3. INTRODUCTION
• The secondary survey does not begin until primary survey is
completed, resuscitation and improvement of the patients
vitals functions have been seen.
• The secondary survey is head to toe examination of trauma
patient i.e complete history and physical examination including
reassessment of all vital signs.
• Each region of body is completely examined.
SIMPLE GUIDE: DCAP BTLS
4. HISTORY
• Every complete medical assessment includes a history of
mechanism of injury.
• Includes :- allergies,
• medication currently used,
• past illness or pregnancy
• last meal ,
• events/environment related to the injury
5. C0NC….
• Knowledge of the mechanism of injury can enhance
understanding of the patients physiological state and provide
clue of anticipated injuries.
6. BLUNT TRAUMA
• Blunt trauma often results from automobile collisions falls
and other injuries related to transportation and occupation
• Important information to obtain about automobile collisions
includes
• Seat belt use
• Steering wheel deformation
• Present and activation of airway device
7. PENETRATING TRAUMA
• Factors that determine type and extent of injury and
subsequent management includes the body organ that was
injured organs in the path of the penetrating object, and
velocity of the missile. Therefore in gunshot victims the
velocity ,caliber, presumed path of the bullet and distance
from weapon to the wound can provide important clues
regarding the extent of injury.
8. PHYSICAL EXAMINATION
• During the secondary survey physical examination follows sequence of head,
maxilla facial structures, cervical spine and neck, chest ,abdomen ,pelvis,
peritoneum/rectum/vagina ,musculoskeletal and then neurological system
• HEAD
• The secondary survey begins with evaluating the head to identify all related
neurological injury and any other significant injury
• MAXILLOFACIAL STRUCTURES
• Examination of face should include palpation of all bony structure, assessment of
occlusion ,intra oral examination and assessment of soft tissue.
• Maxillofacial trauma that is not associated with airway obstruction and major
bleeding should be treated only after the patient is stabilized and life threatening
injuries has been managed.
9. CONC…
• CERVICAL SPINE AND NECK
• Patient with maxillofacial or head trauma should be
presumed to have a cervical spine injury and cervical spine
motion must be restricted
• CHEST
• Visual evaluation of chest both anterior and posterior can
identify conditions such as open pneumothorax and large
flair segments.
• Significant chest injuries can manifest with pain, dyspnoea
and hypoxia.
10. • ABDOMEN AND PELVIS
• Abdominal injury must be identified and treated aggressively
• Pelvis fracture can be suspected by identification of ecchymosis over iliac
wings,pubis,labia or scrotum
• PERINEUM,RECTUM AND VAGINA
• Perineum should examine for contusion, hematoma, laceration and urethral
bleeding
• MUSCULOSKELETAL
• The extremities should be inspected for contusion and deformity
• Palpation of bones and examination for tenderness and abnormal movement adds
in the identification of occult fractures.
11. • NEUROLOGICAL SYSTEM
• A comprehensive neurological examination includes motor,
sensory evaluation of extremities as well as revaluation of
the patients level of consciousness and pupil size and
response
• The GCS score facilitates detection of early changes and
trends in patient neurological status
