The secondary survey is simply a head-to-toe examination that you'll perform on injury victims who are awake and responsive. It's important to remember to not get too focused on one obvious symptom. If you come upon a patient with an obvious arterial bleeding wound, remain focused on other potential head-to-toe problems, as you help care for the more obvious injury.
How to Conduct a Head-to-Toe Exam
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim.
Are you OK? Can you hear me?
If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment.
Pro Tip #1: Even though the patient is awake and responsive, symptoms can always worsen. And conditions that didn't seem life-threatening a minute ago, may seem so now. If at any point things do get worse, call 911 and activate EMS.
Remember to ask yourself questions like:
- Is the victim favoring an area or limb?
- Is there noticeable bleeding, protruding limbs, or other injuries?
- Is the victim demonstrating any concussion symptoms?
- Is there an obvious cause of the injury – slippery walkway, etc.?
- Is the victim demonstrating any airway, breathing, or circulation problems?
Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. Do you know what happened today? Are you in any pain?"
Notice how much they are able to move. Are they nodding when you ask a question? Are they able to move their fingers and toes?
"Can you wiggle your fingers?"
Look for the early signs of shock. Shock is a progressive condition in which the circulatory system fails to adequately circulate oxygenated blood to all parts of the body.
When organs don't receive enough blood, the body begins to conserve blood flow by limiting it to legs, arms, and the skin. This insufficient blood volume is one thing that can lead to shock, as can low levels of plasma and fluids in the blood and airway obstruction.
Early signs of shock include:
- Nervousness
- Rapid heart rate or breathing
- Anxiousness
- Sweaty
- Fearful
- Clammy skin
Pro Tip #2: A quick way to find out if a victim has a circulation problem, which could be a sign of shock, is to pinch a fingernail bed on the patient and count how long it takes to return to a normal pink color. Longer than 3-4 seconds could be a sign that something else is wrong.
"Can you wiggle your toes?"
Continue working your way down the victim, noticing any potential issues or conditions beyond the obvious. Also, make sure they're in a position of comfort, whether that's sitting, laying down, or getting to their feet and stretching out their legs.
Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert?
Warning: It's important to remember that this secondary survey is only for patients who are awake and responsive. If at any point, a once responsive patient goes unresponsive, call 911 immediately and activate EMS.
A Word About Chest Injuries
Chest injuries are one of the leading causes of trauma deaths in the U.S. each year. Chest injuries are most commonly the result of falls, vehicular accidents, workplace accidents, and direct blows or crushing incidents.
Warning: The area around the chest, abdomen, and pelvis contain several vital organs. Therefore, any life-threatening injury in one of these areas can be particularly fatal if left untreated.
There are several types of chest injuries:
Blunt Trauma
Any blow to the chest or abdomen that doesn't penetrate the skin would be considered a blunt trauma injury. Common symptoms include shortness of breath, chest pain, and rapid pulse.
Traumatic Asphyxia
Traumatic asphyxia occurs due to a severe lack of oxygen caused by a physical trauma, typically one in which the victim was crushed or pinned. Common symptoms include shock, distended neck veins, bluish discoloration, black eyes, broken blood vessels in the eyes, bleeding from the nose or ears, and coughing up blood.
Fractured Ribs
Fractured ribs, though painful, are rarely life-threatening. For victims, breathing will be labored for a while and deep breaths, in particular, will be very painful.
Flail Chest
Multiple rib fractures in multiple places results in flail chest. Flail chest is especially serious if it includes the presence of a loose section of ribs that could puncture a lung.
Pneumothorax
A pneumothorax is the collapse of a lung that results from too much air in the chest cavity. At the very least, breathing will be difficult. At the worst, it could lead to respiratory distress.
Hemothorax
A hemothorax is excessive lung pressure due to the accumulation of blood between the chest wall and lungs, which prevents the lungs from properly expanding.