Secondary survey
Secondary survey
The primary survey checks for danger, prioritises the casualties with the most serious injuries and conditions and ensures that Airway, Breathing and Circulation are working.
The secondary survey gives a more thorough check of the casualty to find out what is wrong. This done by finding out the history and then looking for signs and symptoms.
History
- What happened? Ask the patient or bystanders.
- What is the casualty’s medical history? Ask the patient or look for any bracelets or pendants that indicate a medical condition.
- Does the casualty have any allergies?
- Do they take any medication?
- When did they last eat or drink?
- Was there a force of impact that might have caused any injuries?
Signs
Signs are things you can see or feel, such as:
- Skin pallor
- Pulse rate
- Dilated pupils
- Breathing rate
- Swelling
- Rashes
- Deformity
- Blue tinges to the skin (cyanosis)
Symptoms
Symptoms are things the casualty feels, such as:
- Pain – Where? For how long? Can they describe it? Does anything make it worse or better?
- Dizziness
- Nausea
- Feeling hot or cold
Head to toe check
Once you have done an initial assessment via sight and asking questions, do a thorough check of the casualty from head to toe. Ask their permission if they are responsive and explain clearly what you are doing and why as you complete the check. Talking to the casualty will help to reassure them.
Be considerate and discrete, wear disposable gloves if possible and don’t move them more than necessary.
Head and neck checks:
- Could there be a head or spinal injury?
- Breathing – is it normal? Fast, slow, irregular, noisy?
- Pulse – fast, slow, strong, weak, irregular?
- Pupils – equal? Dilated? Pinpoint?
- Check head and face for bleeding, bruising, swelling, deformity or discharge from ear or nose.
Shoulder and chest checks:
- Compare shoulder and collar bone with the other. Are there deformities?
- Get the casualty to take a deep breath and check that the chest moves evenly on each side.
- Is there pain when breathing deeply?
- Check for bleeding, bruising and swelling.
Abdomen checks:
- Check for abnormalities and response to pain.
- Check for incontinence or bleeding.
Limb checks:
- Can they move arms, legs, knees, elbows, hands and knees without pain or restriction?
- Check for deformity, swelling, bruising or bleeding.
Other clues:
- Medical alert bracelets
- Needles
- Alcohol
- Pills
Loosen tight clothing, especially around the neck and chest – ask permission if possible and inform casualty of what you are doing and why.
If you need to remove items from pockets and bags try to get a reliable person to act as a witness. Avoid doing so if you think there could be sharp objects such as needles.
Always maintain checks on airway, breathing and circulation throughout.
