[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Critical care](https://durgical.com/en/nursing/areas/critical-care/) › The trauma patient in the ICU: the primary and secondary survey from the nursing side, the tertiary survey and complications to watch

# The trauma patient in the ICU: the primary and secondary survey from the nursing side, the tertiary survey and complications to watch

- Safe practice

In the ICU the nurse repeats the ABCDE check, helps with the tertiary survey and watches for bleeding, cold, clots and injuries that were missed.

Updated Nov 13, 2026

## Key points

- Repeat the ABCDE check on arrival in the ICU and every time the patient changes: the effect of a treatment can take minutes to show.
- Expose the patient to examine them, then cover them again and measure the temperature: hypothermia is part of the lethal triad.
- Lethal triad: hypothermia, acidosis and coagulopathy feed one another and are closely linked to death after severe trauma.
- The tertiary survey is a full re-examination plus a review of all imaging and blood results within about 24 hours, repeated when the patient is awake.
- Give thromboprophylaxis on time as ordered: missed doses were linked to more deep vein thrombosis.

## What it is

A severely injured patient reaches the ICU after the emergency team has done the primary survey (ABCDE) and the secondary survey (a full head-to-toe examination and history). The nurse does not assume that work is finished. The nurse repeats the ABCDE check on arrival and after every change, keeps the patient warm while exposing them, supports the tertiary survey (a second complete examination and review of every test within about 24 hours and again when the patient is awake), and watches for the complications of major trauma: ongoing bleeding, the lethal triad of hypothermia, acidosis and coagulopathy, injuries that were missed, and venous thromboembolism. Early thromboprophylaxis, mobilisation and enteral feeding follow the team's orders.

## What it requires

- ABCDE: Airway, Breathing, Circulation, Disability (level of consciousness by AVPU or the Glasgow scale, pupils, glucose) and Exposure.
- Definitions used in one large trauma registry study: hypothermia below 35 °C core temperature, acidosis pH below 7.2, coagulopathy by a low prothrombin ratio. Adding low ionised calcium («lethal diamond») has limited evidence.
- Thromboprophylaxis is started early (within 24 hours) after severe trauma when there is no brain injury and no active bleeding; in brain injury the team decides case by case.
- A protocolised early mobilisation programme in trauma ICU patients was linked to fewer days on the ventilator.
- Enteral nutrition is preferred to parenteral nutrition once the gut is in continuity, started early by protocol.

## How it is applied (and why)

- Take the handover, then do your own ABCDE check — the patient may have changed during transport.
- Airway: the patient speaks normally or the tube is secure; noisy breathing or stridor means partial obstruction — it can lead to cardiac arrest.
- Breathing: count the rate, look at chest movement and symmetry, listen and apply oximetry — chest injuries such as a tension pneumothorax show here.
- Circulation: pulse, blood pressure, capillary refill, skin, wounds and drains; check the IV access — low blood pressure is a serious, late sign.
- Disability: AVPU or Glasgow, pupils, limb movements and capillary glucose — low glucose is quick to correct.
- Exposure: uncover by sections, look for wounds and bruises, cover again and measure temperature — find injuries without making the patient cold.
- Support the secondary and tertiary surveys: record each wound, device and new complaint; check every result was reviewed — fewer injuries are missed.
- Follow the daily plan: thromboprophylaxis on time, early mobilisation and early enteral feeding as ordered — each prevents a known complication.

## In nursing practice

- Report early a falling temperature, a worsening blood gas or worsening clotting tests: these are signs of the lethal triad.
- Large volumes of crystalloid are linked to abdominal compartment syndrome and dilutional coagulopathy; follow the fluid plan set by the team.
- When the patient wakes and starts to move, new pain, swelling or bruising may reveal a missed injury; most missed injuries are musculoskeletal or soft tissue.
- Trauma patients have a higher risk of drug and alcohol withdrawal in the ICU; report new agitation.

## Common mistakes

- Doing the ABCDE check once at admission and not repeating it after changes.
- Leaving the patient uncovered for a long time during examinations or procedures.
- Assuming the emergency team found every injury.
- Holding a thromboprophylaxis dose without an order.

## Test yourself

Think of the answer, then tap the question to see it.

## What are the three parts of the lethal triad in trauma?

Hypothermia, acidosis and coagulopathy. They worsen one another and are closely linked to death after severe trauma.

## What is the tertiary survey?

A complete re-examination and review of all imaging and blood results within about 24 hours, repeated when the patient is awake and cooperative, to find missed injuries.

## Why does the nurse repeat the ABCDE check in the ICU if the emergency team already did it?

Because the patient may change during transport and later, and the effect of each treatment must be reassessed.

## Why should thromboprophylaxis doses not be skipped?

Because missed doses were linked to a higher rate of deep vein thrombosis in trauma patients.

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## Elsewhere in DurgiPedia

- [The ABCDE of pigmented lesions](https://durgical.com/en/clinical-exam/the-abcde-of-pigmented-lesions/)

## Connections

## Related 3

- [Massive transfusion and the lethal triad: warming, calcium and clotting checks, and transfusion reactions](https://durgical.com/en/nursing/massive-transfusion-and-the-lethal-triad-warming-calcium-and-clotting-checks-and/)
- [Acute spinal cord injury in the ICU: spinal precautions, log roll, breathing, neurogenic shock and autonomic dysreflexia](https://durgical.com/en/nursing/acute-spinal-cord-injury-in-the-icu-spinal-precautions-log-roll-breathing-neurog/)
- [Recognising deterioration and calling the rapid response team](https://durgical.com/en/nursing/recognising-deterioration-and-calling-the-rapid-response-team/)

## Related conditions 4

- [Major trauma (polytrauma): ATLS primary survey](https://durgical.com/en/conditions/major-trauma-atls-primary-survey/)
- [Blunt abdominal trauma](https://durgical.com/en/conditions/blunt-abdominal-trauma/)
- [Penetrating trauma (stab and gunshot wounds)](https://durgical.com/en/conditions/penetrating-trauma/)
- [Traumatic brain injury](https://durgical.com/en/conditions/traumatic-brain-injury/)

[← All of nursing](https://durgical.com/en/nursing/)

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach](https://pmc.ncbi.nlm.nih.gov/articles/PMC3273374/) (International Journal of General Medicine (Thim et al.), 2012); [A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey](https://pmc.ncbi.nlm.nih.gov/articles/PMC3889299/) (World Journal of Surgery (Keijzers et al.), 2014); [Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC), Paper 2: Postoperative and Intensive Care Recommendations](https://pmc.ncbi.nlm.nih.gov/articles/PMC12338449/) (World Journal of Surgery (ERAS Society and IATSIC), 2025); [Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort](https://pmc.ncbi.nlm.nih.gov/articles/PMC11705660/) (World Journal of Emergency Surgery, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/the-trauma-patient-in-the-icu-the-primary-and-secondary-survey-from-the-nursing/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/the-trauma-patient-in-the-icu-the-primary-and-secondary-survey-from-the-nursing/