Secondary Survey

If the patient is conscious proceed with the secondary survey (Box H). Since the pulse rate and character and the rate and character of respiration have already been determined, assess the blood pressure at this time. Next, correlate the patient’s chief complaint and signs and symptoms to a specific organ system. The goal is to identify those problems that are not immediately life-threatening, but require timely stabilization (e.g., hypoglycemia, angina pectoris, ventilation failure).

Box H. Secondary Survey: Conscious Patient.

Quickly determine:
  • Blood pressure
  • Chief complaint (subjective information) associated with acute distress
  • Signs and symptoms (objective data)
    • Identify organ system involved
Quickly review history and correlate to signs and symptoms:
  • Allergies
  • Current medications
  • Past and present illnesses
  • Last oral intake of food
  • Events leading up to the emerging event

Physical signs and symptoms are produced by physical causes and must be recognized before a physical problem can be diagnosed and treated. Without at least a presumptive or working diagnosis there is nothing to treat. Based on symptoms analysis, medical emergencies can be characterized as altered consciousness; chest pain; and ventilatory, allergic (pruritus, urticaria, angioedema), neurogenic (i.e., sensory, affective, motor), and toxic events (Box I).

Box I. Potential Medical Emergencies Based of Symptom Analysis during Secondary Survey.

SymptomsPrimary Working DiagnosesSecondary Working Diagnoses
Altered consciousness
  • Syncope
  • Postural hypotension
  • Hypoglycemia
  • Anaphylaxis
  • Cardiac arrest
  • Seizure
  • Cerebrovascular accident
  • Hyperglycemia
Chest pain
  • Angina pectoris
  • Myocardial infarction
  • With tachycardia
    • Syncope
    • Hyperventilation
    • Airway obstruction
    • Sympathetic reaction
    • Thyrotoxicosis
    • Panic attack
    • Hypertension
  • With bradycardia
    • Drug overdose
  • With deceased BP
    • Syncope
    • Postural hypotension
    • Anaphylaxis
    • Cardiac arrest
    • Adrenal insufficiency
    • Allergic reactions
Ventilation failure
  • Hyperventilation
  • Asthma
  • COPD
  • Airway obstruction
  • Anaphylaxis
  • Myocardial infarction
  • Drug overdose
  • Hyperglycemia
Pruritus, urticaria, angioedema
  • Pruritus
  • Urticaria
  • Angioedema
  • Anaphylaxis
  • Delayed hypersensitivity reaction
Altered sensory, affective and/or motor function
  • Seizure
  • Cerebrovascular accident
  • Syncope
  • Hyperventilation
  • Hypoglycemia
*Airway obstruction, respiratory arrest, and cardiac arrest are discussed under primary survey.
**Rare office emergencies (e.g., thyrotoxicosis, Addisonian crisis and emergencies that evolve over hours or days (e.g., advanced diabetic ketoacidosis, extreme hyperosmolarity) are mentioned, but no separate protocols are presented.