Surgery - Secondary Survey

Objectives of the Secondary Survey

The secondary survey begins after immediate life-threatening injuries have been identified and treated.

Its purpose is to obtain a definitive history, perform a thorough examination, assimilate relevant investigations, and formulate an appropriate management plan.

The patient should be examined systematically from head to toe, including both the front and back of the body.

A thorough assessment includes examination of all relevant orifices where indicated, traditionally summarized by the phrase “fingers and tubes in every orifice.”

A detailed history of the incident should be obtained, including collateral information from witnesses, paramedics, or accompanying persons when available.

A complete medical history should also be obtained.

All directed investigations should be reviewed and incorporated into the overall clinical assessment.

The secondary survey should conclude with the formulation of a definitive management plan.

Investigations

Any investigations relevant to the patient’s injuries and clinical condition should be performed.

At the very least, a trauma imaging series should be obtained or considered as appropriate, together with basic blood investigations and an electrocardiogram (ECG).

Further investigations should be directed by the mechanism of injury, examination findings, and the patient’s clinical condition.

History

A paramedic handover should be obtained to establish the mechanism of injury, events at the scene, pre-hospital findings, and any treatment already given.

A collateral history should be obtained from witnesses or accompanying persons whenever possible.

The patient’s own history should be obtained whenever their clinical condition allows.

An AMPLE medical history should also be obtained.

A – Allergies: Any known drug, food, or other relevant allergies should be identified.

M – Medications: Current medications should be documented.

P – Past Medical History: Relevant previous medical conditions, operations, and comorbidities should be established.

L – Last Meal: The timing of the patient’s last meal or oral intake should be determined.

E – Events Leading to the Situation: The events and circumstances leading to the injury or current situation should be clarified.

Deterioration During the Secondary Survey

If there is any change or deterioration in the patient’s clinical condition during the secondary survey, assessment should immediately return to the ABCDE approach.

Any newly identified life-threatening problem should be evaluated and treated as necessary.

The secondary survey should only be resumed once the patient has been sufficiently stabilized.