Chapter 14: The Secondary Assessment

Question 1

Secondary Assessment

Answer 1

• where you find out what is wrong with the pt
• a series of examinations, both hands on and through pt history
• performed after the scene size-up and the primary assessment

Question 2

Medical pt

Answer 2

a pt w/ one or more medical diseases or conditions

Question 3

Trauma pt

Answer 3

a pt suffering from one or more physical injuries

Question 4

Components of the secondary assessment

Answer 4

physical examination, patient history, vital signs

Question 5

Physical examination of the S.A.

Answer 5

• use your sense to exam the pt

- you may feel for injuries, listen for abnormal breathing sounds, and look for swelling

Question 6

Patient history of the S.A.

Answer 6

• obtained by asking important questions that will provide you with vital info about your pt’s current condition or complaint
• you find out history of the present illness (HPI) and the past medical history (PMH)

Question 7

History of the Present Illness (HPI)

Answer 7

info gathered regarding the symptoms and nature of the pt’s current concern

Question 8

Past Medical History (PMH)

Answer 8

info. gathered regarding the pt’s health problems in the past

Question 9

Vital signs of the S.A.

Answer 9

• you will take vital signs such as pulse, respirations, blood pressure, and pulse ox.
• assess the skin and pupils

Question 10

When to perform components of the S.A. in medical pts

Answer 10

• history first b/c history provides the most relevant info.

- then perform physical exam based on what you find in the history

Question 11

When to perform components of the S.A. in trauma pts

Answer 11

• perform the hands on exam first–it provides the most info (you can ask initially if the pt hurts anywhere)
• in some pts you will do a head to toe exam, in others with minor injuries, you might just palpate one area

Question 12

When to perform components of the S.A. in unresponsive pts

Answer 12

• get info from family and bystanders when you can

- physical exam will also be a primary source of info

Question 13

sign

Answer 13

something regarding the pt’s conditions that YOU can see

Question 14

symptom

Answer 14

something regarding the pt’s condition that the PT tells you

Question 15

When to perform components of the S.A. in seriously ill or injured pts

Answer 15

• a serious trauma pt will get a primary assessment and a very quick secondary assessment to check for major injuries before transport.
• same goes for medical pts; they must be transport promptly to the hospital for lifesaving interventions

Question 16

Reassessment

Answer 16

• a procedure for detecting changes in a pt’s condition
• involves 4 steps:
  1. repeating the primary assessment
  2. repeating and recording vital signs
  3. repeating the physical exa,
  4. checking interventions

Question 17

Open-ended question

Answer 17

a question requiring more than just a yes or no

Question 18

closed-ended question

Answer 18

a question requiring only a yes or no answer

Question 19

SAMPLE

Answer 19

• a memory aid in which the letters stand for elements of the past medical history

Question 20

S in SAMPLE

Answer 20

• S = signs and symptoms

- What is wrong?

Question 21

A in SAMPLE

Answer 21

• A = allergies

- Are you allergic to medications or foods, or do you have environmental allergies?

Question 22

M in SAMPLE

Answer 22

• M = medications

- What meds are you currently taking or are you supposed to be taking?

Question 23

P in SAMPLE

Answer 23

P = pertinent past history
Have you been having any medical problems?
Have you had any recent surgeries or injuries?
Have you been seeing a doctor?

Question 24

L in SAMPLE

Answer 24

L = last oral intake
When did you last eat or drink?
What did you eat or drink?

Question 25

E in SAMPLE

Answer 25

E = events leading to the injury or illness | what sequence of events led up to today's problem?

Question 26

OPQRST

Answer 26

a memory aid in which the letters stand for questions asked to get a description of the present illness

Question 27

O in OPQRST

Answer 27

Onset | What were you doing when the pain began?

Question 28

P in OPQRST

Answer 28

Provocation | Does anything seem to trigger the pain? Does anything make it feel better?

Question 29

Q in OPQRST

Answer 29

Quality | Can you describe the pain?

Question 30

R in OPQRST

Answer 30

Region, relief | Where is the pain? Will you please point toward it? Does it seem to shoot or spread anywhere?

Question 31

S in OPQRST

Answer 31

Severity | How bad is the pain on a scale of 1-10 with 10 being the worst pain you've ever felt.

Question 32

T in OPQRST

Answer 32

Time | When did the pain start? Has it changed at all since it started?

Question 33

Physical Exam Techniques

Answer 33

Observe, auscultate, palpate

Question 34

Observation

Answer 34

looking at the pt for an overall sense of his condition as well as evaluating their chief complaint

Question 35

Auscultation

Answer 35

listening for abnormal signs of an abnormal condition; mostly done with a stethoscope

Question 36

Body systems exam: respiratory

Answer 36

- work of breathing and position - pedal and sacral edema - lung sounds - pulse ox - respiratory specific history - dyspnea on exertion - orthopnea - weight gain

Question 37

Body systems exam: cardiovascular

Answer 37

- check pulse (presence/rate/regularity) - skin color/temp/condition - blood pressure - orthostatic blood pressure changes - JVD - many components of the respiratory exam also applies to the cardiovascular exam

Question 38

Body systems exam: neurologic

Answer 38

- cincinnati prehospital scale (or other approved scale) - pupils (equality, size, reactivity) - monitoring mental status changes over time

Question 39

Body systems exam: endocrine

Answer 39

- blood glucose monitoring - skin (color/temp/condition) - breath odors - excessive hunger, thirst, or urination - pupils - monitoring mental status changes over time - diabetic specific history - oral intake - medication history/use - recent illness

Question 40

Body systems exam: GI/GU

Answer 40

- palpation of abdominal quadrants - GI/GU specific history - input/output amount and frequency - question or observe for bright red or digested blood in vomit, stool, or urine - menstrual history and pregnancy where appropriate

Question 41

Jugular vein distention (JVD)

Answer 41

bulging of the neck veins

Question 42

crepitation

Answer 42

the grating sound or feeling of broken bones rubbing together

Question 43

rapid trauma assessment

Answer 43

a rapid assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect signs and symptoms of injury

Question 44

stoma

Answer 44

a permanent surgical opening in the neck through which the pt breathes

Question 45

tracheostomy

Answer 45

a surgical incision help open by a metal or plastic tibe

Question 46

paradoxical

Answer 46

movement of a part of the chest in the opposite direction to the rest of the chest during respiration

Question 47

distention

Answer 47

a condition of being stretched, inflated, or larger than normal

Question 48

priapism

Answer 48

persistent erection of the penis that may result from spinal injury and some medical problems

Question 49

detailed physical exam

Answer 49

- an assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect signs and symptoms of injury - it differs from the rapid trauma assessment only in that it also includes examination of the face, ears, eyes, nose, and mouth during the examination of the head

Question 50

trending

Answer 50

changes in a pt's condition over time, such as slowing respirations or rising pulse rate, that may show improvement

Question 51

diagnosis

Answer 51

a description or label for a pt's condition that assists a clinician in further evaluation and treatment

Question 52

differential diagnosis

Answer 52

a list of potential diagnoses compiled early in the assessment of the pt

Question 53

How an EMT can learn to think like an experienced physician

Answer 53

- learn to love ambiguity - understand the limitations of technology and people - realize that no one strategy works for everything - form a strong foundation of knowledge - organize the date in your head - change the way you think - learn from others - reflect on what you have learned