Synopsis
Use repeated structured assessment, definitive report reconciliation and closed-loop handover to detect injuries obscured by resuscitation, altered consciousness, distracting pain or transfers.
- Schedule a documented tertiary survey after initial resuscitation and imaging, commonly within 24 hours, and repeat when the patient is awake, sober or able to cooperate.
- Start with interval events and another CABCDE review; any deterioration takes priority over completing the checklist and triggers immediate treatment.
- Rebuild the mechanism and AMPLE history from patient, witnesses, ambulance and records, including anticoagulants, baseline function, pregnancy and pre-existing deficits.
Key red flags
New hypoxia, shock, falling GCS, focal deficit, escalating pain or loss of distal perfusion after admission represents active deterioration, not a routine tertiary-survey finding.
Investigation priorities
Identify incomplete assessments, pending results and discrepancies across transitions.
Management branches
Initial resuscitation and urgent treatment are complete enough for systematic reassessment.
- Schedule the survey within the trauma pathway and identify which regions or history remain unreliable because of sedation, pain, intoxication or urgent intervention.
- Collect ambulance, emergency, operative and transfer records, preliminary and final imaging reports, laboratory trends and current device lists before bedside review.