Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 28 2021

Secondary Survey

  • Snapshot
    • A 45-year-old woman is brought to the ED after falling 6 feet from a ladder into a bed of bushes while cleaning windows during work as a housemaid. She is brought bound to a backboard with a C-collar. She is breathing spontaneously, but with light and shallow breaths. Her blood pressure is 90/60 mmHg, pulse is 110/min, respirations are 25/min, and SaO 2 92% on room air. The patient's pupils are 3 mm bilaterally, reactive to light; she blinks appropriately. She has scrapes throughout her lower and upper extremities, but no hemorrhaging wounds. Two 18-gauge IVs are inserted and 1 L Lactated Ringer's is started.
  • introduction
    • Secondary survey is done after rapid primary survey problems have been addressed
    • Major injuries, areas of concern, points of contact are identified
    • Full physical exam and radiographs are needed (C-spine, chest, pelvis especially in blunt trauma)
  • Presentation
    • Trauma-focused history using AMPLE mnemonic
    • Often obtained by emergency medical technician to guide primary survey interventions, but needs to be reviewed again
      • Allergies
      • Medications
      • Past medical history
      • Last meal
      • Events related to injury
  • Diagnosis
    • Head and neck
      • pupils
        • assess equality, size, symmetry, reactivity to light
          • relative afferent pupillary defect: optic nerve damage
          • extraocular movements and nystagmus
          • fundoscopy (papilledema, hemorrhages)
        • reactive pupils + decreased level of consciousness (LOC) → metabolic or structural cause
        • non-reactive pupils + decreased LOC → structural cause (especially if asymmetric)
          • if unilateral, dilated, non-reactive pupil, think focal mass lesion, epidural / subdural hematoma
            • if slow loss of consciousness over a few days in an elderly patient suspect subdural hematoma
            • if sudden loss of consciousness with return to consciousness with head trauma (talk and die syndrome) think epidural hematoma
          • best initial diagnostic test: non-contrast head CT if intracranial injury is suspected
      • palpation of facial bones, scalp
    • Chest
      • inspect for midline trachea, flail segment: ≥ 2 rib fractures in ≥ 2 places; if present, look for associated hemothorax, pneumothorax, contusions
      • auscultate lung fields
      • palpate for subcutaneous emphysema
      • chest radiograph
    • Abdomen
      • assess for peritonitis, abdominal distention, evidence of intra-abdominal bleeding
      • FAST ultrasound or CT (if stable)
      • rectal exam for GI bleed, high-riding prostate and anal tone (best to do during log roll)
      • bimanual exam in females as appropriate
    • Musculoskeletal
      • examine all extremities for swelling, deformity, contusion, tenderness, range of motion
      • check for pulses and sensation in all injured limbs
      • log roll and palpate thoracic and lumbar spines
      • palpate iliac crests and pubic symphysis, pelvic stability (lateral, AP, vertical)
      • pelvic radiograph
    • Neurological
      • repeat Glasgow Coma Scale assessment
        • remember, change in score is more important than absolute score
      • full cranial nerve exam
      • alterations of rate and rhythm of breathing are signs of structural or metabolic abnormalities
        • progressive deterioration suggests elevating intracranial pressure (and worsening CNS injury)
      • spinal cord integrity
        • conscious patient: assess distal sensation and motor
        • unconscious patient: response to painful or noxious stimulus applied to extremities
  • Management
    • Based on history and physical exam, obtain:
      • complete blood count
      • electrolytes
      • BUN and Cr
      • glucose
      • INR/PTT
      • β-hCG for women
      • toxicology screen
      • type and cross
    • Imaging workup based on mechanism of trauma
    • Urgent consultations based on differential diagnosis
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options