Chapter 15 | The Secondary Assessment

Question 1

List:

conditions which call for rapid trauma exam

4 points

Answer 1

• unresponsive or AMS
• significant MOI
• multiple injuries
• multiple body systems involved

Question 2

List:

conditions which call for focused trauma exam

3 points

Answer 2

• responsive (alert and oriented)
• no significant MOI
• single injury

Question 3

List:

conditions which call for rapid medical exam

2 points

Answer 3

• un-responsive or AMS
• unknown issues

Question 4

Fill in the blank:

Conduct a [BLANK] or [BLANK] if you do not know what is wrong with the patient.

Answer 4

rapid trauma exam or rapid medical exam

Question 5

List:

conditions which call for focused medical exam

2 points

Answer 5

• no significant distress
• responsive (CAOx4)

Question 6

List:

components of secondary assessment

3 points

Answer 6

• patient history
• physical exam
• vital signs

can be performed in any order or simultaneously in a team

Question 7

Define:

DCAP-BTLS

Answer 7

• deformities
• contusions
• abrasions
• punctures/penetrations
• burns
• tenderness
• lacerations
• swelling

Question 8

Define:

priaprism

Answer 8

persistent erection of the penis

Question 9

Describe:

significance of priaprism

Answer 9

persistent erection may stem from spinal injury or other medical problems

Question 10

Define:

paradoxical motion

(respiratory assessment)

Answer 10

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

Question 11

Define:

distention

Answer 11

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

Question 12

Answer:

You are assessing a patient who fell three stories. He is unresponsive and bleeding into his airway. The driver of the ambulance is positioning the vehicle and bringing equipment to you.

How do you balance the patient’s need for airway control (frequent suctioning) with your need to assess his injuries?

Answer 12

patient definitely requires immediate intervention

bleeding into the airway must be corrected before any further assessment can be completed

closed airway will doom all other care interventions to failure and the patient to death

continue suctioning until your partner returns to provide more help

notify ALS for backup or intercept while enroute

Question 13

Answer:

You arrive at a residence to find a patient who explains that he has accidentally cut his finger with a kitchen knife. The cut is bleeding profusely.

As an EMT, how would you balance the need for appropriate on-scene assessment and treatment with the need for speed in getting the patient to the hospital?

Answer 13

cut to a finger is not a significant MOI (despite profuse bleeding)

unless you are unable to control the bleeding with direct pressure and other normal methods, you can complete on-scene assessment and initiate care before transporting the patient

Question 14

Answer:

You arrive at a schoolyard to find a girl who bystanders say was shot by a rival gang member. She is lying in a pool of blood but is able to speak to you.

As an EMT, how would you balance the need for appropriate on-scene assessment and treatment with the need for speed in getting the patient to the hospital?

Answer 14

shooting is a significant MOI (significant blood loss has already taken place and caused unknown internal injuries to the patient)

assume that her airway and breathing are adequate because she can speak (at least for the moment)

immediately apply direct pressure to control the bleeding, administer oxygen by nonrebreather mask, and transport her expeditiously, providing ongoing monitoring and any needed additional care en route

contact ALS for intercept while enroute

Question 15

Answer:

You are called to respond to a man who has been found unconscious on a sidewalk next to an apartment building in the middle of the night. There were no witnesses to explain what may have happened to him.

As an EMT, how would you balance the need for appropriate on-scene assessment and treatment with the need for speed in getting the patient to the hospital?

Answer 15

no way to know the cause of patient’s condition

quickly ensure adequate ABCs, provide ventilation/oxygen (as needed), provide spinal motion restriction precautions (if protocol), and transport without spending additional time at the scene

monitor the patient’s condition en route

notify ALS for backup or intercept while enroute

Question 16

Answer:

A patient with a chest injury may have a lung collapse. Why are the breath sounds on the injured side typically decreased or absent when the chest cavity is filled with air?

The chest cavity filling with air typically transmits sound very well.

Answer 16

air cannot move through these structures if lung collapses

Question 17

Define:

pneumothorax

Answer 17

lung collapse in the chest cavity

Question 18

Fill in the blank:

For a patient without a significant MOI, collect the [BLANK] and conduct a [BLANK] focused on areas that the patient complains about and areas that you think may be injured.

Answer 18

collect the patient history and conduct a physical exam focused on areas that the patient complains about and areas that you think may be injured.

Question 19

Fill in the blank:

For the patient with a significant MOI, provide [BLANK], consider whether to [BLANK], collect a [BLANK], and perform a [BLANK].

Answer 19

For the patient with a significant MOI, provide spinal precautions, consider whether to call ALS backup, collect a brief patient history, and perform a rapid trauma assessment.

Question 20

Fill in the blank:

In a rapid trauma assessment, you should primarily look for [BLANK], [BLANK], and [BLANK] on the patient.

Answer 20

you should primarily look for wounds, tenderness, and deformities on the patient.

Question 21

Fill in the blank:

The detailed physical exam is very similar to the rapid trauma assessment, except that [BLANK].

Answer 21

except that there is time to be more thorough in the assessment.

Question 22

Answer:

Should you conduct the detailed physical exam before transport?

Answer 22

no (unless transport is delayed)

Question 23

Answer:

Should rapid trauma assessment be performed on all patients regardless of mechanism of injury?

Answer 23

a rapid trauma assessment is performed on patients with a severe MOI or other high-priority trauma patients (threat to ABCs or change in mental status) based on primary assessment.

Question 24

Fill in the blank:

DCAP-BTLS is used to [BLANK].

Answer 24

DCAP-BTLS is used to conduct a rapid trauma assessment.

Question 25

Define:

PMS

(acronym)

Answer 25

• pulse presence
• motor abilities
• sensory perception

(used to check if limb is working alright)

Question 26

Define:

PMS is used for [BLANK].

Answer 26

PMS is used for checking limbs during rapid/focused trauma assessment.

Question 27

Define:

flail segment

Answer 27

portion of chest that moves inward while the rest of the chest wall moves outward

Question 28

Explain:

how and why the secondary assessment for a medical patient differs from the secondary assessment for a trauma patient

Answer 28

why: in medical patients (unlike trauma patients), there are not many external sources of information about what is wrong with the patient

how: for medical emergencies, the most important source of information about the problem is usually what the patient can tell you

Question 29

Explain:

how and why the secondary assessment for a responsive medical patient differs from the secondary assessment for an unresponsive medical patient

Answer 29

for the responsive medical patient: the first step of your secondary assessment is talking with the patient to obtain the history of his present illness and the past medical history, followed by performing the physical exam and gathering the vital signs

in the unresponsive medical patient: because you cannot obtain a history from the patient, you will begin with a rapid physical assessment and collection of baseline vital signs… then gather as much of the patient’s history as you can from any bystanders or family members who may be present

process for unresponsive medical patient is basically flipped around

Question 30

Answer:

What questions would you ask to get a history of the present illness (HPI) from a patient with a chief complaint of chest pain?

Answer 30

• onset: What were you doing when the pain started?
• provocation: Can you think of anything that might have triggered this pain?
• quality: Can you describe the pain for me?
• radiation: Where exactly is the pain? Does it seem to spread anywhere, or does it stay right here?
• severity: How bad is the pain?
• time: When did the pain start? Has it changed at all since it started?

Question 31

List (in order):

steps after primary assessment of responsive medical patient

4 points

Answer 31

1. gather chief complaint and the HPI using OPQRST
2. gather a PMH using SAMPLE
3. conduct physical exam (focusing on the area the patient complains about and the related body systems)
4. obtain baseline vital signs