Secondary Survey

G = Give Comfort Measures.

-Assess, treat, and reassess for pain, anxiety • Provide emotional support to patient and caregiver. • Provide additional comfort measures as appropriate (e.g., distraction, ice, position of comfort, warm blanket, analgesia). -Pain meds are usually given after stabilization and assessment, usually IV fentanyl. Given in increments. Monitor respiratory rate and pattern, and BP

F= Full Set of Vital Signs, Focused Adjuncts, Facilitate Family Presence

-Establish baseline vital signs: • Obtain vital signs: temperature, heart rate, respiratory rate, oxygen saturation, BP bilaterally. -Focused Adjuncts: •Determine need for additional procedures • Initiate continuous ECG, O2 saturation, and end-tidal carbon dioxide monitoring. • Insert urinary catheter (if not contraindicated). • Insert gastric tube. • Obtain blood for laboratory studies. • Arrange for diagnostic studies (e.g., chest x-ray). • Provide tetanus prophylaxis, if appropriate. -Facilitate Family Presence: • Determine caregiver's desire to be present during invasive procedures and/or cardiopulmonary resuscitation • Assign team member to support caregivers.

H = Head-to-Toe Assessment.

-Head, Neck, and Face: • Note general appearance, including skin color. • Examine face and scalp for lacerations, bone or soft tissue deformity, tenderness, bleeding, and foreign bodies. • Inspect eyes, ears, nose, and mouth for bleeding, foreign bodies, drainage, pain, deformity, ecchymosis, lacerations. • Palpate head for depressions of cranial or facial bones, contusions, hematomas, areas of softness, bony crepitus. • Examine neck for stiffness, pain in cervical vertebrae, tracheal deviation, distended neck veins, bleeding, edema, difficulty swallowing, bruising, subcutaneous emphysema, bony crepitus. -Chest: • Observe rate, depth, and effort of breathing, including chest wall movement and use of accessory muscles. • Palpate for bony crepitus, subcutaneous emphysema. • Auscultate breath sounds. • Obtain 12-lead ECG and chest x-ray. • Inspect for external signs of injury: petechiae, bleeding, cyanosis, bruises, abrasions, lacerations, old scars. -Abdomen and Flanks • Look for symmetry of abdominal wall and bony structures. • Inspect for external signs of injury: bruises, abrasions, lacerations, punctures, old scars. • Auscultate for bowel sounds. • Palpate for masses, guarding, femoral pulses. • Note type and location of pain, rigidity, or distention of abdomen. -Pelvis and Perineum • Gently palpate pelvis. • Assess genitalia for blood at the meatus, priapism, ecchymosis, rectal bleeding, anal sphincter tone. • Determine ability to void. -Extremities: • Inspect for signs of external injury: deformity, ecchymosis, abrasions, lacerations, swelling. • Observe skin color and palpate skin for pain, tenderness, temperature, and crepitus. • Evaluate movement, strength, and sensation in arms and legs. • Assess quality and symmetry of peripheral pulses. -Inspect Posterior Surfaces: • Logroll and inspect and palpate back for deformity, bleeding, lacerations, bruises.

Secondary Survery

-begins after addressing each step of the primary survey and starting any lifesaving interventions. -The secondary survey is a brief, systematic process that aims to identify all injuries -Ongoing assessment, must monitor pt's response to your interventions -If at any point, pt becomes hemodynamically unstable- YOU NEED TO RETURN TO A PRIMARY SURVEY FORMAT

I= Inspect

The trauma patient should always be logrolled (while maintaining cervical spine immobilization) to inspect the patient's posterior surfaces and whenever movement is needed. This often requires three to four or more people with one person supporting the head. Inspect the back for ecchymosis, abrasions, puncture wounds, cuts, and obvious deformities. Palpate the entire spine for misalignment, deformity, and pain.

H = History

• Obtain details of the incident/illness, mechanism and pattern of injury, length of time since incident occurred, injuries suspected, treatment provided and patient's response, level of consciousness. •* Use the mnemonic AMPLE to determine Allergies, Medication history, Past health history (e.g., preexisting medical/psychiatric conditions, last menstrual period), Last meal, and Events/Environment preceding illness or injury.