The secondary assessment is a systematic evaluation that occurs in traumas or life-threatening situations to help a medical team efficiently gather pertinent information related to the patient’s condition. This happens after or in conjunction with the primary assessment, which evaluates the airway, breathing, circulation, disability, and exposure, or ABCDE. Once the patient is stabilized, the secondary assessment can be completed. The purpose is to analyze vital signs, complete a physical examination, obtain a detailed history of present illness, and gather relevant medical history. If the individual cannot participate or answer questions, then an attempt should be made to collect information from a bystander, friend, or family. Clinicians can use the SAMPLE acronym to gather this information systematically.
In addition to asking questions, the clinician should complete a thorough physical exam, or head-to-toe assessment, to evaluate the patient’s current state and gather more information. To begin, vital signs including heart rate, blood pressure, oxygen saturation, temperature, and respiratory rate should be evaluated and analyzed. Vital sign changes can indicate an underlying condition such as shock, hemorrhage, respiratory distress, or infection. The physical exam may require urgent evaluation of the presenting issue, such as the site of hemorrhage or fractured bone. Then, a head-to-toe assessment may be conducted, which includes evaluation of the head (e.g., trauma, bruising); neck, while ensuring C-spine stability (e.g., jugular venous distension); chest (e.g., crepitus, tenderness, respiratory effort, heart sounds, lung sounds, rash); abdomen (e.g., tenderness to abdominal palpation, distension, bruising); back (e.g., bruising, costovertebral angle tenderness); perineum (e.g., pelvic instability, bleeding); extremities (e.g., radial pulses, posterior tibial pulses and swelling, bruising, visible bone fracture); and neurologic system (e.g., pupil size, eye movements, facial movement, sensation, strength, reflexes). Fetal heart tones, fundal height, and bleeding should also be assessed in patients who are pregnant.
