Chart — Emergency Nursing
Primary vs Secondary Survey Chart
Trauma assessment quick-reference chart — primary survey ABCDE with life-threatening injuries and immediate interventions versus systematic secondary survey head-to-toe, AMPLE history, and nursing priorities.
Educational use only. This content is intended for nursing students and exam preparation. Always follow your institution's trauma protocols and ATLS guidelines. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Primary Survey — ABCDE
Performed first. Identifies and treats the 6 immediately life-threatening injuries. Concurrent with resuscitation. Do NOT move to secondary survey until primary is stable.
Secondary Survey — Head to Toe
Performed after primary survey is complete. Systematic head-to-toe exam + AMPLE history to find ALL injuries. Any deterioration → return to primary survey immediately.
Primary Survey: ABCDE Life Threats & Interventions
Life Threats
Complete airway obstruction; foreign body; laryngeal fracture; expanding neck hematoma; angioedema
Immediate Interventions
Jaw thrust; suction; OPA/NPA; RSI (GCS ≤8); surgical cricothyroidotomy if RSI fails
Life Threats
Tension pneumothorax; open pneumothorax; massive hemothorax; flail chest segment
Immediate Interventions
Tension PTX: needle decompression (4th/5th ICS anterior axillary line; 2nd ICS MCL alt) → chest tube. Open PTX: 3-sided dressing. Hemothorax: large-bore chest tube. Flail: IPPV.
Life Threats
Uncontrolled hemorrhage; cardiac tamponade; massive pelvis fracture hemorrhage
Immediate Interventions
Tourniquet/direct pressure; 2 large-bore IVs; pRBC transfusion if hemorrhagic shock; pelvic binder; pericardiocentesis
Life Threats
Herniation (fixed, dilated pupil); hypoglycemia; expanding epidural hematoma
Immediate Interventions
GCS; pupils; blood glucose; intubate if GCS ≤8; head CT; neurosurgery for expanding hematoma
Life Threats
Missed penetrating wounds; deformity; hypothermia (a coagulopathy trigger)
Immediate Interventions
Completely undress; log-roll; inspect ALL surfaces; warm blankets + IV fluids; warming lights
Primary vs Secondary Survey Comparison
| Component | Primary Survey (ABCDE) | Secondary Survey (Head-to-Toe) |
|---|---|---|
| Purpose | Identify and treat immediate life-threatening injuries — stabilize before anything else | Find ALL injuries (life-threatening AND non-life-threatening) after patient is stabilized |
| Timing | First — occurs simultaneously with resuscitation; may take 60–90 seconds to several minutes depending on acuity | Second — begins only after primary survey is complete and patient is hemodynamically stable (or stabilizing) |
| Framework | ABCDE: Airway → Breathing → Circulation → Disability → Exposure | AMPLE history + systematic head-to-toe physical examination (head → neck → chest → abdomen → pelvis → extremities → neuro → back) |
| Goal | Prevent immediate death from the 6 immediately life-threatening injuries: airway obstruction, tension PTX, open PTX, massive hemothorax, flail chest, cardiac tamponade | Create a complete injury inventory — identify fractures, internal injuries, and missed wounds that are not immediately life-threatening but require treatment |
| Who can perform | Trained nurse begins alongside provider — airway management, hemorrhage control, vascular access, monitoring | Usually provider-led; nurse documents, monitors vitals, and assists with exam components |
| Interrupted by | Nothing — if patient deteriorates during secondary survey, immediately RETURN to primary survey | Any change in patient condition prompts return to primary survey (ABCDE) |
| C-spine rule | Maintain spinal motion restriction throughout primary survey until cleared by clinical criteria (NEXUS or Canadian C-Spine Rule) | C-spine is evaluated as part of head and neck exam — cervical spine tenderness, step-off deformity, neurological deficits |
| Airway (A) | Look: Is patient speaking? (best airway assessment). Listen for stridor, gurgling. Act: jaw thrust (not chin-lift if trauma), suction, OPA/NPA, RSI if GCS ≤8 | Reassess for subglottic injury, expanding neck hematoma, tracheal deviation, surgical airway need |
| Breathing (B) | Inspect, auscultate, percuss chest. Identify: tension PTX (needle decompression), open PTX (3-sided occlusive dressing), flail chest (positive-pressure ventilation), massive hemothorax (chest tube) | Serial chest auscultation; repeat CXR; reassess chest tube output; monitor SpO₂ and RR trend |
| Circulation (C) | HR, BP, cap refill, skin color/temp. Control external hemorrhage (tourniquet, pressure, pelvic binder). 2 large-bore IVs. Cardiac tamponade → pericardiocentesis. | Identify vascular injuries (expanding hematoma, absent/diminished pulses, ABI <0.9), pelvis stability, extremity perfusion status |
| Disability (D) | GCS (best predictor of neurological injury): GCS ≤8 = intubate. Pupils: PERRL or asymmetry (herniation). Check glucose. | Full neurological exam: cranial nerves, motor/sensory function, reflexes, rectal tone (spinal cord injury), GCS trend |
| Exposure (E) | Completely undress patient (cut clothes off). Identify all wounds, deformities, skin findings. Warm blankets AFTER — hypothermia triad of death. | Inspect back (log-roll): spine tenderness, posterior wounds, rectal exam, testicular exam if indicated |
| AMPLE History | Not part of primary survey — performed later. Mechanism of injury (MOI) clue: SCAT = Speed, Crash vs rollover, Airbags deployed, Time at scene | A = Allergies; M = Medications; P = Past medical/surgical history; L = Last meal; E = Events/mechanism of injury |
| NCLEX distinction | PRIMARY SURVEY = life threats only. If options include airway management + a non-emergent finding, choose airway. ABCDEs take priority over comfort, history, and non-urgent labs. | SECONDARY SURVEY = comprehensive — head-to-toe after ABCDEs are addressed. If patient deteriorates during secondary, return to primary. |
The Golden Rule: Return to Primary Survey
If at ANY point during the secondary survey the patient deteriorates — new hypotension, dropping SpO₂, change in consciousness, new tachycardia — STOP the secondary survey and immediately return to the primary survey (ABCDE). Stabilize first. Secondary survey can wait. The patient cannot.
NCLEX Pearls — Primary vs Secondary Survey
Source: ATLS 10th Edition (American College of Surgeons); Emergency Nurses Association TNCC
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with ATLS 10th Edition (American College of Surgeons); Emergency Nurses Association TNCC. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →