In a medical emergency, rapid and organized patient assessment is necessary to identify and manage life-threatening conditions. Healthcare providers follow a structured approach to quickly prioritize interventions and gather necessary information. This assessment is typically divided into two distinct phases. The first phase, the primary survey, focuses on identifying and immediately addressing immediate life threats related to airway, breathing, and circulation. Once these immediate dangers are stabilized, the detailed, investigative phase begins with the secondary survey, which aims to uncover all other injuries or underlying medical issues.
When and Why the Secondary Survey is Performed
The transition to the secondary survey occurs only after the primary survey is complete and any immediate life-threatening problems have been corrected. If the patient’s airway is secure, breathing is adequate, and circulation is stable, the focus can shift from immediate life support to a thorough investigation. Initiating the secondary survey prematurely while a serious life threat remains unaddressed can lead to a preventable decline in the patient’s overall status.
The purpose of the secondary survey is to identify injuries or illnesses that were not immediately apparent during the initial rapid assessment. This systematic process helps ensure that no injury is overlooked, especially in patients with altered mental status or multiple traumatic injuries. Information gathered during this phase guides definitive treatment plans, influences transport decisions, and prepares the receiving facility for the patient’s specific needs.
Gathering Patient History (The SAMPLE Tool)
A significant component of the secondary survey involves gathering a comprehensive patient history, which is often guided by the easily remembered acronym SAMPLE. Obtaining this subjective information from the patient, or from witnesses and family members, provides necessary context for the observed physical findings. The history can reveal circumstances, pre-existing conditions, or factors that significantly influence subsequent treatment decisions.
The SAMPLE tool covers six distinct pieces of information:
- Signs and Symptoms (S): Objective findings noted by the provider and the patient’s subjective complaints.
- Allergies (A): Particularly to medications, food, or environmental triggers, which limit safe treatment options.
- Medications (M): Including prescriptions, over-the-counter drugs, and herbal supplements, which can interact with emergency treatments.
- Past medical history (P): Previous illnesses, surgeries, or chronic conditions that might affect the patient’s current presentation.
- Last oral intake (L): Necessary information for anticipating complications like aspiration or preparing the patient for surgery.
- Events (E): The timeline of symptom onset or mechanism of injury, helping determine the cause of the emergency.
Knowing a patient takes a blood thinner like warfarin or missed a recent dialysis treatment, for example, drastically changes the interpretation of a minor fall or a mild headache. Without a thorough history, the medical team is operating with incomplete data, which can compromise the quality of care provided.
The Head-to-Toe Assessment
Following the history taking, the secondary survey transitions into a comprehensive, systematic physical examination known as the head-to-toe assessment. This process involves thoroughly inspecting and palpating the patient’s entire body to discover injuries or abnormalities that the patient may not have mentioned or be aware of due to altered mental status or distracting pain. The assessment begins by examining the patient’s scalp and face, feeling for deformities, tenderness, or evidence of bleeding around the ears or eyes.
Attention then shifts to the neck, checking for tenderness along the cervical spine, distended neck veins, or displacement of the trachea, all of which can indicate serious internal pathology. The chest is inspected for paradoxical movement during breathing and palpated for rib fractures or subcutaneous emphysema, which suggests air leaking into the tissues. Auscultation of the lungs is performed to check for equal and clear breath sounds.
The abdomen is examined next, checking for rigidity, tenderness, or distention that could indicate internal bleeding or organ damage. The pelvis is gently assessed for stability, as an unstable pelvic fracture can lead to massive, life-threatening blood loss into the abdominal cavity. Assessment of the extremities involves checking all four limbs for deformities, swelling, and open wounds, while also assessing distal pulses and motor and sensory function.
Finally, the patient must be carefully log-rolled to examine the back and posterior surfaces, including the spine, for any signs of injury that are often missed when a patient remains only on their back. By combining the patient’s story with the objective physical findings, a complete diagnostic profile begins to emerge.
Continuous Monitoring and Documentation
The completion of the head-to-toe assessment does not signify the end of the patient assessment process; rather, it marks the beginning of continuous monitoring. Frequent reassessment of the patient’s vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation, is mandatory. A patient who appears stable after the initial survey can rapidly deteriorate, especially in cases involving internal injuries or evolving medical conditions.
Any change in the patient’s level of consciousness, breathing effort, or pain level must immediately trigger a repeat of the primary survey to ensure no new life threats have developed. Accurate and timely documentation of all findings and interventions is also necessary. Clear documentation supports continuity of care and helps prevent diagnostic errors as the patient moves through the healthcare system.