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?