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EMST

5. Secondary Survey

  • Start after 1° Survey & Resus finished
  • Reassess
    • RR, PR, BP, UO, O² Sat, & ABG
  • History
    • Of injury & Past Medical History
    • Car deformation = Energy t'fer
  • Head to toe evaluation
    • Evaluate by region
    • Look, Listen, Feel technique
      • Head & Neck
      • Chest & Abdo
      • Extremities & Neurol GCS
      • Back & PR
    • Head
      • Pupil size
      • Fundal bleed
      • Scalp
    • Facial fracture
      • Identify
      • Orogastric tube if fracture
    • Neck
      • Inspect
      • Palpate
      • XR
    • Chest
      • Inspect sucking wound
      • Palpate flail segment
      • Listen for absent sounds
      • Deviated trachea
      • Dilated neck veins
      • CXR
    • Abdo
      • Definitely bleeding = Laparotomy
      • Uncertain = DPL/ US
    • Perinum/ Rectum/ Vagina
      • Tears
      • Open pelvic fracture
      • PXR
    • Musculoskeletal
      • Palpate limbs
      • Pelvic spring
      • Log roll & palpate back
      • Hand fracture missed +++
    • Neuro
      • GCS
      • Limb neurology
      • CT Head PRN
  • Don’t forget trauma series: CXR, PXR, Cx Spine
    • Cx spine
      • Lateral Cx spine identifies 70% injuries
      • Lateral + AP + peg view identifies 95% injuries
      • If one level affected then
        • Multilevel involvement seen in 10% cases
        • One injury at C1-2 level, the other subaxial