Chp 14 Performing a Secondary Assessment Rapid and Focused

Question 1

BP-DOC

Answer 1

an assessment mnemomic, or memory aid, used primarily for the trauma patient. The letters stand for bleeding, pain, deformity, open wounds, and crepitus

Question 2

Medical Assessment

Answer 2

the examination of someone with an illness.

Question 3

Reassessment

Answer 3

the component of the patient assessment that is repeated at regular intervals and designed to monitor the status of the ABCs, vital signs, mental status, and effectiveness of interventions

Question 4

Chief Complaint

Answer 4

the patient’s complaint in their own words.

Question 5

Multisystem Trauma

Answer 5

the damage to multiple organ systems within the body caused by a mechanism of injury.

Question 6

Referred Pain

Answer 6

pain that is perceived at a site other than that of the painful stimulus.

Question 7

Crepitus

Answer 7

the grating, crackling, or popping sounds and sensations that can be heard and felt beneath the skin.

Question 8

National Trauma Triage Protocol

Answer 8

a systematic approach for assessing and categorizing trauma patients developed by the CDC. It is used to determine whether or not the patient should be transported directly to a trauma center. Abnormal altered mental status (GCS<14); Significcant chest or abdominal pain or discomfort; Significant MOIm including physiological and anatomical considerations; uncontrolled bleeding; Moderate to severe breathing difficulty; abnormal vital signs

Question 9

Secondary Assessment

Answer 9

the component of the patient assessment that includes the physical examination and medical history of the patient

Question 10

Distention

Answer 10

the state of being stretched beyond normal dimensions

Question 11

Nonsignificant Mechanism of Injury

Answer 11

an injury with a very low likelihood of involving multiple organ systems

Question 12

Significant Mechanism of Injury

Answer 12

a type of mechanism of injury that has a strong likelihood for multiple organ system injury.

Question 13

Focused Secondary Assessment

Answer 13

the part of the secondary assessment that is performed on stable medical and trauma patients

Question 14

Paradoxical Movement

Answer 14

a sign found on the chest wall where a flail segment of the chest moves in a direction opposite from the rest of the chest during inspiration and expirations

Question 15

Stable

Answer 15

a term used to describe a patient who is not likely to get worse in the immediate future

Question 16

Guarding

Answer 16

the act of contracting the abdominal muscles in response to pain

Question 17

Pertinent Past Medical History

Answer 17

a patient’s past illnesses and medical problems that pertain to the current event

Question 18

Stoma

Answer 18

a surgical opening at the anterior of the neck

Question 19

Interventions

Answer 19

anything that the EMT does to comfort or provide care for the patient

Question 20

Rapid Secondary Assessment

Answer 20

the part of the secondary assessment that is performed on unstable patients and on patients who have sustained a significant mechanism of injury.

Question 21

Subcutaneous emphysema

Answer 21

air that has become trapped beneath the skin; characterized by crepitus

Question 22

Jugular Vein Distention (JVD)

Answer 22

an abnormal bulging of the neck veins commonly caused by a compromise of the circulatory system.

Question 23

Trauma Assessment

Answer 23

the part of the secondary assessment that is performed on a patient who has an injury.

Question 24

Mechanism of Injury

Answer 24

the event or mechanism that caused the injury.

Question 25

Unstable

Answer 25

a term used to describe a patient who has a high likelihood of getting worse in the immediate future.

Question 26

14-.2 Explain the importance of developing a systematic approach to patient assessment.

Answer 26

a. Essential to ensuring that all of the steps of the assessment will be addressed and in the correct order. Developing a consistent approach and routine also will minimize wasted time and allow you to begin providing the appropriate care sooner.

Question 27

14-.3 Describe the four main components of the patient assessment

Answer 27

a. Scene Size-up b. Primary Assessment c. Secondary Assessment d. Reassessment

Question 28

14-.4 Differentiate the medical patient from a trauma patient

Answer 28

a. Patients whose Chief Complaint is related to an illness such as difficulty breathing, chest pain or headache are categorized as medical patients. b. Patients whose Chief Complaint is related to an injury are categorized as trauma patients.

Question 29

14-.5 State the purpose of the secondary assessment

Answer 29

a. To perform a more detailed physical assessment and history of the patient i. Whether the patient’s overall condition is stable, unstable, or potentially unstable ii. If the patient has a medical complaint iii. If the patient has a traumatic injury

Question 30

14-.6 Differentiate the common signs of a stable patient, unstable patient, and patient who is at risk for becoming unstable

Answer 30

a. Stable Patient Signs and Symptoms i. Alert and Oriented ii. No major complaint of chest or abdominal pain iii. Absence of recent trauma iv. No uncontrolled bleeding or recent blood loss v. Normal breathing characteristics vi. Vital signs that are within normal limits b. Unstable Patient Signs and Symptoms i. Abnormal altered mental status (GCS <14) ii. Significant chest or abdominal pain or discomfort iii. Significant mechanism of injury, including physiological and anatomical considerations (Not all patients with a significant MOI will turn out to be unstable, but the ultimate determination is best made at the hospital after advanced evaluation.) iv. Uncontrolled bleeding (seen or unseen) v. Moderate to severe breathing difficulty vi. Abnormal vital signs c. Patient at risk for becoming unstable i. Unexplained changes in vital signs ii. Unexplained changes in mental status iii. Patients who develop new (additional) complaints

Question 31

14-.7 Differentiate anatomical and systems approaches to patient assessment and state when each is used

Answer 31

a. Anatomical Approach – i. Head to toe direction ii. Addresses each area or region in a systemic fashion iii. Standard used on the Trauma patient as well as physicians in the ER b. Body System Approach – i. Used commonly on medical patients ii. Focuses on the specific body systems related to the chief complaint 1. Can be used on trauma as well (chest pain can be medical or from trauma) Insert Table 14-1 and 14-2 page 381 here

Question 32

14-.8 Differentiate a rapid secondary assessment from a focused secondary assessment and state when each might be used. The focused secondary assessment is much more detailed than the rapid secondary assessment, and includes a thorough medical history.

