EC Chp 14 Secondary Assessment Flashcards
Secondary Assessment is done when?
After scene the size up and primary assessment
3 components of secondary assessment
- Physical examination - feel for injuries, listen breathing, look for swelling
- Patient history - past medical history and history of present illness (HPI)
- Vital signs - Pulse, respiration’s, blood pressure and pulse Ox, assess skin and pupils also.
A Sign
Something you can see regarding the patients condition
Symptom
Is something the patient tells you
Ex. Abdominal pain or difficulty breathing
Reassessment means
Procedure for detecting changes in patient condition which involves
4 steps:
- repeat primary assessment
- repeat and record vital signs
- physical exam
- Checking interventions
How to gain a rapport with patient
- get to same level as them
- demonstrate empathy
- listen carefully
Ask open ended questions.
S.A.M.P.L.E stand for?
Signs and Symptoms Allergies Medications Pertinent past medical history Last oral intake Events
Allergy questions
Are you allergic to medications or foods or do have environmental allergies?
Medication questions
What are you currently taking? Or should be taking
Are you on birth control?
Do you have a medical tag?
Do you take any herbal supplements or vitamins
O.P.Q.R.ST
Onset: Provocation: Quality: Region/Relief: Severity: Time:
Onset:
What were you doing when the pain began
Provocation:
Does anything seem to trigger the pain or anything to make it feel better?
Quality:
Can you describe the pain for me?
Region/Relief:
Where is the pain, will you please point to it? Does it seem to spread or shoot anywhere?
Severity:
How bad is the pain? If 0 were no pain and 10 being the worst pain, what number would you say yours is?
Time:
When did the pain start? Has it changed at all since it started
Physical Examination Techniques (3)
Observe(look): overall sense of his condition as well as evaluating chief complaint
Auscultate(listen): listening for signs of abnormal condition
Palpate (touch): feeling an area for deformities or other abnormal findings
The most important determination you can make when assessing the respiratory system is?
Whether the patient is breathing adequately
Orthopnea
Does the patient have difficulty. Breathing when lying down?
Respiratory Assessment - Physical Exam what do you do and look for?
- Mental Status
- Level of respiratory distress
- Observe Ches wall motion (significant expansion and equally)
- Auscultate lung sounds
- use Pulse Ox
- Observe Edema (in lungs and check ankles
- Fever does the patient have one
Cardiovascular Assessment - Physical exam, what do you do?
Effects the heart and the blood vessels
- Look for signs that the condition may be severe
- Obtain Pulse
- Obtain blood pressure
- note pulse pressure
- look for JVD
- Palpate chest
- observe posture and breathing
Neurological Assessment - Physical exam what do you do?
- Perform Stroke Test ( Speaking, Smile, Raise hands)
- Check Peripheral sensation (wiggle you fingers for me)
- Gently palpate spine
- Check Extremity strength ( can you squeeze your fingers?)
- Check pupils
Most common endocrine emergency?
A Diabetic patient
Endocrine Assessment - Physical Exam what do you do?
- Evaluate mental status
- Observe patients skin (cool and moist indication of hypoglycemia)
- Obtain blood glucose level (if allowed to do so)
- look for an insulin pump
GI Assessment - Physical exam, what do you do?
- Observe patients position (may take fetal or knees to chest for)
- Assess Abdomen (palpate each quadrant
- inspect other parts of the GI system as appropriate
- If there is vomitus or feces available. INSPECT IT. Note volume and color
Crepitation is what?
The grating sound of feeling of broken bones rubbing together.
If you patient were responsive what do you do next for your secondary assessment?
- Talk with the patient to obtain the history of his present illness OPQRST
- Then past history using AMPLE
- Followed by physical exam and base line vitals
If patient is unconscious you will do what?
- Do a rapid physical exam
- Then complete a set of baseline vitals
- Gather relevant info from any relatives or bystanders
Most important time to check the pupils is when?
When the patients eyes are closed
Rapid Physical exam:
Check entire body:
Neck - JVD
Chest - presence and quality
Abdomen - Distention, firmness or rigidity
Pelvis - incontinence of urine or feces
Extremities - pulse, motor function, sensation, O2 saturation, medical ID
Baseline Vital Signs include what?
- Pulse
- Respiration rate
- Skin
- Pupils
- blood pressure
- and note any abnormalities
How to determine how serious the patient is include the following:
The location of the injury or injuries The patients mental status The patients airway status Vital signs Mechanism of injury Patients age or presence of preexisting conditions.
DCAP - BTLS stand for?
And WTD
Deformities, Contusions, Abrasions, Punctures
Burns, Tenderness, Lacerations, and Swelling
Wounds, Tenderness, and Deformities
Rapid assessment of the head
Gently palpate the cranium for wounds, tenderness and deformities
- run gloved fingers through the patients hair
- Inspect and palpate face gently
- inspect and palpate ears for WTD and drainage of blood or other fluids
Tension Pneumothorax is?
Air trapped in the chest
Cardiac Tamponade is?
Blood filling with sac around the heart
Flat neck veins in a patient lying down may be a sign of what?
Blood loss, not enough to fill them
When the patient is sitting up and veins are bulging it could be a sign of what?
The heart is not pumping blood effectively as the blood is backing up in the veins
Priapism
Persistent erection of the penis that may result from spinal injury and some medical problems
several important principles when examining a patient? (5)
- Tell the patient what you are going to do
- Expose any injured area before examining it
- Try to maintain eye contact
- apply your spinal protocols
- during physical exam you may stop or alter assessment process to provide care that is necessary for the priority of the patient
Trauma patient who is not seriously injured
Focus on your assessment on just eh areas the patient tells you, plus those you suspect
This patient received all asserted while at the scene and does not generally need a detailed physical exam.
Pediatric Note: Mental status of an unresponsive child or infant can be checked by?
Shouting (verbal stimulus) Flicking feet (painful stimulus)
Crying would be an expected response from a child with an adequate mental status
Differential diagnosis
The list of potential diagnoses compiled early in the assessment of the patient
Emergency medicine approach to Diagnosis?
- Ruling out life threatening conditions
- Narrowing the range of possible diagnoses
- Instituting urgent treatment
Representativeness
When you encounter a patient with a certain group of signs and symptoms that resemble a particular condition, you assume the patient has that condition.
Availability:
The urge to think of things because they are more easily recalled often ve cause of a recent exposure
Overconfidence
Thinking you know more than you really do
Confirmation bias
When he primarily looks for evidence that supports the diagnosis he already has in mind. But may overlook evidence that refutes or reduce dies the probability of that one
Illusory correlation:
A one event may appear to cause another when in fact the two events are either coincidental or both caused by the same thing
Anchoring and adjustment
Considers a particular condition and his later thinking is anchored to that hypothesis
Search satisfying
Stop searching or assessing a faster you determine what causing the patients problem
How an EMT can learn to think like a physician
- learn to love ambiguity
- understand the limitations of tech and people
- realize that no one strategy works for everything
- form a strong foundation of knowledge
- organza the data in your head
- change the way you think
- learn from others
- reflect on what you’ve learned
