Secondary Survey Alfred Trauma Orientation

1. SECONDARY SURVEYSECONDARY SURVEY
July 2016July 2016

2. IF YOU DO NOT LOOK YOU DO NOT FIND
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3. Secondary Survey
• Identification of all injuries irrespective of severity
• Injuries not identified in the Primary Survey
• Thorough systematic review of the entire patient
• Occurs both in Series + in Parallel with the Primary Survey
• Time factor 3

4. Secondary Survey = Detective Work
• Top to Toe
• Front + Back + Sides + Under + Over
– Inspect Auscultate Palpate Percuss Move
• Monitoring
– Arterial Line BP
– Urine Output / Urinalysis
• Radiography 4

5. Secondary Survey = Systematic
• Vital Signs
• Scalp Head Face
– Scalp wounds  Bleeding
– Otorrhoea
– Rhinorrhoea
– Facial fractures may be subtle
– Hair
– Piercings – removal
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6. Secondary Survey
• Throat Neck
– C-Spine tenderness – in-line immobilisation
– Surgical Emphysema
> Laryngeal injury
> Tracking up from Pneumothorax
– Swelling
> Pulsatile expansile mass
– Pulses
– Hair 6

7. Secondary Survey
• Chest
– Paradoxical breathing
– Subcutaneous emphysema
– Ribs
– Sternum
– Muffled Heart Sounds !
– Seat Belt sign
– ECG
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8. Secondary Survey
• Abdomen Pelvis
– Serial examinations in the conscious patient
– Bruising – Seat Belt sign
– Wounds
– Pelvic springing
– Genitalia Perineum
– Pulses
– Log Roll
> Entire back of the body
> Digital Rectal Examination – tone / sensation / blood / prostate 8

9. Secondary Survey
• Limbs
– Pain Swelling Deformity Crepitus
– Long Bone Fractures if missed on Primary Survey
– Open Fractures
– Pulses
– Vascular injuries
– Soft Tissue injuries
– Muscles – Compartment Syndrome
– Tendons
– Joint Stability 9

10. Secondary Survey
• Neurology
– GCS Glascow Coma Scale – progression
– Level of response pre-intubation
– Lateralising signs
– Pupil reaction to light – progression
– Peripheral nerve injuries
– Spinal tenderness / steps
• GCS 1974 Teasdale + Jennet
• Traditional ATLS mantra “GCS 8 Intubate” 10

11. Secondary Survey
• Radiology
• Plain X-Rays
– Two orthogonal plain films
– Joints Above + Below suspicious area
• CT
• MRI
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12. Secondary Survey
• Identification of all injuries irrespective of severity
• Occurs both in Series + in Parallel with the Primary Survey
• Does Not Delay Primary Survey
• Missed or Delayed Diagnosis of injuries  Morbidity
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14. IF YOU DO NOT LOOK YOU DO NOT FIND
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