The Trauma Secondary Survey
Entails
performing a detailed head-to-toe examination of the patient to make
sure one has not missed thing from the previous two steps. Its done in a
systematic way as follows;
Head,
Ears, Eyes, Nose, Throat (HEENT)
Look, Listen and Feel for :
- Scalp wounds or bruising
- Skull deformities
- Blood in mouth or throat
- Unequal or unresponsive pupils
- Vision loss or changes and eye injuries
- Blood or fluid from ear or nose indicating injury or open skull fracture
- Tooth injury
- Signs of airway burns: ash, burnt nasal hairs, or new or worsening lip or mouth swelling
- Stridor (high pitched sound on breathing in)
- Gurgling
- Tenderness or abnormal movement of facial bones
- Loose teeth
- Defects or crepitus in the skull or facial bones
Neck
Look. Listen and Feel for:
- Penetrating neck wounds
- Visible trauma
- Haematoma
- Distended neck veins
- Air in the skin or soft tissue
- Pain or deformity in the cervical spine
- Reduced ability to move neck or pain on movement
Chest
Look. Listen and Feel for:
- Bruising, deformity, wounds
- Uneven chest wall movement
- Burns around the entire chest
- Breath sounds (Decreased,unequal or absent, wheeze, rhonchi)
- Muffled or distant heart sounds
- Tenderness
- Crepitus
Abdomen
Look, Listen and Feel for:
- Abdominal distension
- Visible abdominal wound, bruising or abrasions
- Bruising on back or abdomen
- Circumferential burns to the abdomen
- Rebound tenderness or guarding
- Abdominal tenderness
Pelvis and
Genitourinary
Look. Listen and Feel for:
- Bruising / lacerations to pelvis
- Blood at the opening of the penis or vagina
- Vaginal lacerations or bleeding
- Penile lacerations
- Priapism--This can indicate spinal injury
- Urine color changes (dark or gross blood) that might indicate muscle breakdown or kidney injury
- Bony pelvis for tenderness
Extremities
Look. Listen and Feel for:
- Swelling or bruising
- Deformity
- Open fractures
- Circumferential burns
- Amputation
- Palor
- Absent or weak pulses
- Cold extremities
- Tenderness
- Abnormally firm, painful muscular compartments
Spine
Look. Listen and Feel for:
- Bruising
- Deformity
- Tenderness down the spine
- Bones that are not lined up along the entire spine
- Tenderness or crepitus to scapulae
Skin
Look, Listen and Feel for:
- Bruising
- Abrasions
- Lacerations
- Burns particularly if circumferential
Neurologic
Look, Listen and Feel for:
- Decreasing level of consciousness (AVPU or GCS), agitation or seizures/convulsions
- Movement and strength in each limb
- Priapism
- Sensation on face, chest, abdomen, limbs: if there is a sensory deficit, identify the level where it begins.
