Secondary Assessment (Ch. 15)

Sign vs Symptom

Sign is something you can see

Symptom is something the patient tells you about

General Steps for: Secondary Assessment for Responsive Medical Patients

1. Obtain patient history

2. Body System specific Physical Exam

3. Baseline Vital Signs

General Steps for: Secondary Assessment for Unresponsive Medical Patients

1. Rapid Physical Exam (entire body)

2. Baseline Vital Signs

3. Consider requesting ALS

4. Obtain Patient History

Rapid Physical Exam. Who is it done on? What do you look for in each part of the body?

Neck: JVD, Med ID devices

Chest: Presence and Equality of breaths

Abdomen: Distention, firmness, or rigidity

Pelvis: Incontinence of urine or feces

Extremities: Pulse, motor function, sensation, oxygen saturation, Med ID devices.

General Steps for: Secondary Assessment for Low Priority Trauma Patients

1. Patient History

2. Physical Exam

3. Baseline Vital Signs

DCAP-BTLS

What is it meant for?

Distention

Contusions

Abrasions

Punctures and Penetrations

Burns

Tenderness

Lacerations

Swelling

It is meant as a general guide, you should not recite this for every body part.

SMR

When should the collar be put on?

What does size depend on? What does it need to fit in between?

What are necessary things to do before and after applying collar?

The collar should only be put on after life-threatening problems have been cared for.

Size depends on the length of the neck more so than the width. Length should fit between chin and suprasternal notch

Before: Inspect neck fully, remove necklaces, large earrings, and keep hair out of way.

After: Maintain manual stabilization if possible.

Suprasternal Notch

The U shaped dip where the clavicle and sternum meet

General Steps for: Secondary Assessment for High Priority Trauma Patients

1. Continue SMR

2. Consider Requesting ALS

3. Perform Rapid Trauma Assessment

4. Obtain Baseline Vitals

Does the Rapid Trauma Assessment cover the whole body or just the area of suspected injury?

It covers the whole body.

The reason I include this as a flashcard is that I split the later flashcards for Rapid Trauma Assessment with specific body parts.

Rapid Trauma Assessment - Head

As for all body systems, check for wounds, tenderness, and deformities

1. Check head for crepitation

2. Check ears, eyes, and nose for blood or clear fluids.

3. Check eyes for discoloration, unequal pupils, and foreign bodies.

4. Mouth look for teeth or any other objects which could obstruct the airways or do damage, remove objects if found. Look for unusual odors or coloring.

5. Check for blood under hair (if supine start from neck and go upwards)

6. Look for bruises on back of ears.

What are bruises on the back of ears called and what do they tell us?

They’re called Battle’s Sign

They are an indicator of skull fracture.

What should be done to eyes, nose, or ears leaking fluid?

Should be kept clean to prevent contamination of brain.

Rapid Trauma Assessment - Neck

As for all body systems, check for wounds, tenderness, and deformities

1. Crepitation

2. JVD if sitting up or lying flat if the patient is flat or head is declined.

3. Stoma or Tracheostomy

4. Med ID Device

In what cases are the jugular veins abnormal and what do they tell us?

JVD (while sitting up) is a sign that blood is backing up n the veins, which means the heart isn’t pumping properly. This can be caused by:

1. Tension Pneumothorax. Air trapped in the chest.

2. Cardiac Tamponade. Which is blood filling in the sacs around the heart.

If it’s flat while the patient is lying or head down then this is a sign of blood loss.

Rapid Trauma Assessment - Chest

As for all body systems, check for wounds, tenderness, and deformities.

1. Crepitation

2. Paradoxical Motion

3. Auscultate chest.

What is paradoxical motion a sign of

Multiple ribs fractured on two sides.

What is crackling or crunching sensations or sounds a sign of

Subcutaneous Emphysema which is a sign that air has escaped it’s normal passageways

What is unequal lung sounds a sign of

A collapsed lung (pneumothorax)

Rapid Trauma Assessment - Abdomen

How should you palpate the abdomen?

As for all body systems, look for wounds, tenderness, and deformities.

1. Look for unusual firmness or softness (done while palpating)

2. Look for distention (belly looks 8-9 months pregnant)

3. Look out for colostomy or ileostomy

4. Check for tenderness (done also while palpating)

Palpate each abdominal region ending with the one with pain. Press about one inch with the palm side of your fingers. Then suddenly let go.

What is abdominal distention a sign of? What is abdominal firmness a sign of?

Distention can be from internal bleeding.

Firmness can be from internal bleeding or internal organ damage (or both).

What does it mean if you feel a pulsating mass while palpating the abdomen?

This can be from an enlarged aorta. You should avoid pressing as this could cause further damage.

Rapid Trauma Assessment - Pelvis

As for all body systems, look for wounds, tenderness, or deformities.

• Especially look for bleeding or priapism

Conscious patients:

1. Gently palpate, stopping as soon as patient identifies pain.

Unconscious patients:

1. Palpate for tenderness or motion of bones. Stopping when either have been identified.

Existence of pain (and obv movement of bones) is enough reason to treat pelvic injury, so you should not palpate any further once pain is identified

What is priapism?

Priapism is a persistent erection of the penis.

In our case this is the result of a spinal cord injury.

Rapid Trauma Assessment - Extremities

As for all body systems, look for wounds, tenderness, and deformities.

Patients with injury to extremities are at high priority for transport.

1. Sensation

2. Motor Function

3. Circulation

Who is a detailed physical exam performed on?

What is the point?

Typically performed on severe trauma patients

Sometimes performed on less severe trauma patients

Rarely performed on medical patients

The point is to identify non-life threatening injuries.

When is the detailed physical exam performed for severe trauma patients?

What does a detailed physical exam involve on severe trauma patients

1. Done only after redoing the primary assessment

2. Only perform the exam en route or while waiting for ambulance

This is also a good time to splint needed injuries and alert the hospital

The detailed physical exam is a lot like the rapid trauma assessment but done usually done en route and while having to work around treatments you gave to the patient.

What does a detailed physical exam involve on not seriously injured trauma pateints.

Only look at places of suspected injury.

What are the five components of establishing a good rapport with the patient?

1. Introduce yourself and your role on the team.

2. Ask patient if it’s okay for you to ask some questions

3. Ask the patient their name and use it frequently

4. Ask patient how old they are

5. Ask patient what made them call you.