The secondary survey is performed if time permits once the patient has been resuscitated and stabilised. It involves a more thorough head-to-toe examination, and the aim is to detect any delayed injuries that were not detected or managed during the initial assessment and resuscitation. If during the examination or at any time a deterioration is detected, go back and reassess the primary survey using the ABCDE systematic approach. Consider further diagnostic imaging if available and indicated.
Taking an adequate history from the patient, bystanders or emergency personnel of the events surrounding the injury can assist with understanding the extent of the injury and any possible other injuries. Use the AMPLE acronym to assist with gathering pertinent information: Allergies Medication Past medical history including tetanus status Last meal Events leading to injury12
During this examination, any injuries detected should be accurately documented and any required treatment should occur, such as covering wounds, managing non-life-threatening bleeding and splinting of fractures.
Head and face:
Face: examine & palpate for lacerations, depressions, swelling, bruising to mastoid / peri-orbital region