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Trauma Management: Secondary survey |
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Secondary survey—Key components: ¨ History ¨ Physical examination: head-to-toe, ‘tubes and fingers in every orifice’ ¨ Complete neurological examination ¨ Special diagnostic tests ¨ Re-evaluation
History ¨ A Allergies ¨ M Medications ¨ P Past illnesses ¨ L Last meal ¨ E Event / environment
Head examination ¨ Complete neurological exam ¨ GCS Score determination ¨ Comprehensive eye/ear exams ¨ Pitfalls: Unconscious patient, periorbital oedema, occluded auditory
Maxillofacial examination ¨ Bony crepitus/ stability ¨ Palpable deformity ¨ Pitfalls: Potential airway obstruction, cribiform plate fracture
Cervical Spine ¨ Palpate for tenderness ¨ Complete motor/sensory examination ¨ Reflexes ¨ C-spine imaging ¨ Pitfalls: Altered LOC for any reasons, other painful injuries
Neck (Soft Tissues) ¨ Mechanism: Blunt vs. penetrating ¨ Symptoms: Airway obstruction, hoarseness ¨ Findings: Crepitus haematoma, strider, bruit ¨ Pitfalls: Delayed symptoms and signs, progressive airway obstruction, occult injuries
Chest ¨ Inspect, palpate ¨ Auscultate, percuss ¨ Radiographs ¨ Pitfalls: Elderly and children
Abdominal Evaluation ¨ Inspect, auscultate, palpate, percuss ¨ Re-evaluate frequently ¨ Special studies ¨ Pitfalls: Hollow viscous and retroperitoneal injuries, excessive pelvic manipulation
Perineum ¨ Perineum: Contusions, haematomas, lacerations, urethral blood ¨ Rectum: Sphincter tone, high-riding prostate, pelvic fracture, rectal wall integrity ¨ Vagina: Blood, lacerations ¨ Pitfalls: Urethral injury in women, pregnancy
Musculoskeletal and Extremities ¨ Contusion, deformity ¨ Pain ¨ Perfusion ¨ Peripheral neurovascular status ¨ Radiographs as required
Musculoskeletal: Pelvis ¨ Pain on palpation ¨ Symphysis width ¨ Leg length uneven ¨ Instability ¨ Radiographs as needed ¨ Pitfalls: Potential blood loss, missed fractures, soft tissues or ligamentous injury, occult compartment syndrome ( especially with altered LOC/ hypotension)
Neurological examination ¨ Complete motor and sensory exams ¨ Imaging as indicated ¨ Reflexes ¨ CNS: Frequent re-evaluation, prevent secondary brain injury, early neurosurgical consultation ¨ Pitfalls: Incomplete immobilization, rapid deterioration, subtle increase in intra-cranial pressure with manipulation
Re-evaluation ¨ Minimizing missed injuries ¨ High index of suspicion ¨ Frequent re-evaluation and monitoring |
