EM SAQs · Secondary survey
The secondary survey of the stable trauma patient
An ACEM-style SAQ on the ATLS secondary survey.
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AMPLE history: allergies, medications (anticoagulants), past history, last meal, events (mechanism).[2] Head and face: scalp lacerations, raccoon eyes or Battle sign for basal skull fracture, pupils, mouth, ears.[2] Neck: trachea, JVP, penetrating wounds. Cervical spine cleared by NEXUS (all five criteria) or imaged by CT.[3] Chest: clavicular and rib fractures, breath sounds, cardiac murmurs, FAST review.[6] Abdomen: distension, tenderness, guarding, seat-belt sign. Pelvis by gentle lateral compression only.[2] Perineum/rectum: blood at the meatus (urethral injury — withhold catheter), sphincter tone, prostate position.[2] Extremities: deformity, pulses, sensation, compartment syndrome. Log roll for the back and spine.[2] Neurological: GCS, pupils, motor and sensory.[2] Decision rules: Canadian CT Head Rule (the high-risk criteria for the CT head in the minor head injury), NEXUS or the Canadian C-Spine Rule for the cervical-spine clearance.[1][3][5] Tertiary survey: a complete repeat within 24 hours, with the review of all imaging and labs, to catch the missed injuries.[4]
References6ShowHide
- [1]Papa L, Stiell IG, Clement CM, et al. Performance of the Canadian CT Head Rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States Level I trauma center. Acad Emerg Med, 2012.PMID 22251188
- [2]Polmear MM, et al. Early care of polytraumatized patients: a framework for orthopaedic surgeons. J Am Acad Orthop Surg, 2025.PMID 39739953
- [3]Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group N Engl J Med, 2000.PMID 10891516
- [4]Keijzers GB, Giannakopoulos GF, Del Mar C, et al. The effect of tertiary surveys on missed injuries in trauma: a systematic review Scand J Trauma Resusc Emerg Med, 2012.PMID 23190504
- [5]Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma N Engl J Med, 2003.PMID 14695411
- [6]Stengel D, Rademacher G, Ekkernkamp A, et al. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma Cochrane Database Syst Rev, 2015.PMID 26368505