Chapter 15: The Secondary Assessment
Head to toe - extremeties
-Check each extremity for DCAP-BTLS -At the distal portion of each extremity, check for: Circulation, Sensation, and Motor function (CSM) also known as PMS (Pulse, Motor Sensation)
Head to toe - pelvis
-Compression -Flexion
Components of secondary assessment
-Patient history -Physical exam -Vital signs
Paradoxical motion
One side of the chest moves opposite of the other
Head to toe - head
• Check Head • Check Face • Check Neck (Step Off, JVD, Tracheal Deviation)
DCAP-BTLS
• Deformities • Contusions • Abrasions • Punctures/Penetrations/Pertrusions • Burns • Tenderness • Lacerations • Swelling
Responsive medical patient
• History of present illness (HPI) • Past medical history (PMH) • Focused physical exam • Baseline vital signs
Unresponsive Medical Patient
• 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
Additional HPI questions
• 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: distention, firmness or rigidity • Pelvis: incontinence of urine or feces • Extremities: pulse, motor function, sensation, oxygen saturation, medical identification devices
Focused exam (medical)
• No Significant Distress • Responsive • Alert and Oriented
Focused trauma exam
• No Significant MOI • Responsive • Single Injury • Alert and Oriented
Head to toe - abdomen
• Palpate all four quadrants • Distention • Rigidity • Tenderness
What is a rapid trauma (head to toe) exam used for
• Significant MOI • Unresponsive, AMS • Multiple injuries • Multiple body systems
Rapid Physical Exam
• Similar to physical exam for trauma patient • Assess head, neck, chest, abdomen, pelvis, extremities, and posterior • Consider ALS backup
Head to toe - chest
• 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
The rapid trauma exam
• Un-Responsive or AMS • Significant MOI • Multiple injuries • Multiple body systemsinvolved
The rapid medical exam
• Un-Responsive or AMS • Unknown Issue(s)
Question bystanders
• What is patient's name? • What happened? • Did you see anything else? • Did patient complain before this happened? • Does patient have any illnesses or problems? • Is patient taking medications?
