# NREMT EMR Medical Assessment - Confused on Secondary Assessment



## benasack2000 (Mar 10, 2017)

Hi All - I was told by a guest instructor to my EMR class that for the NREMT medical assessment practical test - we had to evaluate every single body system to get full points and "cover all the bases". Is this true? For a chest pain patient, I would be apparently required to evaluate musculoskeletal and reproductive to get full points for the secondary. He said I at least had to "cover the bases" (For example, asking the female chest pain patient if she was pregnant and I would be awarded a point). This seems very contrary to the skill sheet which says "assesses affected body part/system". This also is contrary to all the videos and exam help I see online. Can someone explain? Am I assessing only what is pertinent to the chief complaint (like respiratory and cardiac for a chest pain pt) or am I doing all of them for the test? 

SECONDARY ASSESSMENT *Assesses affected body part/system* -Cardiovascular -Neurological -Integumentary -Reproductive 5 -Pulmonary -Musculoskeletal -GI/GU -Psychological/Social


Thanks,
B


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## DesertMedic66 (Mar 10, 2017)

You are correct and your "guest" is wrong.


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## EmergencyMedicalSike (Mar 11, 2017)

You would only do a rapid assessment or detailed physical exam if it were a trauma case since in the rapid you're only looking for life threading injuries and in a detailed, you're actually looking for DCAPBTLS which could be as a result of trauma. Your guest is wrong. In a medical secondary, there's no need to check the whole body. You are right in checking pertinent areas where the chief complaint is.


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## Hold My Beer (Mar 17, 2017)

Think about the secondary assessment as assessing other body systems to help rule out or come up with differential diagnoses.  If the patient is complaining of chest pain think of why that pain is there. Cardiac? musculoskeletal? Respiratory?  Just with that example you should have assessed 3 systems.  While you're there assessing the chest why not quickly palpate the abdomen and ask about nausea, vomiting, and diarrhea; now your at 4 systems. This will also help you see the bigger picture about the patient's overall condition.  Chest tightness with a productive cough, shortness of breath, along with GI distress should open the idea of other possible conditions aside from just cardiac chest pain like flu.  Chest tightness with a rash (after assessing the integumentary system) should point you towards possible allergic reaction.  So now with that chest pain patient you have assessed 5 total systems.  Need more points? what brought on the chest pain? did they get in a fight or argument? are they stressed? do they have anxiety? that takes care of psychological / social; that's 6 total systems.  From what I recall the scoring sheet doesn't ask to check all systems but just a few.  Ask to see the scoring rubric prior to the test.  Good luck!


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