The Secondary Survey is a methodical, detailed evaluation of a patient who has experienced trauma or a severe medical event. It is a comprehensive head-to-toe examination and historical data gathering process. This systematic procedure is designed to identify all injuries or conditions not immediately apparent during the initial, rapid assessment. The goal is to develop a definitive treatment plan by obtaining a complete picture of the patient’s health status and the full extent of their injuries.
Placing the Survey in Emergency Care
Emergency assessment follows a strict hierarchy to prioritize immediate threats to survival. The process begins with the Primary Survey, which uses the widely accepted mnemonic ABCDE (Airway, Breathing, Circulation, Disability, Exposure/Environment) to quickly identify and manage life-threatening problems. For instance, a blocked airway or massive external bleeding must be addressed and stabilized before proceeding to the next steps. This initial phase is entirely focused on resuscitation and stabilizing the patient’s immediate physiological functions.
The Secondary Survey is only initiated once the patient is physiologically stable and all immediate life threats identified in the Primary Survey have been successfully managed. If the patient’s condition deteriorates at any point, the medical team must immediately stop the detailed assessment and return to the Primary Survey to manage the new instability. This deliberate phase identifies injuries that are not immediately life-threatening but still require attention to prevent future complications.
Components of the Secondary Assessment
The Secondary Survey consists of two major procedural parts: a complete, systematic physical examination and the collection of historical information from the patient or witnesses. This dual approach ensures that both physical evidence of injury and relevant medical background data are gathered to inform treatment decisions.
The focused patient history is often guided by the SAMPLE mnemonic, which helps organize information relevant to the current situation. The elements gathered include:
- Signs and Symptoms: The patient’s subjective complaints and the objective findings of the examiner.
- Allergies: Identifying any known sensitivities to medications or environmental triggers.
- Medications: Current medications the patient is taking, as these can affect injury presentation or treatment response.
- Past medical history: Covering pre-existing conditions and previous surgeries that might complicate current care.
- Last oral intake: Important for anticipating potential complications during procedures like surgery or intubation.
- Events leading up to the injury or illness: Helps determine the mechanism of injury and predict potential internal damage.
The physical examination is a methodical, head-to-toe inspection, palpation, and auscultation of the entire body. It begins with the head and face, checking the scalp for lacerations and the skull for depressions or irregularities that might indicate a fracture. The neck is assessed for tenderness, deformity of the cervical spine, or tracheal deviation, while continuously maintaining spinal precautions if injury is suspected.
Moving down the torso, the chest is examined for symmetry of movement, paradoxical motion, or tenderness, and the lungs are auscultated for abnormal breath sounds. The abdomen is palpated for rigidity, tenderness, or distension, which could signal internal bleeding or organ injury. The pelvis is gently assessed for stability to identify potential fractures that could be associated with massive blood loss.
The examination concludes with the extremities, checking for fractures, deformities, or circulatory compromise. Neurological status is evaluated, including establishing a baseline Glasgow Coma Scale score. A complete inspection of the patient’s posterior surfaces is also performed, usually by log-rolling the patient while maintaining spinal alignment, to look for injuries that may have been missed.
The Importance of Ongoing Monitoring
A patient’s condition following trauma or acute illness is dynamic and can change rapidly. Continuous reassessment of the patient’s vital signs and neurological status is therefore an ongoing requirement. The medical team must remain vigilant for any signs of deterioration that were not present during the initial stabilization.
For a patient whose condition is considered unstable, the full Primary Survey should be repeated frequently, typically every five minutes, to catch any rapid decline in their ABCDE status. In a more stable patient, a thorough reassessment of vital signs and neurological function is usually performed every fifteen minutes. This repeated monitoring helps detect developing issues, such as delayed signs of intracranial bleeding or internal hemorrhage that might only become clinically apparent hours after the initial injury.
A decline in the level of consciousness or the development of hemodynamic instability, such as a drop in blood pressure or a sharp increase in heart rate, signals the need for an immediate return to the Primary Survey. This systematic repetition ensures that any new or worsening life-threat is recognized and treated before it progresses to an irreversible state.