What is secondary survey in first aid?
In first aid, a secondary survey is a systematic and detailed assessment of a casualty after initial life-saving interventions (primary survey and resuscitation) have been performed and the casualty is stable. The primary survey focuses on critical, life-threatening conditions that require immediate attention, while the secondary survey aims to identify and manage any other injuries or medical conditions that may not be immediately apparent but could potentially affect the casualty's health and well-being.
The secondary survey involves a head-to-toe examination of the casualty, checking for signs and symptoms of various injuries and conditions. It typically includes the following steps:
- Medical history: Obtain information about the casualty's past medical history, allergies, current medications, and any relevant medical conditions. This information can help identify potential risk factors and guide further assessment and treatment.
- Vital signs: Check and record the casualty's vital signs, including pulse, respirations, blood pressure, and temperature. Deviations from normal ranges can indicate underlying medical conditions.
- Head and face: Inspect the head and face for any injuries, deformities, or tenderness. Check for signs of bleeding, swelling, bruising, lacerations, or contusions. Gently palpate the skull for any depressions or lumps that may indicate a fracture.
- Neck: Assess the neck for any tenderness, pain, or difficulty swallowing. Check for deformities or abnormal positioning that could indicate a spinal injury. Perform a gentle range of motion test to assess for neck stability.
- Chest and lungs: Inspect the chest for any deformities, asymmetry, or paradoxical movement (movement in the opposite direction of normal breathing). Listen to the lungs using a stethoscope for any abnormal breath sounds, such as wheezing, crackles, or rales, which may indicate respiratory problems.
- Abdomen: Examine the abdomen for any tenderness, pain, bruising, or distension. Gently palpate the abdomen, paying attention to any localized tenderness or guarding (voluntary muscle contraction to protect an injured area).
- Pelvis: Check the pelvis for any tenderness, pain, or instability. Gently squeeze the iliac crests (hip bones) and symphysis pubis (joint at the front of the pelvis) to assess for possible fractures.
- Limbs: Inspect the limbs for any deformities, fractures, sprains, or dislocations. Check for pulses, sensation, and movement in each limb. Assess for any signs of compartment syndrome (increased pressure within a muscle compartment), which can be indicated by pain, swelling, and decreased sensation.
- Neurological assessment: Perform a brief neurological assessment, including checking the casualty's level of consciousness, pupil size and reactivity, orientation to time, place, and person, and any focal neurological deficits (such as weakness or paralysis on one side of the body).
- Psychosocial assessment: Consider the casualty's emotional state and support needs. Provide psychological first aid if necessary, and ensure that the casualty feels safe and reassured.
Throughout the secondary survey, it's important to communicate findings and concerns with other healthcare professionals involved in the patient's care and to prioritize treatment based on the casualty's overall condition and the severity of their injuries or medical conditions.