PRIMARY SURVEY

Occupational Health & Hygiene Department

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 OBJECTIVES
1. Able to define and compare primary and secondary
survey
2. Able to initiate primary survey and secondary survey
after this lecture

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 Definition
Primary survey is done as the approach to trauma
care which focused for the patient’s body function /
physiology. The primary survey is the first approach
for screening the patient for life threatening
condition.

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Components of Primary Survey

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 AIRWAY
• C-Spine Immobilization (use cervical collar)
• Clear obstruction
• Jaw thrust instead of head tilt chin lift
• Pocket Mask
• Oral Airway
• I-gel

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 BREATHING
• Adequate gas exchange is required to maximize
– oxygenation and carbon dioxide elimination
• Ventilation requires adequate function of the
lungs, chest wall, and diaphragm.
• Each component must be rapidly
• examined and evaluated.
• IPPA is applied

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 BREATHING cont…
• Auscultation for bilateral breath sounds
• Palpation for subcutaneous emphysema
Inspection for flail chest
• Observation of respiratory rate, oxygen saturation, and
overall work of breathing

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 CIRCULATION
• Hemorrhage is the predominant cause of
preventable deaths after injury
• Crucial to identify the source of bleeding.
➢External
➢Internal
• Level of Consciousness
• Skin Color
• Pulse

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 CIRCULATION cont…
• 5 Places life threatening hemorrhage can occur
-Chest
-Abdomen
-Pelvis
-Long bones
-Externally

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 CIRCULATION cont…
• Check peripheral pulses, heart rate, BP, pulse pressure,
capillary refill, cyanosis
• All hypotensive trauma patients are assumed to be in
hemorrhagic shock
• 2 large bore peripheral IV’s (at least 18 gauge)
• Control external bleeding

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 DISABILITY
• Quick assessment of ability to move all extremities
• Check glucose level as well
• Glasgow Coma Scale and pupillary size and reaction

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 EXPOSURE
• Completely undress the patient and inspect the entire
patient from head to toe both front and back.
• Maintain spinal precautions during logrolling
• Inspect both axillae and peritoneum
• Warm blankets

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 ADJUNCTS TO PRIMARY SURVEY
• Electrocardiographic monitoring
• Urinary and gastric catheters
• Ventilatory Rate and Arterial Blood Gases
• Pulse Oximetry
• Blood Pressure
• X-RAY
• FAST

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SECONDARY SURVEY

Occupational Health & Hygiene Department

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 SECONDARY SURVEY
• What is the secondary survey, and when does it
start?
➢The secondary survey does not begin until the primary
survey (ABCDEs) is completed, resuscitative efforts are
underway, and the normalization of vital functions has
been demonstrated.
➢When additional personnel are available, part of the
secondary survey may be conducted while the other
personnel attend to the primary survey.
➢The comprehensive survey of history and physical
examination

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 SECONDARY
• Head-to-toe evaluation of the trauma patient, that is, a
complete history and physical examination, including
reassessment of all vital signs.
• Each region of the body is completely examined. The
potential for missing an injury or failure to appreciate the
significance of an injury is great, especially in an
unresponsive or unstable patient.

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 HISTORY TAKING
• S Sign and Symptoms
• A Allergies
• M Medications
• P Past illnesses
• L Last meal
• E Events related to injury
1.Blunt
2.Penetrating
3.Burns
4.Hazardous Environment

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 Secondary Survey (PE) Head
• Head
• External examination
• Scalp palpation
• Eye and ear exam including visual acuity
• Midline facial fractures
• Bleeding

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 Secondary Survey (PE) Chest
• Visual evaluation (ant & post)
• Palpate rib cage
• Sternal pressure
• Auscultation (heart & lungs)
• Chest x-ray

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 Secondary Survey (PE) Abdomen
• Frequently repeated exams
• Inspection
• Palpation
• Normal initial exam does not rule out injury
• Peritoneal lavage v.s. CT scan v.s. U/S (FAST)

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 Possible injury
• Liver or splenic flexure
• Pancreatic injury
• Major intraabdominal vascular injury
• Renal injury
• Pelvic fractures

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 Secondary Survey (PE) Perineum/Rectum Vagina
• Contusions,Hematomas, Lacerations
• Urethral bleeding
• Rectal blood
• Vaginal vault injuries (pelvic fractures)
• Desktop’s Sign

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 Secondary Survey (PE) Musculoskeletal
• Contusion
• Deformity
• Palpation
• Pelvic pressure and compression
• Vascular exam
• Neurologic exam

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 Secondary Survey (PE) Neurologic
• Immobilization of entire patient
• Reevaluate GCS
• Cranial nerve exam
• Motor exam
• Sensory exam
• Monitor frequently for changes in neuro status
• Assess O2 delivery if changes noted
• Early neurosurgical consultation

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 Summary
• Trauma patients must be reevaluated constantly
to ensure that new findings are not overlooked
and to discover deterioration in previously noted
findings
➢ Reassess, documentaDon and monitoring
➢Transfer procedures and communication to receiving
hospital

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Internal
Thank You

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