Head-to-Toe Exam is Part of the Secondary Survey
The head-to-toe examination is performed during the secondary survey, not the primary survey, making option A the correct answer. 1
Understanding the Primary vs. Secondary Survey
Primary Survey Components (ABCDE Approach)
The primary survey focuses exclusively on immediately life-threatening conditions and follows a strict ABCDE sequence 1, 2:
- Airway assessment with cervical spine protection 2
- Breathing evaluation and management of life-threatening chest injuries 2
- Circulation assessment with hemorrhage control 2
- Disability (brief neurological assessment using Glasgow Coma Scale) 2
- Exposure with prevention of hypothermia 2
The pulse examination occurs during the circulation component of the primary survey, making option C part of the primary—not secondary—survey 2.
Secondary Survey Components
The secondary survey begins only after the primary survey is completed and the patient is relatively stable. 1 This comprehensive evaluation includes:
- Complete head-to-toe physical examination 1
- Detailed history using the SAMPLE approach (Symptoms, Allergies, Medications, Past medical history, Last meal, Events leading to injury) 1
- Appropriate diagnostic imaging based on clinical findings 1
- Laboratory investigations as indicated 1
Why Option D (Urine Drug Screen) is Incorrect
While urine drug screening may be performed during trauma evaluation, it is not a defining component of the secondary survey framework 3. The secondary survey emphasizes systematic physical examination and targeted diagnostic studies based on clinical findings, not routine toxicology screening 1.
Critical Clinical Pitfall
Never proceed to the secondary survey before completing the primary survey and stabilizing life-threatening conditions. 1 Conducting a head-to-toe examination while the patient has unaddressed airway compromise, uncontrolled hemorrhage, or inadequate ventilation can result in preventable mortality 1. The systematic ABCDE approach must be completed first, with continuous reassessment throughout the patient's care 3, 1.