Secondary Survey or Assessment
Secondary Survey or Assessment
Following successful CPR or after ABC evaluation secondary survey is initiated and it includes, systematic assessment (physical examination) of the patient from the head to toes.
Quickly observe life-threatening conditions: eg.
| Finding During Physical Examination | Expected Risks |
|---|---|
| Serious facial injury, broken upper or lower jaw | Airway obstruction |
| Over swelling of jugular vein, low pressure, irregular pulse | Cardiac tamponade |
| Over swelling of jugular vein, tracheal displacement, subcutaneous emphysema, breathing disturbance, absent breath sound on auscultation, tympanic on percussion | Tension pneumothorax |
| Swaying in chest contour | Flail chest |
| Abdominal swelling, tension in abdominal wall, tender abdomen | Abdominal hemorrhage, injury to organs |
| Pelvic movement, tenderness, length difference of legs | Pelvic fracture |
| Penetrating trauma to head, chest, abdomen, groin | Serious organ injury, injury to large vessel, open pneumothorax |
| Facial or airway burns | Airway obstruction |
| Quadriplegic paralysis, unconscious | Spinal cord injury, head injury |
| Identified Problem | Action |
|---|---|
| Airway problems | Suction, airway clearance, oxygen administration, assisted breathing |
| Circulatory problems | ABC, administer O2, secure IV, connection to monitor, vital signs, keep patients warm |
| Cardio Pulmonary Arrest | Start CPR and activate EMS TEAM |
| Active bleeding | Stop bleeding |
| Penetrating object | Stabilize the object in place. |
| Open pneumothorax | 3-sided taping |
| Flail chest | Immobilization, pain management |
| Intestinal hernia | Covering to avoid dryness and infection |
Tertiary Assessment
following effective primary and secondary assessment and intervention patients may develop life threatening conditions, therefore since this patients are not fully stabilized they need your close attention for:
- Re-evaluation of the stable effectiveness of given treatment,
- Assessment of the progress of general clinical condition of the patient
- Decision making on further management,
- Early detection of instability
- In the event of abrupt changes (deterioration), return to initial assessment
As already described assessment of emergency patients are quite different in regard of flow and intervention. During evaluation of cold patients we do: thorough history taking, physical exam and diagnostic orders then we start treatment. But during emergency medical history is brief and or sometimes not available, and you start with inspection of the patient and if patient is unconscious you assess A and mange immediately as found and go to the next step…using a such systematic approach you will be capable to identify the most common causes of deaths and mange accordingly.