Clinical meaning
The secondary survey is a systematic head-to-toe evaluation performed AFTER the primary survey (ABCDE) has been completed and life-threatening conditions have been addressed. The primary survey follows the ATLS sequence: Airway (with cervical spine protection), Breathing, Circulation (hemorrhage control), Disability (neurological status), and Exposure/Environment. Only after the patient is stabilized does the secondary survey begin. The secondary survey includes: a complete history (AMPLE: Allergies, Medications, Past medical history, Last meal, Events/environment related to the injury), complete physical examination from head to toe, and appropriate diagnostic studies. Each body region is systematically inspected, palpated, and assessed: head (scalp lacerations, skull depressions, Battle sign, raccoon eyes, CSF otorrhea/rhinorrhea), face (midface stability, dental injuries, ocular injuries), cervical spine (tenderness, step-off deformity), chest (rib fractures, flail segment, crepitus, pneumothorax), abdomen (distension, rigidity, tenderness, seatbelt sign), pelvis (instability — compress ONCE only), extremities (deformity, pulses, sensation, compartment syndrome), back (logroll examination for spinal tenderness, flank ecchymosis), and neurological (detailed GCS, pupil reactivity, motor/sensory exam). Missed injuries are a leading cause of preventable trauma death — the secondary survey is designed to identify these injuries before they become life-threatening.