As soon as it is confirmed that the casualty is not going to die from an immediately life-threatening injury, the secondary survey can commence. The secondary survey is a top-to-toe, thorough front-and-back assessment of the patient and it identifies injuries that are not immediately life threatening. In some patients this will mean that the secondary survey takes place after emergency surgery for traumatic haemorrhage.
It is important to constantly review the patient during initial resuscitation. If the patient's condition deteriorates, they should be reassessed starting at the beginning of the primary survey with airway and cervical spine.
The log roll (see Figure 14.2)
The log roll allows assessment of the casualty's back. The procedure requires four helpers to roll the patient (one at the head and three along the sides of the casualty) and one person to examine the casualty. The person at the head maintains manual in-line stabilisation of the head and neck. The spine should be kept in alignment during the roll. The three team members on the side position themselves so one member is at the chest, one at the abdomen/pelvis and one at the legs. These three team members reach across the casualty to the opposite side of their body and place their hands on the casualty in preparation to log roll. On direction from the person at the head, the command is given to roll the casualty on the 'count of three'. The casualty is rolled toward the three team members and the back is inspected in detail and all clothing, straps and debris removed. The spine is palpated and the lungs auscultated. The rectum is examined to check for perineal injuries and anal tone. This is also a good time to remove the long spine board, as it is uncomfortable to lie on and can cause pressure sore development.
When the examination is complete the process is reversed and the casualty is rolled onto their back in a controlled manner, keeping the spine aligned.
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