Secondary Survey

Question 1

What are the two sections of this examination that you should look at?

Answer 1

• Initial Assessment
• Head to toe exam

Question 2

What is involved in the Initial assessment?

Answer 2

Initial assessment;
- Further history if possible
- Look for external clues: medication/medical alert bracelets/auto-injectors/ inhalers

Question 3

What is involved in the Head to toe examination?

Answer 3

Head-to-toe examination:

• Do not move casualty if suspect spinal injury
• Assess breathing: Rate/Depth/Nature
• Check the carotid pulse: Rate/Rhythm/Strength

Ensure adequate exposure as examine and start examination at casualty’s head. Do not move casualty if suspect a neck fracture. Ask assistant to stabilise neck if suspect injury.

• Examine the scalp: boggy/swelling/bleeding/depression of bone
• Speak clearly into both ears and check for a response
• Examine the ears: blood or clear fluid (CSF) leak
• Examine both eyes: Are they open? Are the pupils equal? Examine the sclera.
• Examine the nose: blood or clear fluid (CSF) leak
• Examine the mouth: airway obstruction/ wounds/teeth irregularity/ burns on the lips
• Examine the skin: colour and temperature
• Feel the neck: including cervical spine
• Examine the chest: inspect for signs of trauma/ listen for abnormal respiratory sounds/ assess chest expansion/ palpate the rib cage
• Examine the shoulders and clavicles: check for bruising/ swelling/ deformity/ irregularity or tenderness
• Check sensation in arms/hands and assess finger colour (capillary nail refill time CRT)
• Examine the arms: inspect for signs of trauma. If conscious, check active movement. If impaired consciousness - palpate.
• Examine the back: check for spinal tenderness with hand under hollow of back. Do not move casualty to examine spine (in case spinal injury.)
• Examine the abdomen: inspect for signs of trauma and gently palpate
• Examine the pelvis: gently feel the pelvis. Look for incontinence/bleeding
• Examine the legs and feet: Check sensation and skin colour in the feet.
• Inspect for signs of trauma.
• If conscious, check active movement of legs and feet. If impaired consciousness - palpate.

Question 4

How should you do a hand over?

Answer 4

MIST is a useful acronym for succinctly describing events when handing over a casualty to Paramedics.
*Mechanism of injury
*Injury found or suspected
*Vital signs: (pulse rate, respiratory rate) *Treatment given

Question 5

Other things to remember ?

Answer 5

Positive Findings:
- Phone for additional help, reporting your findings.
- Manage any immediate problems found e.g. controlling bleeding and fracture stabilisation.
- Keep casualty warm and calm.
- Monitor vital signs.
- Do not give anything by mouth.
- Pass on relevant information to the next responder.