• • done after primary survey once patient is hemodynamically and neurologically stabilized

  • identifies major injuries or areas of concern

  • full physical exam and x-rays (C-spine, chest, pelvis – required in blunt trauma, consider T-spine and L-spine)

HISTORY

• • “SAMPLE”: Signs and symptoms, Allergies, Medications, Past medical history, Last meal, Events related to injury

PHYSICAL EXAM

Head and Neck

• • palpation of facial bones, scalp

Chest

• • inspect for: 1. midline trachea and 2. flail segment: ≥2 rib fractures in ≥2 places; if present look for associated hemothorax, pneumothorax, and contusions

  • auscultate lung fields

  • palpate for subcutaneous emphysema

Abdomen

• • assess for peritonitis, abdominal distention, and evidence of intra-abdominal bleeding

  • DRE for GI bleed, high riding prostate and anal tone

Musculoskeletal

• • examine all extremities for swelling, deformity, contusions, tenderness, ROM

  • check for pulses (using Doppler probe) and sensation in all injured limbs

  • log roll and palpate thoracic and lumbar spines

  • palpate iliac crests and pubic symphysis and assess pelvic stability (lateral, AP, vertical)

Neurological

• • GCS

  • full cranial nerve exam

  • alterations of rate and rhythm of breathing are signs of structural or metabolic abnormalities with progressive deterioration in breathing indicating a failing CNS

  • assess spinal cord integrity

  • conscious patient: assess distal sensation and motor function

  • unconscious patient: response to painful or noxious stimulus applied to extremities

INITIAL IMAGING

• • non-contrast CT head/face/C-spine (rule out fractures and bleeds)

  • chest x-ray

  • FAST or CT abdomen/pelvis (if stable)

  • pelvis x-ray