Emergency secondary assessment
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Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Do not begin the secondary assessment until the primary assessment is complete and resuscitation procedures have been initiated as indicated.
Continue to monitor airway, breathing, circulatory, and neurologic status during the secondary assessment. If any life-threatening problems arise, return to the primary assessment and intervene as indicated.
Prioritize and initiate interventions for injuries or conditions discovered in the secondary assessment after the entire head-to-toe examination is complete.
The purpose of the secondary assessment is to rapidly and systematically assess critically ill and injured patients from head to toe to identify all injuries and signs of illness and to rapidly and systematically assess critically ill patients when the cause of their signs and symptoms is unclear. Interventions for injuries or conditions discovered in the secondary assessment should be prioritized and initiated after the entire secondary assessment is complete.
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Rationale: Evidence shows that family presence during trauma resuscitation helps the family cope and supports the patient.
Avoid the nasogastric route in patients with a suspected head injury or mid-face fractures.
Do not rely on pulse oximetry readings in a patient with poor perfusion; they may not be accurate. Assess the quality of the plethysmographic waveform if there is any doubt.
To facilitate patient cooperation, palpate known painful areas last.
Placement of an indwelling urinary catheter is contraindicated if there is blood at the urinary meatus, perianal ecchymosis, or scrotal ecchymosis.
Avoid rolling the patient onto an injured extremity or side if possible. If necessary, for adequate assessment of posterior surfaces, roll the patient to both sides.
There is evidence that the log roll maneuver can result in spinal and pelvic movement. Carefully consider the risks and benefits of performing this maneuver, especially if the potential for spinal cord injury or pelvic fracture is significant.2
When spinal or pelvic injuries are suspected, radiographs are recommended before logrolling the patient.4
Prostate position as determined by rectal examination is not a reliable indicator of urethral injury.1
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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