Prehospital Academy Lesson 10.5
Patient Assessment: The EMT Secondary Assessment
This lesson page builds upon the foundation of primary assessment by detailing the secondary assessment for EMTs. While the primary assessment addresses immediate life threats, the secondary assessment involves a more thorough, head-to-toe or focused examination, gathering more in-depth information to identify and manage less immediately critical but still important injuries and medical conditions.
Purpose and Timing of the Secondary Assessment
The secondary assessment is performed after the primary assessment has been completed and any immediate life threats have been managed. Its purpose is to conduct a systematic, detailed examination of the patient. The type and extent of the secondary assessment are dictated by the patient's condition and the nature of their complaint:
Responsive Medical Patient: Typically involves a focused assessment on the chief complaint and a detailed history.
Unresponsive Medical Patient: Requires a rapid head-to-toe physical examination.
Trauma Patient with Significant Mechanism of Injury: Demands a rapid trauma assessment (head-to-toe).
Trauma Patient with Isolated Injury: A focused assessment on the injured area.
The secondary assessment is where EMTs delve deeper into understanding the patient's pathophysiology and formulating a more precise field impression.
Components of a Secondary Assessment
The secondary assessment typically includes:
Physical Examination: This can be a detailed head-to-toe exam or a focused exam of a specific body area, depending on the patient's presentation. It involves observation (look), palpation (feel), and auscultation (listen).
Vital Signs: Obtain a complete set of vital signs, including blood pressure, pulse, respirations, skin CTC, pupils, and oxygen saturation. Reassess these frequently.
History Taking: Conduct a thorough SAMPLE history and, if applicable, an OPQRST for pain. For responsive patients, this often guides the physical exam.
Interventions: Perform interventions based on findings (e.g., splinting, wound dressing, medication administration within scope of practice).
Remember, the secondary assessment is an ongoing process. Patient conditions can change rapidly, requiring continuous reassessment and adaptation of your care plan.
Head-to-Toe vs. Focused Assessment in Trauma
In trauma patients, the approach to the physical exam depends on the mechanism of injury (MOI):
Rapid Trauma Assessment (Head-to-Toe): Performed for patients with a significant MOI, altered mental status, or multi-system trauma. This is a quick but thorough assessment looking for deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAP-BTLS). It systematically covers the head, neck, chest, abdomen, pelvis, extremities, and back.
Focused Trauma Assessment: Conducted for patients with an isolated injury and no significant MOI. The examination concentrates solely on the injured area and associated complaints.
Regardless of the approach, the goal is to identify all injuries and initiate appropriate care before transport.
Medical Secondary Assessment
For medical patients, the secondary assessment is heavily driven by the chief complaint and the history obtained. For example:
Chest Pain: Focus on cardiac and respiratory systems; auscultate lungs, palpate chest, assess for jugular venous distention.
Shortness of Breath: Focus on respiratory system; auscultate lungs, assess work of breathing, inspect airway.
Abdominal Pain: Focus on abdominal exam; palpate quadrants, assess for tenderness, rigidity, distention.
For unresponsive medical patients, a rapid head-to-toe exam is appropriate, similar to a rapid trauma assessment, to identify any missed clues or signs of underlying conditions.
Key Takeaways for EMTs
The secondary assessment transforms the initial life-saving actions of the primary assessment into a more detailed and refined understanding of the patient's condition. It allows for the identification of less obvious problems, continuous monitoring, and the implementation of interventions that stabilize the patient for transport. A strong history, coupled with a systematic physical exam, is crucial for effective patient management.
Critical Thinking Questions
You are on scene with a responsive medical patient complaining of severe abdominal pain. Outline your approach to the secondary assessment, including which components you would prioritize and why.
Contrast the indications and methodology for performing a "rapid trauma assessment" versus a "focused trauma assessment." Provide an example for each.
An unresponsive patient with no obvious signs of trauma is found at home. How would your secondary assessment differ from that of a responsive patient, and what specific findings would you be looking for?
During a secondary assessment of a patient with a suspected isolated ankle fracture, you discover a significant deformity and swelling. What are the key steps in managing this injury on scene, and what reassessments are crucial before and during transport?
How does the information gathered during history taking (SAMPLE and OPQRST) directly influence the scope and direction of your physical examination during the secondary assessment?