Secondary survey - Resuscitation Emergency Management

Secondary survey

·        Check BP, respiratory rate, temperature

·        Check for palpable pulse, capillary return to compressed fingernail bed, and neck veins

·        Work systematically from head, to chest, abdomen, pelvis.

·        Check limbs and vertebrae for fractures 

·        External haemorrhage: pressure bandages, splints for fractures, if Military Anti-Shock Trousers (MAST) used for pelvic/femoral fracture, should only be very temporary and let down slowly (to avoid hypotension) 

·        Non-obvious injuries to exclude (as they may be life threatening): aortic dissection, pulmonary contusion, spinal injury, penetrating wounds (esp to back), and intra-abdominal bleeding (e.g. if persisting shock) 

·        Complications can occur insidiously: hypothermia, acidosis, sepsis, coagulopathies, shock 

·        Need 2 iv access sites with 14 gauge: arms, femoral, jugular, saphenous, subclavian vein, or cutdown to medial basilic or long saphenous vein (1 cm anterior to medial melleolus). Intraosseous in infants

·        Fluid replacement: warmed crystalloid (watch for cerebral oedema) or colloid, blood where indicated.

·        Monitor pulse, BP, skin colour, capillary refill and urine output

·        Check for neurological disability

o  Very common, esp in road trauma

o  Check: Alert, responding to vocal stimuli, pain, or unresponsive

o  Moving limbs doesn‟t exclude spinal injury

o  Check pupils