Overview of Trauma Secondary Survey
Treating a patient who has been through trauma can be tough because they could have many injuries. Before beginning a detailed evaluation, a basic evaluation, known as the primary survey, needs to be completed. Often, in patients with injuries to multiple body systems, examining and treating these injuries can happen at the same time. So, the detailed evaluation, also called the secondary survey, may happen alongside and after the basic evaluation. The primary objective is to make sure that all critical conditions are found and dealt with properly.
Sometimes, not all injuries can be noticed right away in trauma patients. “Occult injuries” are hidden injuries that may be overlooked, and if they are not diagnosed in time, they can lead to further health problems or even death. Therefore, the secondary survey involves a quick but complete check of the patient from head to toe to find all potential major injuries. This helps doctors to decide what needs to be focused on for ongoing care. It is done after the basic evaluation and initial stabilisation of the patient’s condition.
The secondary survey also aims to gather important information about the patient and their injury, as well as to check and treat all major injuries that were not spotted in the primary survey. The survey involves a systematic and comprehensive examination. Since the condition of trauma patients can change quickly, it’s necessary to regularly assess them. If a patient’s condition gets worse, the basic evaluation needs to be repeated and the evaluation of vital functions such as airway, breathing, and circulation – also known as ABCs – should be started. This procedure helps in spotting conditions that require immediate attention and treatment.
Why do People Need Trauma Secondary Survey
The secondary survey is a step that all patients who’ve experienced trauma go through after their initial check-ups are done. The goal of this second stage is to take a more in-depth look into the patient’s condition. It includes getting a detailed account of the patient’s health history, conducting a thorough physical exam from head to toe, rechecking all important health signs like temperature, pulse, and blood pressure, and carrying out relevant lab tests and imaging scans like x-rays or MRIs. This thorough examination helps to find any injuries or imbalance in the body’s normal functions.
When a Person Should Avoid Trauma Secondary Survey
If a patient is too unwell to progress beyond their initial examination and cannot be effectively treated and stabilized, a follow-up examination should not be carried out. The only time a follow-up examination is not advised is if the patient unfortunately passes away due to their injuries. Other than that, all patients who have experienced trauma need to complete a follow-up examination. However, if a patient is severely injured, they may not be able to provide a history of what happened. In these cases, the information can be gathered from emergency medical service personnel, family members, or even people who witnessed the incident.
Who is needed to perform Trauma Secondary Survey?
The medical team that will be taking care of you includes specialized trauma professionals, alongside other helpful staff. Their role is to work together to ensure you receive the best possible care and treatment.
Preparing for Trauma Secondary Survey
Follow typical safety measures to protect against infections that can be passed through blood or other bodily fluids.
How is Trauma Secondary Survey performed
Before a secondary survey is conducted, the doctor needs to make sure the primary survey is completed, the initial steps to treat the patient have started, any immediate life-threatening problems have been found and treated, and they’ve begun to stabilize the patient’s vital signs (like heart rate, blood pressure, etc.). If a patient’s condition is unstable, they need to be stabilized before they take them to a trauma center.
Doctors need to find out about the accident or injury, since this can help them guess what kind of injuries the patient might have. For example, if there’s been a car crash, they’ll want to know if the patient was wearing a seat belt, if the airbag deployed, how badly the car was damaged, etc. Or, if the patient has been shot, they’ll need to know what type of gun was used and how many times the patient was hit.
Doctors also run through a quick history using the “AMPLE” acronym which stands for: Allergies, Medications the patient is currently taking, any Previous medical issues or if the patient is pregnant, when their Last meal was, and Events/environment related to the injury, like what happened or if they were in a hazardous environment like exposure to chemicals, toxins, or radiation. This is to understand if there’s a risk for any organ dysfunction or health threats.
