Head, Neck, & Back Injuries

Secondary Survey

The secondary survey is an organized way to check a conscious person for conditions which may not be visible or immediately life threatening, but may become so if not cared for. Call 911 for any altered level of consciousness, signs of shock, or potential head, neck or back injuries. Perform a head to toe exam:

Look from head to toe for:

  • Deformities
  • Contusions
  • Abrasions
  • Penetrations
  • Burns
  • Tenderness
  • Lacerations
  • Swelling

Head – soft spots, blood, look at the eyes, blood or loose teeth in the mouth, blood or fluid from nose or ears, bruising of the eyes and behind the ears

Neck – bleeding, pain, tenderness, bruising, open wounds

Chest – blood, accessory muscle breathing, broken ribs, or open wounds

Abdomen – bleeding, abdominal evisceration, guarding, tenderness, bruising

Pelvis – bleeding, instability

Legs – bleeding, bruising, deformity, open wounds, sensation and movement

Arms – bleeding, bruising, deformity, open wounds, distal sensation and movement

Head, Neck, and Back Injuries

Common causes include:

  • Motor vehicle accidents
  • Pedestrian-vehicle collisions
  • Falls
  • Blunt trauma
  • Diving accidents
  • Any trauma leaving the patient unresponsive

Signs and symptoms include:

  • Bruising around the eyes and behind the ears
  • Irregular or abnormal breathing patterns
  • Altered mental status
  • Unconsciousness
  • Headache
  • Pain, pressure, stiffness in the back or neck area
  • Inability to move the arms or legs
  • Numbness or tingling in the extremities

Treatment: Activate EMS, do not move the patient unless life threatening danger arises, minimize movement, check and correct ABC.


Signs and Symptoms include:

  • Dizziness
  • Inability to track movement with eyes
  • Blurred vision
  • Loss of balance
  • Confusion
  • Acute memory loss
  • Dazed look
  • Nausea

Treatment: Activate EMS, let patient sit in position of comfort, monitor patient for life threatening issues, check and correct ABC.

Concussion in sports: If a player shows signs of having a concussion, the player is not allowed to go back to play until cleared by a physician.

Musculoskeletal Injuries

Sprains and strains:

A sprain is an overextended ligament. A strain is an overextended muscle. In either case, a minor sprain or strain is usually not serious. A more serious strain or sprain may show the same signs as a fracture and require medical attention. Sprain or strain signs include:

  • Pain upon movement
  • Tenderness
  • Minor swelling or bruising

Treatment: RICE- Rest the injured area, Ice for 10-15 minutes every hour, Compress by wrapping with an ACE or elastic bandage, Elevate the injured area above the person’s heart level.


  • If patient is not to able to move the body part, treat as a fracture.
  • Consider the mechanism that caused the injury.
  • Look for deformity, open wounds, tenderness, significant swelling, discoloration, bruising, crepitus (a grating sensation), and loss of movement.
  • Cover any open wounds with dry clean dressings, but do not apply pressure over possible fracture.
  • General splinting is not recommended. Stabilize fractures in the position found. Splinting may be appropriate if there will be an extended time for EMS response, EMS is not available, or an individual will be transport- ing the patient to a hospital.

Treatment: Activate EMS if necessary, manually stabilize the affected body part, do not attempt to straighten, use ice to minimize swelling.