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Initial AssessmentThe initial assessment is designed to help the Emergency Medical Responder detect all immediate threats to life. Immediate life threats typically involve the patients ABCs, and each is corrected as it is found. The initial assessment has six components;
top of page Focused History and Physical Exam (Secondary Survey)A focused history and physical exam should be performed after the initial assessment. It is assumed that the life-threatening problems have been found and corrected. If you have a patient with a life-threatening problem that requires intervention (i.e. CPR) you may not get to this component. The main purpose of the focused history and physical is to discover and care for a patient's specific injuries or medical problems.
Focused History and Physical ExamThe focused history and physical exam includes a physical examination that focuses on a specific injury or medical complaint, or it may be a rapid examination of the entire body. It also includes obtaining a patient history and vital signs. Patient History - A patient history includes any information relating to the current complaint or condition, as well as past medical problems that could be related. Utilize bystanders/family... when needed
Acronym to obtain a patient's history S - Signs/symptoms Rapid assessment - this a quick, less detailed head - to toe assessment of the most critical patients Focused assessment - This is an exam conducted on stable patients. It focuses on a specific injury or medical complaint. Vital signs - This include pulse, respirations, skin signs, pupils and blood pressure. This may include documenting the oxygen saturation level (this is highly useful when dealing with chemical agent exposure). Pulse - Assess for rate, rhythm, and strength Respiration - Assess for rate, depth, sound, and ease of breathing Skin signs - Assess for color, temperature, and moisture Pupils - Check pupils for size, equality, and reaction to light. Constricted pupils in a mass casualty event are highly suggestive of nerve agent/organophosphate toxicity. Age-associated Vital Signs
Head to Toe Examination of a Trauma Patient with Significant MOI - The physical examination of the patient should take no more than two to three minutes
Neck - Examine the patient for point tenderness or deformity of the cervical spine. Any tenderness or deformity should be an indication of a possible spine injury. If the patient's C-spine has not been immobilized immobilize now prior to moving on with the rest of the exam. Check to see if the patient is a neck breather, check for tracheal deviation Head - Check the scalp for cuts, bruises, swellings, and other signs of injury. Examine the skull for deformities, depressions, and other signs of injury. Inspect the eyelids/eyes for impaled objects or other injury. Determine pupil size, equality, and reactions to light. Note the color of the inner of the inner surface of the eyelids. Look for blood, clear fluids, or bloody fluids in the nose and ears. Examine the mouth for airway obstructions, blood, and any odd odors. Chest - Examine the chest for cuts, bruises, penetrations, and impaled objects. Check for fractures. Note chest movements a look for equal expansion. Abdomen - Examine the abdomen for cuts bruises, penetrations, and impaled objects. Feel the abdomen for tenderness. Gently press on the abdomen with the palm side of the fingers, noting any areas that are rigid, swollen, or painful. Note if the pain is in one spot or generalized. Check by quadrants and document any problems in a specific quadrant. Lower Back - Feel for point tenderness, deformity, and other signs of injury Pelvis - Feel the pelvis for injuries and possible fractures. After checking the lower back, slide your hands from the small of the back to the lateral wings of the pelvis. Press in and down at the same time noting the presence of pain and/ or deformity Genital Region - Look for wetness caused by incontinence or bleeding or impaled objects. In male patients check for priapism (persistent erection of the penis). This is an important indication of spinal injury Lower Extremities - Examine for deformities, swellings, bleedings, discolorations, bone protrusions and obvious fractures. Check for a distal pulse. The most useful is the posterior tibial pulse which is felt behind the medial ankle. If a patient is wearing boots and has indications of a crush injury do not remove them. Check the feet for motor function and sensation. Upper Extremities - Examine for deformities, swellings, bleedings, discolorations, bone protrusions and obvious fractures. Check for the radial pulse (wrist). In children check for capillary refill. Check for motor function and strength. Rapid Physical Exam - Unresponsive Medical Patient The rapid physical examination of the unresponsive medical patient is almost the same as the rapid trauma assessment of a trauma patient with a significant mechanism of injury. You will rapidly assess the patient's head, neck, chest, abdomen, pelvis, extremities and exterior. Focused Physical Exam - Responsive Medical Patient The focused physical exam of the responsive medical patient is usually brief. The most important information is obtained through the patient history and the taking of vital signs. Focus the exam on the body part that the patient has the complaint about. In a mass casualty situation pay particular attention to following signs and symptoms;
Head
Neck
Chest/Lungs
Heart/Circulation
Abdomen
Pelvis
Neurological
Skin
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