Next, a head-to-toe examination is performed to find any significant injuries. This assessment involves a thorough check of all regions of the body, including airway and lungs. Throughout this process, the doctor ensures standard precautions against any blood or fluid-borne infections. Pertinent factors include:
Vital signs like pulse, and heart rate are observed as they can provide important clues about the patient’s condition. For example, a narrow pulse pressure and faster heart rate might indicate shock in trauma settings, and should be watched closely to assess how the patient is responding to treatment. Importantly, elderly patients might not show these signs immediately, so normal vital signs should not be counted as reassuring.
The doctor will examine the head for any possible signs like a scalp injury, skull fracture, or laceration. The whole face will be examined carefully by touching the facial bones like the orbit (eye socket), the maxilla (upper jaw), the nose, and jaw. A tube should not be inserted through the nose if there’s facial injury or evidence of a basilar skull fracture (a break at the base of the skull). The ears should be examined for any sign of trauma or a basilar skull fracture. The pupils and response of the eyes should also be examined carefully, including any signs that might suggest a fracture, like ‘Raccoon eyes’ where bruising appears around the eyes.
The neck is examined for any injuries while being carefully immobilized. Particular care is given to injuries that might not be readily visible if a hard collar is worn. If there’s blunt trauma, the healthcare team will assume a neck injury until proven otherwise.
The chest is checked for any signs like subcutaneous emphysema (when air gets into tissues under the skin) and pain. The sternum and clavicles are paid special attention to, as fractures here might indicate a need for further evaluation of other chest injuries. Breathing effort, heart sounds, and any bruises from a seatbelt are also evaluated.
The abdomen is examined for distension, bowel sounds, bruising, skin marks, and tenderness. If any of these are found, further tests need to be done. The presence of a seatbelt sign or other marks on the abdomen also indicate a need for further tests. It should be kept in mind that not finding tenderness in the abdomen doesn’t mean that there’s no abdominal injury. An examination of the rectum and genitalia is also conducted.
The extremities are evaluated for fractures, tenderness, and decreased range of motion. The status of blood flow and nerves in each limb is assessed and documented. If a compartment syndrome (a dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues) is suspected, it’s noted.
The pubic area is checked for any signs of instability. The presence of bruising over the iliac wings, pubis, labia, or scrotum and tenderness along the pelvic ring, also, requires further tests.
In the neurological examination, the sensory and motor functions are assessed again alongside the Glasgow Coma Scale score (a tool that measures a patient’s level of consciousness). This is important as a patient’s condition can change over time. The neurological assessment also takes into account an examination of the pupils’ reaction to light.
Finally, a complete skin examination is carried out to check for any sign of injury. This holistic and thorough approach allows doctors to make the best possible assessment about the patient’s condition and plan the next steps for treatment.
Possible Complications of Trauma Secondary Survey
When a person becomes injured, there’s a chance some injuries might be overlooked. This risk tends to be higher for certain types of injuries:
* Abdominal Trauma: injuries within the digestive or central part of the body can sometimes be missed.
* Blunt Trauma: injuries to the bowel, pancreas, and duodenum (the first part of the small intestine), or a tear in the diaphragm can be overlooked.
* Penetrating Trauma: injuries to the rectum.
* Thoracic Trauma: injuries to the aorta (the main blood vessel), pericardial tamponade (a buildup of fluid around the heart), and tears in the esophagus can be missed.
* Extremity Trauma: fractures in the far parts of limbs, and a severe condition called compartment syndrome (where pressure increases in a muscle compartment which can harm blood flow) can sometimes be overlooked.
* Blood loss in the pelvis might be underestimated or not accounted for properly.
In order to avoid missing any injuries, especially when a person has injuries in multiple areas of the body, a complete and comprehensive check should be done.
Regular assessments are vital to identify any complications, like compartment syndrome. It’s important to stay alert and reassess frequently to make sure no injuries are missed.
If a person’s injuries are severe and beyond the capability of the current medical facility, they will need to be transferred to a specialized trauma center. Any required specialized tests should not delay this transfer. The process to transfer the patient should begin as soon as they are stable.
What Else Should I Know About Trauma Secondary Survey?
The secondary survey is a full examination from head to toe that doctors perform on patients who have experienced trauma. This thorough check is done to spot any injuries that might have been missed during the initial examination.
