Need a certification?
We want you to feel confident that you're receiving the best training, so ProFirstAid is fully available for preview below. If you're in need of a certificate of completion for work, create your account today to track your progress.
"Hey, hey, stop! Pull forward! Pull forward!" Now we're gonna cover the head-to-toe exam which is virtually the secondary survey. We do this when we have an awake and responsive patient. So we know the scenario when we came in and asked what happened. That this individual was crushed between a hard surface and a heavy piece of equipment so the injuries could be very very bad. But we're going to not get focused so much on one given symptom we want to make sure we're covering all the others. At any point in time we discover a potentially life-threatening condition, that's when we activate EMS or send somebody to go call 911 and bring AED back because if the progression of that life threatening condition gets worse we need to be ready to be able to treat it. But a quick head to toe is gonna look something like this. "Hi my name is Roy I'm a paramedic, do you know what happened today?" They don't really understand what's happening so he may have a decreased level of consciousness. "Are you in a lot of pain?" They're in a lot of pain, she's nodding so I know that her neck is probably still intact. "Can you move your fingers for me?" I'm looking at her face she looked at me but she kinda looks through me she's also looking like she's got blueish nail beds as well as blue around the lips. I pinched the nail bed and it takes longer than three to four seconds or the time it takes to say capillary refill these are the first signs and symptoms of shock and we need to key into that to know that that could be a life-threatening emergency. I'm gonna send somebody now to go call 911 and come back and bring in an AED if they have one available so that we're ready in case this person goes unresponsive. Now am going to ask them if they can move their toes. "Can you move your toes?" She appears that she can but she's in a great deal of pain. If this is the position of comfort then she can stay in this position of comfort. If they're starting to stretch their legs out, and you can see that there's no deformity, we can begin to take that mental checklist and say, you know look, from head to toe her pupils were equal, doesn't seem to be any kind of deformity of the face, she seems to be breathing normally though she's blue around the lips she's got slow capillary refill so she may be going into shock. It's hard to tell if her chest wall has been damaged she's already guarding her hips. I asked her if she's in pain she says a large amount, abdominal, pelvis, this is a crushing injury. But it's this head-to-toe exam that helps us uncover in the awake patient what might not be obvious to someone who walks up and there's a huge arterial bleed. So again this is reserved for people that are awake responsive in breathing, not for those who are unresponsive and not breathing, but as soon as we find something that could be potentially life-threatening, we're going to activate EMS and get help on the way.
The secondary survey is simply a head-to-toe examination that you'll perform on injury victims who are awake and responsive. It's important to remember to not get too focused on one obvious symptom. If you come upon a patient with an obvious arterial bleeding wound, remain focused on other potential head-to-toe problems, as you help care for the more obvious injury.
How to Conduct a Head-to-Toe Exam
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim.
Are you OK? Can you hear me?
If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment.
Pro Tip #1: Even though the patient is awake and responsive, symptoms can always worsen. And conditions that didn't seem life-threatening a minute ago, may seem so now. If at any point things do get worse, call 911 and activate EMS.
Remember to ask yourself questions like:
- Is the victim favoring an area or limb?
- Is there noticeable bleeding, protruding limbs, or other injuries?
- Is the victim demonstrating any concussion symptoms?
- Is there an obvious cause of the injury – slippery walkway, etc.?
- Is the victim demonstrating any airway, breathing, or circulation problems?
Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. Do you know what happened today? Are you in any pain?"
Notice how much they are able to move. Are they nodding when you ask a question? Are they able to move their fingers and toes?
"Can you wiggle your fingers?"
Look for the early signs of shock. Shock is a progressive condition in which the circulatory system fails to adequately circulate oxygenated blood to all parts of the body.
When organs don't receive enough blood, the body begins to conserve blood flow by limiting it to legs, arms, and the skin. This insufficient blood volume is one thing that can lead to shock, as can low levels of plasma and fluids in the blood and airway obstruction.
Early signs of shock include:
- Nervousness
- Rapid heart rate or breathing
- Anxiousness
- Sweaty
- Fearful
- Clammy skin
Pro Tip #2: A quick way to find out if a victim has a circulation problem, which could be a sign of shock, is to pinch a fingernail bed on the patient and count how long it takes to return to a normal pink color. Longer than 3-4 seconds could be a sign that something else is wrong.
"Can you wiggle your toes?"
Continue working your way down the victim, noticing any potential issues or conditions beyond the obvious. Also, make sure they're in a position of comfort, whether that's sitting, laying down, or getting to their feet and stretching out their legs.
Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert?
Warning: It's important to remember that this secondary survey is only for patients who are awake and responsive. If at any point, a once responsive patient goes unresponsive, call 911 immediately and activate EMS.
A Word About Chest Injuries
Chest injuries are one of the leading causes of trauma deaths in the U.S. each year. Chest injuries are most commonly the result of falls, vehicular accidents, workplace accidents, and direct blows or crushing incidents.
Warning: The area around the chest, abdomen, and pelvis contain several vital organs. Therefore, any life-threatening injury in one of these areas can be particularly fatal if left untreated.
There are several types of chest injuries:
Blunt Trauma
Any blow to the chest or abdomen that doesn't penetrate the skin would be considered a blunt trauma injury. Common symptoms include shortness of breath, chest pain, and rapid pulse.
Traumatic Asphyxia
Traumatic asphyxia occurs due to a severe lack of oxygen caused by a physical trauma, typically one in which the victim was crushed or pinned. Common symptoms include shock, distended neck veins, bluish discoloration, black eyes, broken blood vessels in the eyes, bleeding from the nose or ears, and coughing up blood.
Fractured Ribs
Fractured ribs, though painful, are rarely life-threatening. For victims, breathing will be labored for a while and deep breaths, in particular, will be very painful.
Flail Chest
Multiple rib fractures in multiple places results in flail chest. Flail chest is especially serious if it includes the presence of a loose section of ribs that could puncture a lung.
Pneumothorax
A pneumothorax is the collapse of a lung that results from too much air in the chest cavity. At the very least, breathing will be difficult. At the worst, it could lead to respiratory distress.
Hemothorax
A hemothorax is excessive lung pressure due to the accumulation of blood between the chest wall and lungs, which prevents the lungs from properly expanding.