Secondary Trauma Survey Questions + Sample Questionnaire Template

The secondary trauma survey is an in-depth survey template that is used to identify presence of other significant but not immediately life-threatening or other injuries that were missed in the primary trauma survey. This survey template involves a more thorough and in-depth head-to-toe examination to check for the presence of injuries that will aid towards the treatment process. Medical professionals can use these survey questions to fill in identifying patient information as well as use the AMPLE acronym to collect pertinent information about the trauma that the patient has suffered.

Secondary Trauma Survey Questions + Sample Questionnaire Template

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Were any life-threatening injuries identified in the primary trauma survey? Yes No Were any life-threatening conditions identified in the primary trauma survey? Yes No State which mnemonic devices are used to collect an in-depth patient history: Allergies Medications Pertinent medical history and looking up the Electronic Health Record (EHR) Last oral intake Events leading to the reason for the visit Head-to-toe focussed, assessment & examinations Which of the following were following were observed when assessing the head and face? Select all that apply: Lacerations and bruising Mastoid or periorbital bruising Injury to eye and disfigured or discolored iris Presence of cerebrospinal fluid and/or blood in the ear Nose deformities, bleeding and dissipated septum Bleeding in the gums Swelling of the mouth Jaw fracture and swelling Other Which of the following were following were observed when assessing the neck? Select all that apply: Cervical spine pain, swelling, tenderness or deformity Deviated trachea Blunt or penetrating injuries Tenderness in the larynx Neck vein distention Other Which of the following were observed when assessing the chest? Select all that apply: Occult blood loss Irregular breath sounds Quality of heart sounds Other Which of the following were observed when assessing the abdomen? Select all that apply: Bruising and lacerations Impact or penetrative injuries Blood in rectal vault Displaced or high-riding prostate Other Which of the following were observed when assessing the limbs? Select all that apply: Soft-tissue tenderness Limited movements in the joints Lacerations, bruising or disfigurations Open fractures Other Which of the following were observed when assessing the back? Select all that apply: Loss of tone or sensation Muscle spasms Disfiguration and discoloration Other Which of the following were observed when assessing the buttock and perineum? Select all that apply: Soft-tissue injury Bruising or lacerations Other Which of the following were observed when assessing the genitalia and the pelvic region? Select all that apply: Priapism Bruising, lacerations or burns Ecchymosis Pelvic instability Other What was the prescribed further course of action, post the secondary trauma survey? Continued care in the out-patient department Radiology or lab work Specialized department treatment (for example, ophthalmology, dental, orthopedics etc.) Acute medical unit Intensive care unit Neonatal or pediatric care Psychiatry Discharge from the hospital or medical facility Other Is there any other feedback you would like to provide?