ATLS - Secondary Survey

Question 1

When would you do the secondary survey

Why do a secondary survey

Answer 1

Delay SS until

• primary survey complete
• resus initiated
• life threatening conditions found and managed
• normal vital signs

Get detailed history
Head => toe physical exam
Investigations, imaging => find injuries and metabolic abnormalities

If patient deteriorates => primary survey

Question 2

SS history taking

Answer 2

AMPLE
Allergy
Medications
Past medical/surgical/illness/pregnancy
Last meal
Events leading to admission

Question 3

Vital signs assessment

-what to look out for

Answer 3

Close monitoring

Narrow pulse pressure + high HR => hypovolemic shock unless proven otherwise

In older adults, hemodynamic changes are delayed so vital signs are not a good measure of CV functioning

Question 4

Head and face examination

• inspect
• palpate
• do

Answer 4

Inspect and palpate for

• scalp hematoma
• skull depression
• lacerations

Inspect for lost, wonky teeth
Palpate orbit, maxilla, nose, jaw

Basal skull fracture signs
Eye neuro exam

Question 5

Neck examination

Answer 5

Inspect and palpate whilst neck immobilised

• ask another team member to manually maintain immobilisation whilst you examine
• reapply cervical collar

Remove immobilisation permanently when safety confirmed by

• CT scan
• decision rules
• clinical decision

Neck swellings, crepitus, pulsatile neck masses?

Question 6

Chest examination

Answer 6

Inspect respiratory effort, work of breathing
-breath and heart sounds?

Any seatbelt bruising?

Palpate chest wall for

• crepitus
• tenderness

Sternum, clavicular fractures?

SaO2, ABG check

Question 7

Abdominal examination

Answer 7

Inspection

• distension
• bruising

Palpation and auscultation

• bowel sounds
• tenderness

Further examination required if any of the above findings

Question 8

Rectal and genital examination

Answer 8

Perineum

• scrotal bruising
• blood on meatus => urethral injury, investigated with retrograde urethrography
• penile hematoma
• pripism

Lower abdo pain, pelvic fracture, perineal laceration => vaginal injury?
-vaginal examination needed

Question 9

Peripheral examination

Answer 9

Palpate each extremity over entire length to rule out fractures, ligament instabilty for

• swelling
• tenderness
• decreased ROM (active and passive)

Immobilise injured joint
Liberal imaging

Neurovascular status

• pulses, CRT
• compartment checks (significant pain, tension, pain on passive mv)

Question 10

Pelvic examination

Answer 10

Pubis, ASIS, AIIS assessed for pelvic instability

Bruising/tenderness over iliac wings, labia, scrotum => further investigation

Question 11

Neuro examination

Answer 11

Repeat GCS as brain function can change
Sensory, motor, reflex test
Pupillary responses to light rechecked

Question 12

Skin examination

Answer 12

Identify any

• lacerations
• abrasions
• bruising
• hematoma

Don’t miss scalp, perineum axillary, abdo and gluteal folds

Question 13

How to examine the back

Answer 13

Log roll patient unless they can sit or roll independently

Palpate spine for step offs/focal tenderness

Question 14

How to handle coverings

Answer 14

Remove dressings to examine injuries
Remove clothes completely
-maintain modesty with warmed blankets and only removing clothing when necassery