Answer 32

a. Rapid secondary assessment – used for unstable patients whether medical or trauma. Thought the path is the same for both the specific signs and symptoms you will be looking for differ slightly. b. Focused Secondary Assessment is used mostly on stable patients whether medical or trauma. It is designed to focus on the chief complaint or injury

Question 33

14-.9 Describe the steps for conducting Rapid secondary assessment for a medical patient.

Answer 33

a. Areas examined are the head, neck, chest, abdomen, pelvis, back and extremities. If caring for a medical patient and cannot rule out injury to the head, neck, or spine you must use spinal precautions. Proceed in a head to toe direction. When you discover something life-threatening, stop and treat it. Follow Table 14-3 Insert flow cart figure 14-4 page 382 here Insert Table 14-3 page 384 here

Question 34

14-.10 Describe the steps for conducting a focused secondary assessment for a medical patient

Answer 34

a. Flow chart is i. Medical Patient ii. Re-evaluate mental status iii. Stable iv. Obtain history of chief complaint and SAMPLE history v. Perform a focused assessment based on the patient’s chief complaint vi. Obtain baseline vital signs

Question 35

14-.11 Discuss obtaining a history during the secondary assessment, including use of the SAMPLE and OPQRST mnemonics.

Answer 35

a. Detailed medical history i. S – Signs and Symptoms ii. A – Allergies iii. M – Medications iv. P – Pertinent Past Medical History v. L – Last oral intake vi. E – Events leading to the injury or illness b. Questions about pain, discomfort or difficulty breathing i. O – Onset. What were you doing when the pain or symptom began? ii. P – Provocation. Does anything you do make the pain better or worse? Or does it hurt to take a deep breath or when I push here? iii. Q – Quality. Can you describe how the pain feels?, Is it sharp or dull? And Is it steady or does it come and go? Be careful not to put words in patient’s mouth and use their words when documenting the call or handing the patient to the next level of care. iv. R – Region/radiation “Can you point to your worst pain?” or “Does your pain move or radiate to another part of your body?” and “Do you feel pain anywhere else?” v. S – Severity. A standard 1-10 scale is typically used vi. T – Time. You will want to know how long the patient has been experiencing pain or discomfort

Question 36

14-.12 Differentiate significant from nonsignificant MOIs.

Answer 36

a. Significant MOI i. Multisystem trauma ii. Suspected injury to the skull, chest, abdomen, or pelvis’ iii. Also those in the National Trauma Triage Protocol b. Nonsignificant MOI i. Injuries to the arms and legs are almost always categorized as nonsignificant with the exception to both upper arms and both upper legs (thighs) at the same time.

Question 37

14-.13 Describe the steps for conducting a rapid secondary assessment for a trauma patient

Answer 37

a. BP-DOC mnemonic i. B – Bleeding ii. P – Pain ask if any and look for signs during palpating the body iii. D – Deformities a deformity is a deviation from the normal shape or size of the body part. They are typically caused by broken bones, or soft-tissue swelling. You must inspect and palpate all areas of the body, looking for signs of deformities. iv. O – Open wounds. Inspect the body carefully for any sign of an open wound such as punctures, lacerations, avulsions, eviscerations, burns, and so on. An open wound can be a sign of both external and internal soft-tissue and organ damage. Control all uncontrolled bleeding and cover open wounds to minimize the possibility of contamination. v. C – Crepitus is grating, crackling or popping sounds and sensations that can be heard and felt beneath the skin. It is common with broken bones rubbing together and the sounds of air trapped beneath the skin. Those sounds and sensations become especially important during the assessment of the un responsive patient because they can reveal a serious condition, even when the patient is unable to respond. b. Glascow Coma Scale i. Eye Opening 1. 4 – Spontaneous 2. 3 – To Verbal Command 3. 2 – To Pain 4. 1 – No response ii. Verbal Response 1. 5 – Oriented and converses 2. 4 – Disoriented and converses 3. 3 – Inappropriate words 4. 2 – Incomprehensible sounds 5. 1 – No Response iii. Motor Response 1. 6 – Obeys verbal commands 2. 5 – Localizes pain 3. 4 – Withdraws from pain (flexion) 4. 3 – Abnormal flexion in response to pain 5. 2 – Extension in response to pain (decerebrate rigidity) 6. 1 – No Response c. Rapid head to toe physical examination of the patient looking for obvious signs of injury. Insert Table 14-4 page 395

Question 38

14-.14 Describe the steps for conducting a focused secondary assessment for a trauma patient.

Answer 38

a. Use specific components of the secondary assessment that relate to the patient’s chief complaint. b. Obtain baseline vitals c. Gather as much SAMPLE history as possible d. Reassess vitals every 15 minutes for stable, noncritical patient Insert Table 14-5 page 399 here

Question 39

14-.15 State the purpose of reassessment and when it should be performed

Answer 39

a. A continuous rechecking of the patient’s condition to ensure that everything checked previously is still within normal limits. 15 minutes.

Question 40

14-.16 List the elements of a reassessment

Answer 40

a. Repeat the primary assessment b. Recheck vital signs and compare them to the baseline vital signs for trending purposes. c. Repeat assessment of chief complaint or injuries and determine if any new complaints have developed d. Check the effectiveness of your interventions e. Confirm the patient’s status and transport priority.