Secondary Survey or Assessment

Secondary Survey or Assessment

Following successful CPR or after ABC evaluation secondary survey is initiated and it includes, systematic assessment (physical examination) of the patient from the head to toes.

Quickly observe life-threatening conditions: eg.

Finding During Physical Examination Expected Risks
Serious facial injury, broken upper or lower jaw Airway obstruction
Over swelling of jugular vein, low pressure, irregular pulse Cardiac tamponade
Over swelling of jugular vein, tracheal displacement, subcutaneous emphysema, breathing disturbance, absent breath sound on auscultation, tympanic on percussion Tension pneumothorax
Swaying in chest contour Flail chest
Abdominal swelling, tension in abdominal wall, tender abdomen Abdominal hemorrhage, injury to organs
Pelvic movement, tenderness, length difference of legs Pelvic fracture
Penetrating trauma to head, chest, abdomen, groin Serious organ injury, injury to large vessel, open pneumothorax
Facial or airway burns Airway obstruction
Quadriplegic paralysis, unconscious Spinal cord injury, head injury

Measures to be taken
Identified Problem Action
Airway problems Suction, airway clearance, oxygen administration, assisted breathing
Circulatory problems ABC, administer O2, secure IV, connection to monitor, vital signs, keep patients warm
Cardio Pulmonary Arrest Start CPR and activate EMS TEAM
Active bleeding Stop bleeding
Penetrating object Stabilize the object in place.
Open pneumothorax 3-sided taping
Flail chest Immobilization, pain management
Intestinal hernia Covering to avoid dryness and infection

Tertiary Assessment

following effective primary and secondary assessment and intervention patients may develop life threatening conditions, therefore since this patients are not fully stabilized they need your close attention for:

  • Re-evaluation of the stable effectiveness of given treatment,
  • Assessment of the progress of general clinical condition of the patient
  • Decision making on further management,
  • Early detection of instability
  • In the event of abrupt changes (deterioration), return to initial assessment

As already described assessment of emergency patients are quite different in regard of flow and intervention. During evaluation of cold patients we do: thorough history taking, physical exam and diagnostic orders then we start treatment. But during emergency medical history is brief and or sometimes not available, and you start with inspection of the patient and if patient is unconscious you assess A and mange immediately as found and go to the next step…using a such systematic approach you will be capable to identify the most common causes of deaths and mange accordingly.

Last modified: Monday, 21 November 2016, 8:04 AM