In this section
Major paediatric trauma - the primary survey
Cervical spine assessment
The secondary survey is only to be commenced after the primary survey has been completed and the child is stable. Continue to monitor the child's:
If there is any deterioration detected in these parameters the
primary survey MUST be repeated immediately and measures taken to rectify the problem.
Before commencing the examination
Inspect the face and scalp. Look in the eyes, ears, nose and mouth. Palpate the bony margins of the orbit, the maxilla, the nose and jaw. Palpate the scalp. Test eye movements pupiliary reflexes, vision and hearing.
Inspect the neck through the hard collar. Palpate the cervical vertebrae. To clear the cervical spine see Cervical spine guidelines. Complete examination of the neck by observing the neck veins and palpating the trachea and the carotid pulse.
Inspect the chest, observe the chest movements , palpate for clavicular and rib tenderness and auscultate the lung fields and heart sounds.
Inspect the abdomen, palpate for areas of tenderness especially over the liver, spleen, kidneys and bladder and auscultate bowel sounds. Inspect the perineum and external genitalia.
Inspect all the limbs and joints, palpate for bony and soft tissue tenderness and check joint movements, stability and muscular power. Examine sensory and motor function of any nerve roots or peripheral nerves that may have been injured.
Log roll the child. Inspect the entire length of the back and buttocks and palpate the spine for tenderness. Inspect the anus. Digital examination of the anus is rarely needed however if indicated should be performed by one person.
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During the examination any injuries that are detected should be accurately documented and any urgent treatment such as covering wounds, tamponading bleeding and splinting fracture should occur. Appropriate analgesia, antibiotics or tetanus immunization should
be ordered. The priorities for further investigation and treatment may now be considered and a plan for definitive care established.