Secondary survey

• Secondary survey is only to be performed once the primary survey has been completed and any life-threatening injuries have been managed

  • Aims to identify injuries that are not life-threatening but require treatment
  • Head to toe exam
  • History
• Physical exam:

  • Examine all areas including front, back, sides
  • Head and face
  • Neck
  • Chest - listen again to breath sounds
  • Abdomen - absence of tenderness does not rule out injury
  • Perineum - PR or vaginal exam if urethral/pelvic injury suspected
  • Extremities
  • Pelvis
  • Neurological exam - repeat GCS
  • Skin
• The history obtained is defined by the mnemonic AMPLE:

  • Allergies
  • Medication
  • Past illness/pregnancy
  • Last meal
  • Events/environment of injury
• An attempt should be made to obtain the patient's history regarding the mechanism of injury, since certain mechanisms can raise the suspicion for certain injuries such as the following:

  • Blunt trauma (seat belt use, airbag deployment, extent of damage to the automobile, ejection, and distance ejected)
  • Penetrating trauma (which firearm and how many gunshots).