Trauma - Secondary Survey

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Last updated 4:56 PM on 7/28/26

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6 Terms

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When would you complete a secondary survey from trauma?

Usually undertaken during transfer, but with time critical conditions may not be possible before arrival at hospital

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Define Blunt and Penetrating trauma mechanisms of injury

Blunt: injuries that do not cause penetration of skin by an internal object
- RTCs
- Fall from height
- Serious sport injuries
- Blast injuries
Penetrating: injuries caused by projections penetrating skin
- Stab wounds
- Gunshot wounds
- Blast injuries involving shrapnel

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What element of the Kinetic energy equation contributes the most to total energy?

KE = (1/2*m)*V²

Velocity of an object makes the greatest difference to the amount of energy to be transferred (E.g. bullets)

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Describe the ‘Head to toe’ part of the secondary survey, and what you may find

Looking head to toe, or ‘nose to toes’ thoroughly to identify any injuries or signs of injury in patients where there is limited history
Running from head to toe, you may see:
- Face/skull
  - Lacerations
  - Swelling/bruising/fractures (crepitis)
  - Asymmetry
  - Pupillary response
  - Blood/csf from ears or nose
  - Teeth and jaw intact
  - Odour on breath
  - Bruising behind ears
- Neck
  - Asymmetry/deformity
  - Swelling/brusing
  - Bleeding
  - Senior clinician to assess C-spine
  - Support neck- MILS
- Chest (Expose)
  - Chest rise and fall (asymmetry)
  - Obvious injury/bruising
  - Obvious rib fractures
  - Breath sounds (auscultate)
  - Senior clinician to palpate ribs
- Abdomen (expose)
  - Obvious injuries
  - Bruising/discolouration
  - Senior clinician to palpate
  - Cullin’s sign (big bruise around umbilicus indicating bleeding)
- Pelvis (expose, do NOT compress or spring)
  - Signs of injury
  - Senior clinician to palpate
- Legs
  - Obvious injuries/deformities
  - If on is obviously injured, assess other first to remove tunnel vision
  - Swelling/bruising
  - Palpate distal pulses
  - Motor/sensory functions, equal and strong
- Arms
  - Obvious injuries/deformities
  - Swelling/bruising/fractures
  - Medical alert bracelets
  - Distal pulses
  - Motor/sensory functions, equal and strong
  - Can make a fist? (Wrist fracture)
- Back (Expose)
  - Keep in mind MILS
  - Check for bruising/swelling/deformity
  - Lacerations, penetrating trauma

$<ul><li>Looking head to toe, or ‘nose to toes’ thoroughly to identify any injuries or signs of injury in patients where there is limited history</li><li>Running from head to toe, you may see:<ul><li>Face/skull<ul><li>Lacerations</li><li>Swelling/bruising/fractures (crepitis)</li><li>Asymmetry</li><li>Pupillary response</li><li>Blood/csf from ears or nose</li><li>Teeth and jaw intact</li><li>Odour on breath</li><li>Bruising behind ears</li></ul></li><li>Neck<ul><li>Asymmetry/deformity</li><li>Swelling/brusing</li><li>Bleeding</li><li>Senior clinician to assess C-spine</li><li>Support neck- MILS</li></ul></li><li>Chest (Expose)<ul><li>Chest rise and fall (asymmetry)</li><li>Obvious injury/bruising</li><li>Obvious rib fractures</li><li>Breath sounds (auscultate)</li><li>Senior clinician to palpate ribs</li></ul></li><li>Abdomen (expose)<ul><li>Obvious injuries</li><li>Bruising/discolouration</li><li>Senior clinician to palpate</li><li>Cullin’s sign (big bruise around umbilicus indicating bleeding)</li></ul></li><li>Pelvis (expose, do NOT compress or spring)<ul><li>Signs of injury</li><li>Senior clinician to palpate</li></ul></li><li>Legs<ul><li>Obvious injuries/deformities</li><li>If on is obviously injured, assess other first to remove tunnel vision</li><li>Swelling/bruising</li><li>Palpate distal pulses</li><li>Motor/sensory functions, equal and strong</li></ul></li><li>Arms<ul><li>Obvious injuries/deformities</li><li>Swelling/bruising/fractures</li><li>Medical alert bracelets</li><li>Distal pulses</li><li>Motor/sensory functions, equal and strong</li><li>Can make a fist? (Wrist fracture)</li></ul></li><li>Back (Expose)<ul><li>Keep in mind MILS</li><li>Check for bruising/swelling/deformity</li><li>Lacerations, penetrating trauma</li></ul></li></ul></li></ul>$

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Describe the ‘Head to toe’ part of the secondary survey, and what you may find

Looking head to toe, or ‘nose to toes’ thoroughly to identify any injuries or signs of injury in patients where there is limited history
Running from head to toe, you may see:
- Face/skull
  - Lacerations
  - Swelling/bruising/fractures (crepitis)
  - Asymmetry
  - Pupillary response
  - Blood/csf from ears or nose
  - Teeth and jaw intact
  - Odour on breath
  - Bruising behind ears
- Neck
  - Asymmetry/deformity
  - Swelling/brusing
  - Bleeding
  - Senior clinician to assess C-spine
  - Support neck- MILS
- Chest (Expose)
  - Chest rise and fall (asymmetry)
  - Obvious injury/bruising
  - Obvious rib fractures
  - Breath sounds (auscultate)
  - Senior clinician to palpate ribs
- Abdomen (expose)
  - Obvious injuries
  - Bruising/discolouration
  - Senior clinician to palpate
  - Cullin’s sign (big bruise around umbilicus indicating bleeding)
- Pelvis (expose, do NOT compress or spring)
  - Signs of injury
  - Senior clinician to palpate
- Legs
  - Obvious injuries/deformities
  - If on is obviously injured, assess other first to remove tunnel vision
  - Swelling/bruising
  - Palpate distal pulses
  - Motor/sensory functions, equal and strong
- Arms
  - Obvious injuries/deformities
  - Swelling/bruising/fractures
  - Medical alert bracelets
  - Distal pulses
  - Motor/sensory functions, equal and strong

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For children, what approach do we take for a ‘head to toe’?

Do a ‘Toe to head’ assessment instead

Sit or kneel at the same height as the patient
Look, listen and feel
Remember to reassure patient, parent/carer as all parties likely to be distressed

Consider:

Using easier to understand language
Distractions/toys
Parents/chaperones