d. Movement of Patient. Has the patient been moved since the injury
e. Patient's Signs/Symptoms. Have the signs and symptoms experienced by
the patient changed since the accident occurred? If so, how?
5-17. PHYSICAL ASSESSMENT
a. Primary/Secondary Survey. The primary survey and the secondary survey
are actually done in a flowing motion. These two surveys are not really separated. The
difference is that the primary survey is done quickly and in a short time while the
secondary survey is done in more depth with touching and feeling the patient. During
the primary survey, temporarily stabilize the patient's head and neck until the survey is
complete. Remember, it is possible to cause permanent paralysis to the patient by
moving him improperly if he has a spinal cord injury.
(1) Primary survey. Primary survey is a rapid examination to determine the
patient's condition. The examination should not take more than one and a half to two
minutes. The examination should consist of the following:
(a) Evaluate the airway, cervical spine control, and the patient's initial
level of consciousness.
(b) Evaluate the patient's breathing.
Evaluate the patient's circulation.
(e) Observe the general appearance of the patient.
(f) Note the position in which the patient was found. Some positions
are characteristic of certain injuries. For example, a patient with his arms in the "stick
em up" position may have a cervical spinal injury. If the patient's arms are flexed across
his chest and his hands are half closed, there may be damage to the 6th vertebra of the
(2) Secondary survey. The secondary survey does not begin until the
primary survey has been completed. The secondary survey is a head-to-toe evaluation.
This indepth evaluation utilizes the look, listen, and feel techniques, evaluating the body
(a) Hypotension (abnormally low blood pressure) minus shock. Be
alert for signs/symptoms of hypotension without signs of shock. This condition indicates
the patient is experiencing neurogenic shock (shock originating in the nervous system).