Secondary Assessment & Reassessment

Secondary Assessment & Reassessment

Information Covered:

  1. Techniques of Physical Examination
    1. General Approach
      1. Examine the patient systematically
      2. Place special emphasis on areas suggested by the present illness and chief complaint
      3. Keep in mind that most patients view a physical exam with apprehension and anxiety—they feel vulnerable and exposed
      4. Maintain professionalism throughout the physical exam while displaying compassion towards your patient
    2. Respiratory System
      1. Expose the chest as appropriate for the environment
      2. Chest shape and symmetry
      3. Respiratory effort
        1. Accessory muscle use
        2. Retractions
      4. Auscultation
        1. Technique – medical versus trauma
        2. Presence of breath sounds
        3. Absence of breath sounds
    3. Cardiovascular System
      1. Pulse
        1. Rate
        2. Rhythm
        3. Predictable
        4. Adjust timing for irregularity
        5. Strength
        6. Location
          1. common locations
          2. pelation to perfusion
      2. Perfusion
        1. Blood pressure
          1. equipment size
          2. placement of cuff
          3. position of patient
          4. position of arm
          5. methods of measurement
            1. auscultation
            2. palpation
          6. relation to perfusion
    4. Neurological System
      1. Mental status
        1. Appearance and behavior
          1. assess for level of consciousness (AVPU)
            1. alert
            2. response to verbal stimuli
              1. drowsiness
              2. stupor
                1. state of lethargy
                2. person seems unaware of surroundings
            3. response to painful stimuli
            4. unresponsive
              1. coma
                1. state of profound unconsciousness
                2. absence of spontaneous eye movements
                3. no response to verbal or painful stimuli
                4. patient cannot be aroused by any stimuli
          2. observe posture and motor behavior
          3. facial expression
            1. anxiety
            2. depression
            3. anger
            4. fear
            5. sadness
            6. pain
        2. Speech and language
          1. rate
          2. appropriateness
            1. slurred
            2. garbled
            3. aphasia
        3. Mood
          1. nature
          2. intensity
          3. suicidal ideation
        4. Thought and perceptions
          1. assess thought processes
            1. logic
            2. organization
          2. assess thought content
            1. unusual thoughts
            2. unpleasant thoughts
          3. assess perceptions
            1. unusual
            2. hearing things
            3. seeing things
        5. Memory and attention
          1. person
          2. place
          3. time
          4. purpose
    5. Musculoskeletal System
      1. Pelvic region
        1. Symmetry
        2. Tenderness
      2. Lower extremities
        1. Overview
          1. symmetry
          2. surface findings
        2. General physical findings
          1. range of motion
          2. sensory
          3. motor function
          4. circulatory function
        3. Peripheral vascular system
          1. tenderness
          2. temperature of lower legs
          3. distal pulses
      3. Upper extremities
        1. Overview
          1. symmetry
          2. strength
          3. surface findings
        2. General physical findings
          1. range of motion
          2. sensory
          3. motor function
          4. arm drift
      4. Back
        1. Overview
          1. symmetry
          2. contour
          3. surface findings
        2. General physical findings
          1. flank tenderness
          2. spinal column tenderness
    6. All Anatomical Regions
      1. Head
        1. Scalp
        2. Skull
        3. Face
          1. symmetry of expression
          2. appropriate facial expression
        4. Eyes
          1. pupil size, shape, and response
            1. normal – equal and reactive to light
            2. abnormal
              1. constricted
              2. dilated
              3. unequal
          2. conjunctiva color and hydration
        5. Ears – fluids
        6. Nose
          1. symmetry
          2. fluid in nares
        7. Mouth and pharynx
          1. odor
          2. hydration
          3. condition of teeth
      2. Neck
        1. Physical findings
        2. Symmetry
        3. Masses
        4. Arterial pulses
      3. Chest
        1. Overview
          1. expose appropriately
          2. chest shape and symmetry
          3. respiratory effort
          4. surface findings – inspection
        2. Auscultation
          1. technique – medical versus trauma
          2. lung sounds
            1. absence of breath sounds
        3. Anterior chest
          1. auscultation findings – lungs
          2. intercostal muscle use
          3. retraction
        4. Posterior chest
          1. auscultation
          2. spinal column
      4. Abdomen
        1. Overview
          1. position patient for examination
          2. shape and size
          3. palpation method
            1. four quadrants
            2. palpate affected area last
        2. Physical findings
          1. symmetry
          2. masses
          3. organ margins
          4. contour
          5. softness
          6. tenderness
          7. findings associated with pregnancy – physical changes of contour and shape
  1. How and When to Reassess
  2. Identify and Treat Changes in the Patient’s Condition in a Timely Manner
    1. Monitor the patient’s condition
    2. Monitor the effectiveness of interventions
    3. Identify trends in the patients vital signs
  3. Reassessments Should Be Performed at Regular Intervals
    1. Unstable Patients – Every Five Minutes, or as Often as Practical Depending on the Patient’s Condition
    2. Stable Patients – At Least Every 15 Minutes or as Deemed Appropriate by the Patient’s Condition
  4. A Reassessment Includes:
    1. Primary Assessment
    2. Vital Signs
    3. Chief Complaint
    4. Interventions
  5. Compare to the Baseline Status of That Component
    1. Level of Consciousness – Is the Patient Maintaining the Same Level of Responsiveness or Becoming More/Less Alert?
    2. Airway – Recheck the Airway for Patency
    3. Breathing – Reassess the Adequacy of Breathing by Monitoring Both Breathing Rate and Tidal Volume
    4. Circulation – Reassess the Adequacy of Circulation by Checking Both Central and Peripheral Pulses
  6. Vital Signs
    1. Repeat Vital Signs as Necessary
    2. Attention Should Be Paid to:
      1. Respirations
      2. Pulse
      3. Blood pressure
      4. Pupils
  7. Chief Complaint
    1. Constantly Reassess the Patient’s Chief Complaint or Major Injury
    2. Determine If Their Pain/Discomfort Is Remaining the Same, Getting Worse, or Getting Better
    3. Be Sure to Ask If There Are Any New or Previously Undisclosed Complaints
  8. Interventions – Reassess the Effectiveness of Each Intervention Performed and Consider the Need for New Interventions or Modifications to Care Already Being Provided

Age-Related Considerations for Pediatric and Geriatric Assessment and Management

 

Content Creator: James Stone

CAPCE Course Number: 17-EMTP-F3-8303

Total CE Hours: 0.5

Level: Basic

EMT-CE uses the NEMSES guidelines as the foundation for every course outline.