Secondary survey Nicole Smith Clinical Nurse Unit Manager Nepean Hospital Sydney, Australia
Secondary survey Nicole Smith Clinical Nurse Unit Manager
Nepean Hospital Sydney, Australia
What we will cover:
� Mechanism of injury and types of injury
� Purpose of the secondary survey
� Patient history and events leading up to the event
� Anterior / posterior secondary survey
� Maintaining C-spine precautions and the log roll procedure
� Common further examinations
Mechanism of injury
Identifying the mechanism of injury is vital to predicting actual and associated injuries
Obtain full history of events if possible
Two most common forms of injury are blunt trauma and penetrating trauma
Blunt trauma – compression injury
Blunt trauma – shearing injury
Penetrating injury – projectile injury with a small or large open wound
Penetrating wound - gunshot
Secondary survey purpose
The primary survey is completed and all life threatening complications have been identified and corrected
� During the secondary survey the focus is now to detect all injuries
� Head to toe assessment
� Guide investigations and interventions
Involves:
� Gathering information, history and mechanism of injury
� Reviewing vital signs
� Full thorough head to toe examination – anterior / posterior with SPINAL PRECAUTIONS
� Pain control
� Reassure and talk with family / friends
Basics of trauma assessment to begin with:
L – Laboratory work up
I - IDC
N - naso / orogastric tube
E - ECG
S – Sa02
A – Allergies
M – Medications
P – Past medical history
L – Last eaten
E – Events leading up to now
Head to Toe Assessment
Head and Face
Identify: Wounds
Deformities & depressions of skull
Drainage from ears / nose
Check pupils = PEARL
Palpate for tenderness
Neck C-Spine precautions if uncleared
Identify:
Wounds
Deformities
Distended neck veins
Tracheal deviation
Tenderness
Neck range of motion if C-spine is clear
Chest
Identify:
Breathing rate, depth, use of accessary muscles
Listen to breath sounds & heart
Feel for tenderness
Inspect for wounds or bony deformities
Look for equal chest rise & fall
Accessory muscles
Abdomen
Identify:
Wounds
Feel for tenderness – note rigid or distended
Pain – targeted or generalised
Listen for bowel sounds
Bruising
Abdomen quadrants
Pelvis and perineum
Identify:
Wounds
Deformities
Palpate pelvis
Bleeding from urethra / or urine
Incontinence
In males – priapism
Extremities
Identify:
Movement
Wounds
Deformities – bone, dislocation of joints
Feel pulses, temperature, sensation and for tenderness
Color
Ecchymosis – bruising
Extremity range of motion
Posterior assessment
Log roll and maintain C-spine stabilisation
Log roll procedure
� video
Posterior view
Identify:
Wounds
Deformities – bony fractures or dislocations
Flank bruising
Palpate downward on the entire spine – noting if any tenderness, bulging and/or deformities
Check anal sphincter tone
Common radiological examinations following trauma
Dependent on mechanism of injury, presentation and symptoms
X-ray: chest / pelvis / obvious extremity deformity
CT scan: C-spine / head / chest / abdomen / pelvis
Points to remember:
� Primary survey is to identify life threatening injuries
� Secondary survey is to identify all injuries from a head to toe assessment; guides investigations and to commence interventions for example, surgeons or radiographers
� Identify mechanism of injury and get a detailed history of events
� Provide comfort and analgesia to the patient
� Information for the patient and family / NOK
References:
Newberry, L. (2003). Sheehy’s Emergency Nursing. Principles and Practice.5thedn. Mosby:USA
The College of Nursing. Emergency Nursing. 2004
Trauma – emergency Medicine Education. Retrieved from: emergencyeducation.net/trauma.html
TRAUMA.ORG: Critical Care: Initial Trauma Assessment
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