The secondary survey in trauma assessment is a structured, comprehensive evaluation used in emergency settings to find and address all non-immediately life-threatening injuries or medical issues in a patient. It functions as the second phase of a systematic approach designed to manage the complexity of trauma patients efficiently. The goal is to identify injuries that may not be obvious but could lead to significant health problems if left untreated. This thorough examination ensures that all parts of the body are checked for subtle signs of trauma, moving beyond the urgent initial stabilization.
The Timing and Purpose of the Secondary Survey
The secondary survey is initiated only after the primary survey has been successfully completed and all immediate threats to the patient’s life have been identified and managed. This means the patient’s airway, breathing, and circulation have been stabilized, and their overall condition is stable enough for a more extensive evaluation. If the patient’s condition deteriorates at any point, the medical team must immediately pause the secondary assessment and return to the primary survey to address the new instability.
The purpose of this phase is to transition the assessment from a rapid, life-saving intervention to a methodical, detailed search for other injuries. This systematic examination aims to uncover “occult injuries,” which are those not immediately apparent but can contribute to delayed diagnosis or increased illness. Performing this survey rapidly yet thoroughly helps establish priorities for the patient’s continued evaluation and subsequent medical or surgical management.
Detailed Components of the Secondary Assessment
The secondary assessment is composed of two major parts: gathering a detailed patient history and performing a comprehensive physical examination.
Obtaining a focused history is a time-sensitive step, often achieved using a mnemonic device like SAMPLE or AMPLE to ensure all pertinent data is collected quickly. This history helps the medical team understand the patient’s past health status and the precise circumstances of the injury event. This information can reveal pre-existing conditions, such as diabetes or heart disease, that might influence treatment decisions.
The SAMPLE mnemonic prompts for:
- Current signs and symptoms
- Known allergies
- Current medications
- Past pertinent medical history
- Last oral intake (important if emergency surgery is needed)
- Events leading up to the injury
The physical examination is a systematic, head-to-toe process that uses inspection, palpation, and auscultation to find signs of trauma.
Head, Neck, and Chest
Clinicians begin by examining the head and face, feeling for skull depressions, checking the eyes for pupillary response, and looking behind the ears for bruising, which may suggest a skull base fracture. The neck is then examined for tenderness or deformity, maintaining spinal precautions if an injury is suspected. The chest is inspected for bruising or asymmetrical movement, and the lungs are listened to for abnormal breath sounds.
Abdomen, Pelvis, and Extremities
The abdomen is palpated for tenderness or rigidity, which could indicate internal bleeding or organ injury. The pelvis is checked for stability, and the extremities are assessed for fractures, pulse integrity, and neurological function. A thorough neurological examination is completed, often including a re-evaluation of the Glasgow Coma Scale score to establish a neurological baseline.
Posterior Surface
The final step of the physical exam involves carefully rolling the patient to inspect and palpate the entire posterior surface, including the back and buttocks. This area is a common site for missed injuries.
Documentation and Continuous Reassessment
Following the completion of the secondary survey, all findings must be accurately documented to create a comprehensive patient record. This documentation forms the baseline for all subsequent care and provides a clear record of the patient’s condition. Any injuries identified, such as open wounds or fractures, are addressed immediately with temporary management like dressing and splinting.
The trauma patient’s condition is dynamic, meaning it can change rapidly and unexpectedly, even after initial stabilization. Therefore, continuous reassessment is a necessary step that follows the secondary survey. Medical teams frequently recheck the patient’s vital signs and monitor their level of consciousness, especially during transport or while awaiting specialized procedures.
The data gathered during the secondary survey ultimately guides the medical team in planning definitive diagnosis and treatment, which may involve specialized imaging studies like CT scans or transfer to an operating room. The findings help establish an ongoing management plan for every injury identified, ensuring a smooth transition to long-term care. If any signs of deterioration are observed during continuous monitoring, the primary survey is repeated to address any new life threats.