ADJUNCTS TO THE SECONDARY

SURVEY

Muhammad Ahmad

Naveed Rafiq

Muhammad Haseeb Anjum

 Learning Objectives

• Investigations performed after secondary survey

• Re-evaluation

• Definitive care

• Records & legal considerations

Adjuncts to the secondary survey
Specialized diagnostic tests may be performed during the secondary survey to identify specific injuries. These include
additional:

• x-ray examinations of the spine and extremities

• CT scans of the head ,chest, abdomen, and spine

• contrast urography and angiography

• transesophageal ultrasound

• Bronchoscopy

• Esophagoscopy
Adjuncts to the secondary survey
• During the secondary survey, complete cervical and thoracolumbar spine imaging may be obtained if the patient’s
care is not compromised and the mechanism of injury suggests the possibility of spinal injury.

• Many trauma centers forego plain films and use CT instead for detecting spine injury.

• Restriction of spinal motion should be maintained until spine injury has been excluded.

• An AP chest film and additional films pertinent to the site(s) of suspected injury should be obtained.
Adjuncts to the secondary survey
• These procedures require transportation of the patient to other areas of the hospital, where equipment and
personnel to manage life-threatening contingencies may not be immediately available.

• Therefore, these specialized tests should not be performed until the patient has been carefully examined and
his or her hemodynamic status has been normalized.

• Missed injuries can be minimized by maintaining a high index of suspicion and providing continuous
monitoring of the patient’s status during performance of additional testing.
 Adjuncts to the secondary survey​

• Missed injuries can be minimized by maintaining a high index of suspicion and providing continuous monitoring of
the patient’s status during performance of additional testing.
Re-evaluation
• Trauma patients must be reevaluated constantly to ensure that new findings are not overlooked
and to discover any deterioration in previously noted findings.

• Continuous monitoring of vital signs, oxygen saturation, and urinary output is essential.

• Periodic ABG analyses and end-tidal CO2 monitoring are useful in some patients.

• The relief of severe pain is an important part of treatment for trauma patients. Effective analgesia
usually requires the administration of opiates or anxiolytics intravenously
Definitive care

• Whenever the patient’s treatment needs exceed the capability of the receiving institution, transfer is considered.
This decision requires a detailed assessment of the patient’s injuries and knowledge of the capabilities of the
institution, including equipment, resources, and personnel.
Records and Legal Considerations

Records
Accurate record keeping during resuscitation can be facilitated by assigning a member of the trauma team the
primary responsibility to accurately record and collate all patient care information.

Consent
Consent is sought before treatment, if possible. In life-threatening emergencies, it is often not possible to obtain
such consent. In these cases, provide treatment first, and obtain formal consent later.

Forensic evidence
If criminal activity is suspected in conjunction with a patient’s injury, the personnel caring for the patient must
preserve the evidence.
Thank you