Chapter 15 - Secondary Assessment

Medical Patient

Patient with one or more medical conditions or diseases

Trauma Patient

Patient suffering from one or more physical injuries

Unknown patient

Patient with a problem of an undetermined nature

Sign

Something regarding the patients condition that can be seen

Symptom

Something regarding the patients condition that the patient tells you

Reassessment

Procedure for detecting changes in patient’s condition

Rapid Trauma Assessment

Assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of body to detect s/s of injuries

Tracheostomy

Surgical incision into the trachea held open by a metal or plastic tube

Paradoxical Chest Movement

Part of the chest moves in opposite direction to rest of chest during respiration

Distention

Condition of being stretched, inflated, or larger than normal

Priapism

Persistent erection of the penis that may result from spinal injuries and some medical injuries

Special areas to consider in pediatric traumas

Head injuries (check for protrusion of fontanelles), Nose/Ears (ANY leaking fluid may indicate skull fractures), Neck (due to incomplete neck bones they can have spinal cord damages with minimal spinal injuries), Chest (ribs many not break but organs may still be damaged), Abdomen (Organs are more susceptible to trauma)

Detailed Physical Exam

Assessment of head, neck, chest, abdomen, pelvis, extremities, and posterior of body to detect S/S of injury. Also, includes examination of face, ears, eyes, nose, and mouth.

First step in assessing an unresponsive medical patient

Conduct a rapid physical assessment

Things to consider when gather HPI for a trauma pt

Nature of force(s) involved, equipment (or lack thereof) that was used to protect pt, Direction + strength of forces involved, areas of pain or injuries resulting from incident, actions taken to prevent or minimize injuries

Deformities

Parts of the body that no longer have their normal shape

Contusions

Medical term for bruises

Abrasions

Superficial injuries to the skin caused by rubbing or scraping, often resulting in pain and bleeding

Punctures/Penetrations

Holes in the body

Tenderness

A medical term indicating pain or discomfort when pressure is applied to a specific area of the body

Lacerations

Cuts or tears in the skin, often caused by sharp objects, which can result in significant bleeding and possible damage to underlying tissues.

Swelling

The enlargement of a body part due to an accumulation of fluid, inflammation, or injury

Edema

A medical term that refers to swelling

Rapid trauma assessment

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

Severe fall for adults is…

> 20 ft

Severe fall for children < 15 years old is…

> 10 ft / 2-3x child’s height

Auto crash is considered high risk when there is __ intrusion

>12 inches (30cm) to occupant site or >18 (46cm) inches to any site

Auto crash is considered high risk when there is (PARTIAL/COMPLETE/NO) ejection

PARTIAL/COMPLETE

Auto vs Pedestrian accidents are considered severe if…

Person was run over, thrown, or with impact > 20mph/32 kph

Seat belts can cause injury (TRUE/FALSE)

TRUE

Pneumothorax

Air trapped in chest

Cardiac Tamponade

Blood filling the sac around the heart

with flail chest, the section of the broken ribs ___ when breathing

Move oppositely

Children are vulnerable to head, neck, and spinal cord injuries due to…

Proportionally larger/heavier head and less developed neck muscles and bone structures

How the detailed physical assessment differs from the rapid trauma assessment

It includes face, ears, nose, and mouth during examination

A​ 40-year-old male has cut his finger in an industrial accident. You perform the scene​ size-up, conduct a primary​ assessment, and determine his chief complaint. The next step should be:

Preform a focused, on scene examination

A​ 25-year-old female had a minor fall from her motorcycle while stopped in traffic. She did not lose​ consciousness, and the accident was simply the result of a loss of balance with the motorcycle. Which of the following systems would be most important to assess first during the secondary​ assessment?

Musculoskeletal

For which of the following patients should you request ALS​ response?

A​ 14-year-old girl who is unresponsive after a Jet Ski accident

The patient is a​ 68-year-old female who has sustained multiple lacerations and​ blunt-force trauma in a car collision. Which of the following actions is recommended before making a decision to call for​ ALS?

Rapidly determine how the patient was injured

A​ 14-year-old female is complaining of knee pain after a fall on the playground. Witnesses state that she had no unconsciousness and stood immediately after falling. She is now alert and complaining of no other pain or injury. After completing a primary​ assessment, the next step should be…

Assess the patient’s knee and leg

The patient fell from the roof of a house. What action should be taken before assessing the​ ABCs?

Manually stabilize the head and neck

Which of the following statements is false of the rapid trauma​ assessment?

Limit the rapid trauma response to a visual inspection only

Which of the following patients has a significant mechanism of injury and would therefore be considered​ unstable?

Pedestrian hit by automobile