SECONDARY ASSESSMENT HISTORYAMPLE history.
A Allergies
M Medications (Anticoagulants, insulin and cardiovascular medications especially)
P Previous medical/surgical history
L Last meal (Time)
E Events /Environment surrounding the injury; ie. Exactly what happened
Secondary Survey
Pitfalls:
1. Head and face
a. Posterior scalp lacs/compound skull fractures
b. Pupil changes since primary survey
c. Visual deficits
2. Neck
a. Injuries under the hard collar are not seen
b. In line immobilisation while the collar is off
3. Chest
a. Clinical rib #s and sternal #s are missed
i. many do not show on the chest X-ray
ii. they can compromise the patient
iii. X-ray 'proof' is not required
4. Abdomen
a. Pain or tenderness or bruising requires further investigation
b. The inaccessible abdomen with appropriate mechanism requires
investigation.
i. FAST or DPL in the unstable
ii. CT in stable patients
c. Vaginal examination in female patients with pelvic fractures or
vaginal bleeding. In pregnancy this examination should be deferred
to an obstetric specialist.
d. A nasogastric tube is contraindicated in the presence of facial
fractures (an orogastric tube should be inserted)
e. a urinary catheter should only be inserted if there is no blood at
the urethral meatus, no perineal bruising, and rectal examination is
normal.
5. Back
a. Log roll takes 5 people, 3 body, one head, one examining
b. Inspection and palpation
c. Perform the rectal examination at this time.
6. Extremities
a. Inspect and palpate each limb for tenderness, crepitation, or
abnormal movement.
b. If the patient is cooperative ask him or her to move the limbs in
response to command in preference to passive movement in the
first instance.
c. Adequately splint any injuries.
d. Reassess after splints, traction or manipulation
7. Neurological examination
a. Repeat the Glasgow Coma Scale - record scores for E, V and M
as well as the total score
b. Re-evaluate the pupils
c. Look for any localising/lateralising signs
d. Look for signs of cord injury
1. Head and face
a. Posterior scalp lacs/compound skull fractures
b. Pupil changes since primary survey
c. Visual deficits
2. Neck
a. Injuries under the hard collar are not seen
b. In line immobilisation while the collar is off
3. Chest
a. Clinical rib #s and sternal #s are missed
i. many do not show on the chest X-ray
ii. they can compromise the patient
iii. X-ray 'proof' is not required
4. Abdomen
a. Pain or tenderness or bruising requires further investigation
b. The inaccessible abdomen with appropriate mechanism requires
investigation.
i. FAST or DPL in the unstable
ii. CT in stable patients
c. Vaginal examination in female patients with pelvic fractures or
vaginal bleeding. In pregnancy this examination should be deferred
to an obstetric specialist.
d. A nasogastric tube is contraindicated in the presence of facial
fractures (an orogastric tube should be inserted)
e. a urinary catheter should only be inserted if there is no blood at
the urethral meatus, no perineal bruising, and rectal examination is
normal.
5. Back
a. Log roll takes 5 people, 3 body, one head, one examining
b. Inspection and palpation
c. Perform the rectal examination at this time.
6. Extremities
a. Inspect and palpate each limb for tenderness, crepitation, or
abnormal movement.
b. If the patient is cooperative ask him or her to move the limbs in
response to command in preference to passive movement in the
first instance.
c. Adequately splint any injuries.
d. Reassess after splints, traction or manipulation
7. Neurological examination
a. Repeat the Glasgow Coma Scale - record scores for E, V and M
as well as the total score
b. Re-evaluate the pupils
c. Look for any localising/lateralising signs
d. Look for signs of cord injury
