UNCONTROLLED WHEN PRINTED
 Description
 Indications
  • A secondary survey is a systematic head-to-toe survey to detect problems that are not always obvious, and do not pose an immediate threat to life but could become serious, or life threatening if not detected and corrected. A CNS survey is a systematic head-to-toe survey using precise responses to specific stimuli to assess presence and extent of damage to the central nervous system.
 Contraindications
Contraindications
 Patient Factors & Considerations

Management of a patient with a head injury or neurological illness depends on careful and ongoing assessment of the patient’s general neurological function.

The first observations conducted pre-hospital provide the basis for monitoring changes in condition throughout the patient’s care in hospital.

Document all findings including important negative findings, for example:

  • No neck pain or tenderness.
  • Pupils equal and reactive to light (PERL, size 4mm)
  • No abnormalities detected (NAD) to Colour / Warmth / Movement / Sensation (CWMS) to distal extremities

Specific observations that could be helpful:

  • Respirations: observe adequacy, depth, frequency, regularity and any abnormal breath sounds.
  • Face: any drooping of facial muscles – which side? Can patient swallow?
  • Speech: slurred or difficulty speaking?
  • Movement: Observe whether all four extremities move with equal precision and strength. Note any tremors.
  • Sensation: Observe for absent, abnormal or normal sensation.
 Procedure

At the completion of this survey, ensure assessment has not aggravated injuries. Ensure all abnormalities have been treated (i.e. dressings, splints etc.)

Keep rechecking any injuries that were found and rectified.

Head:

  • Scalp:
    • Run fingers over scalp without applying excessive pressure, assess for any deformities/abnormalities, bleeding.
  • Facial Structure:
    • Assess for deformity, asymmetry, swelling or bleeding and tenderness, check sensation to different areas of the face and record any irregularities.
  • Eyes/nose/ears:
    • Assess for CSF or bleeding, check pupil size and ocular motor function. Check pupil reaction to light with a pupil torch. Enquire about any hearing disturbances or abnormalities.
  • Mouth:
    • Instruct patient to protrude tongue, and note any tongue deviation from the centre, and assess any injuries to the teeth or tongue. Instruct patient to smile, and note any asymmetry.

Neck:

  • Assess cervical spine for mid-line tenderness, pain or obvious deformity.
  • Prevent movement when assessing the neck of the patient.
  • Assess if swallowing action is present visually, by instructing patient to swallow.

Shoulders:

  • Palpate the shoulders bony parts and assess for deformity, crepitus, bruising and swelling/pain.
  • Apply gentle restraining force to the patient’s shoulders, and instruct him/her to shrug shoulders, assessing strength and equality of muscle action.

Chest:

  • Get the patient to inhale deeply:
    • Assess for deformity, tenderness, bruising and paradoxical movement, look for open/sucking chest wounds, palpate the chest wall.
    • Auscultate all sites as per the Clinical Skill
  • Check for injuries/bruising.
  • Check sensory reaction to touch, comparing left to right side, ask patient to verbally identify area being touched without visualising the action.

Abdomen:

  • Assess for injury, bruising, distension, rigidity, and deformity.
  • Palpate abdomen while assessing for any indication of discomfort.
  • Assess sensory function to touch, and get patient to verbally identify area being touched.

Back:

  • Log roll the patient maintaining C spine precautions if indicated.
  • Palpate the back of the patient, assess for injury, tenderness, bleeding, deformity.
  • Assess sensory function to touch, ask the patient to verbally identify the area being touched.

Pelvis:

  • Check pelvis for signs of instability in conjunction with relevant mechanism of injury - avoid pelvic sprining or excessive manipulation.
  • Check for bleeding, tenderness, deformity, and abnormal positioning of legs and hips.
  • Check sensory function on opposite sides.

Upper & Lower Limbs:

  • Palpate limbs, assess for deformities, crepitus, swelling, bruising and needle marks.
  • Test strength and motor functions by applying gentle restraining force while instructing the patient to push and/or pull against your hands.
  • Assess range of movement.
Secondary-CNS Survey Visual
 Success
Success
 Discontinue
Discontinue
Additional Information
Additional information

Settings
Extended Care:
Colour assist:

References
References

Document Control


Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Version

Published Date

Review Date

Clinical Resources Website

St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.

Other users – Terms of Use

The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.

St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.

St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website. 

No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au

Where links are provided to resources on external websites, St John WA:

  • Gives no assurances about the quality, accuracy or relevance of material on any linked site;
  • Accepts no legal responsibility regarding the accuracy and reliability of external material; and
  • Does not endorse any material, associated organisation, product or service on other sites.

Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.

To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).

Cookies

Please read this cookie policy carefully before using Clinical Resources from St John WA.

The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.

Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.

If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.

St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved

Terms of Use | Privacy Policy | Copyright Statement & Disclaimer