Figure 1-4. Carotid pulse site.
(5) Bleeding (major hemorrhaging). Check for persistent, external bleeding.
If there is profuse bleeding, STOP bleeding by applying a field dressing, direct pressure,
elevation, tourniquet, and so forth.
b. Summary. Now that you have assured that the patient has an open airway,
adequate breathing, a carotid pulse, and any profuse bleeding is controlled, you are
ready to begin the secondary survey.
The secondary survey is performed to discover medical and injury-related
problems that do not pose an immediate threat to survival, but may, if allowed to go
untreated. You will begin by checking/examining the following areas:
a. Vital Signs. Measure and record the patient's pulse, respiration, blood
pressure, and temperature.
(1) Pulse. Normal pulse for adults is 60-80 heartbeats per minute, for
children 80-100, and for infants 120-160. Also observe for regularity and strength. (See
(2) Respiration. Normal respiratory rates for adults are 12-20 per minute, a
higher rate for children is normal. Also observe for rhythm and depth.
(3) Blood pressure. Normal blood pressure for an adult is 110-146 mm/Hg
systolic and 60-90 mm/Hg diastolic. Infant readings are 50-80 mm/Hg systolic and 40-
58 mm/Hg diastolic.
Temperature. Normal temperature is 98.6F (37.0C).
Conduct the remainder of the secondary survey in an orderly pattern from
head to toe. Be sure to record all pertinent findings; for example, abnormal
vital signs, obvious fractures, profuse bleeding, and so forth.