Ch. 15 study guide, The secondary assessment
the focused physical exam
- No significant MOI - patient alert and oriented - specific complaint
physical examination
- areas assessed depend on injuries and chief complaint - mechanism of injury may point to potential injuries
genitals
- as needed based on situation and injury - also check for priapism
pediatric trauma exam: extremities
- capillary refill and distal pulse - check for painful, swollen, and deformed injury sites
pediatric trauma exam: chest
- check for even breath sounds - check for symmetry, bruising, paradoxical movement, and retraction
Head
- check head - check face - check neck: step off, JVD, tracheal deviation
when you reach the distal portion of each extremity check:
- circulation - sensation - motor function - PMS
pelvis
- compression - flexion
DCAP-BTLS
- deformities - Contusions - Abrasions - Puncture/Penetration - burns -tenderness - Lacerations - Swelling
pediatric trauma exam: head
- do not apply pressure to fontanelles - collisions can produce head injuries
obtain baseline vital signs
- essential to assessment of medical patient - later assessments of vital signs twill be compared to baseline
performing detailed physical exam
- expose patient - work around immobilization - components similar to rapid trauma exam - more detail and focus
Primary assessment
- general impression - level of consciousness - chief complaint - ABCs - patient priority - transport if high priority
pediatric note
- get on same level as child - put questions in simple language - gather information from caregivers
responsive medical patient steps
- history of present illness (HPI) - past medical history (PMH) - focused physical exam - baseline vital signs
general principles
- in all areas look for DCAP-BTLS or other abnormal findings - communicate with patient - assume spinal injury - stop or alter assessment process to provide care
unresponsive medical pateint
- inability to communicate, shifts initial focus from chief complaint and history taking - begin with physical exam and baseline vital signs - gather history from bystanders or family members - do rapid assessment of entire body
the assessment process
- scene size up - primary assessment - secondary assessment - reassessment
pediatric trauma exam: airway
- keep infants head in neutral position - keep child's head in neutral-plus or sniffing position
check the back
- log roll maintain c-spine - use at least 3 people if possible - check the patient's back and spine
pediatric trauma exam: nose and ears
- look for blood and clear fluids - mucus or blood clot obstruction can disrupt breathing
additional HPI questions for trauma pateints
- nature of force involved - direction and strength of force - protective equipment used by patient - actions taken to prevent or minimize injury - areas of pain and injuries resulting from incident
important physical findings
- neck: JVD, medical identification devices - Chest: breath sounds - Abdomen: distension, firmness or rigidity - Pelvis: incontinence or urine or feces - Extremities: pulse, motor function, sensation, oxygen saturation, medical identification devices
secondary assessment: focused trauma
- no significant MOI - responsive - single injury - alert and oriented
secondary assessment: focused medical exam
- no significant distress - responsive - alert and oriented
pediatric trauma exam: abdomen
- note rigid or tender areas and distension - injury that impedes movement of diaphragm can compromise breathing
OPQRST
- onset - provocation - quality - radiation - severity - time
assessing the abdomen
- palpate all four quadrants - distension - rigidity - tenderness
components of secondary assessment
- patient history - physical exam - vital signs
pediatric trauma exam: neck
- proportionately larger heads increase chance of spinal cord injury - can have spinal cord injury without spinal bone fractures
Scene size up
- scene safety - BSI - MOI/NOI - # of patients - additional resources - c-spine consideration
the rapid trauma head-to-toe exam is used for:
- significant MOI - unresponsive, AMS - multiple injuries - multiple body systems
SAMPLE
- signs and symptoms - Allergies - Medications - Past pertinent medical history - Last oral intake - Events leading up to
rapid physical exam
- similar to physical exam for trauma - assess head, neck, chest, abdomen, pelvis, extremities, and posterior - consider ALS backup
chest (upper torso)
- start at clavicle - check sternum - apply c-collar - complete sternum - check high and wet - check for paradoxical motion - crepitation
detailed physical exam
- typically completed en route to hospital - gathers additional information - complements primary and secondary assessments - performed after all critical interventions completed - primary assessment re-evaluated again before initiating
secondary assessment: rapid trauma exam
- un-responsive or AMS - significant MOI - multiple injuries - multiple body systems involved
secondary assessment: rapid medical exam
- un-responsive or AMS - unknown issue(s)
focused exam
- usually brief - examine areas of concern based on chief complaint
question bystanders
- what is patient's name? - What happened? - Did you see anything? - did patient complain before this happened? - does patient have any illnesses or problems? - is patient taking medications?
apply cervical collar
assume spinal injury on all trauma patients
extremities
check each extremity for DCAP-BTLS
pediatric trauma exam: pelvis
check stability of pelvic girdle
physical examination: palpation
feel for: - abnormalities in shape - temperature - texture - sensation
body system approach
focus questioning and examination on particular body system most likely involved
PMH and HPI
if no one can tell you this information, YOU NEED TO FIND IT!
tailoring past history
important information can be gained tailoring history to patient's chief complaint
physical examination: auscultation
listen for: - decreased or absent breath sounds
physical examination: look
look for: - abnormalities - color - shape - movement