly population, normal vital signs should not be reassuring as hemodynamic changes such as tachycardia or hypotension may be delayed.Įxamine the head for scalp hematoma, skull depression, or laceration. Vital signs should be closely monitored and response to interventions should be assessed. Throughout the evaluation, standard precautions for blood or fluid-borne infections should be observed.Īssess vital signs A narrow pulse pressure and tachycardia indicate hypovolemic shock in a trauma setting until proven otherwise. This examination involves a second review of the airway and lung examination. This involves a complete head-to-toe examination examine all areas including front, back, sides, under and over. The purpose of the secondary survey is to identify significant injuries. These considerations are important for the following reasons due to exposure to chemical agents can cause pulmonary, cardiac and other internal organ dysfunction, or hazardous environment can pose a threat to the health. This will identify conditions, that require immediate intervention.Įvents/environment related to injury: What happened (example mechanisms such as blunt, penetrating, burns or any hazardous environment, such as exposure to chemicals, toxins or radiation. If deterioration of clinical status is noted, primary survey should be repeated and evaluation of ABCs should be started. Since trauma is a dynamic process, frequent reassessment is required in patients with trauma. The purpose of the secondary survey is to obtain pertinent historical data about the patient and his or her injury, as well as to evaluate and treat all significant injuries not found during the primary survey by performing a systematic, complete examination. ![]() It should be performed after the primary survey, and initial stabilization is complete. It is helpful to set the priorities for continued evaluation and management. The secondary survey is a rapid but thorough head-to-toe examination assessment to identify all potentially significant injuries. Occult injuries may be missed and delayed diagnosis can contribute to morbidity and mortality. Not all injuries are immediately apparent in trauma patients. This evaluation ensures that all potentially life-threatening conditions have been identified and satisfactorily addressed. Therefore, secondary survey occurs both in series and in parallel with the primary survey. However, in patients with multi-system trauma, evaluation and management can often occur simultaneously. This part of evaluation should not be performed until the primary survey is completed. Rendering care to a trauma patient can be a challenging endeavor due to the potential for numerous injuries.
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