# Rapid Trauma Assessment vs Focussed Assessment



## ScoopAndRun (Apr 25, 2012)

Hello Yins, This is my first post at EMTLIFE.  I'm a first responder student.


I've got the rapid trauma assessment down cold, but I'm having trouble laying out in tabular form the specific overlap and the specific differences between these two levels of assessment.  I've read a lot of text, but have yet to find a lawyeristic tabular sort of comparison and so remain confused.  So please forgive me for trying to focus my question in the form of a box.....

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QUESTION 1)   (True or False)

"A Focussed Assessment would include all of the parts of a Rapid Trauma Assessment plus additional things too"

If you'd like to explain and discuss and describe, PLEASE DO and I THANK YOU.  But please start off with "true" or "false".



QUESTION 2)  

If you answered "True" above, please make a list of the additional things you'd do for a focused assessment above and beyond the part you would do for a Rapid Trauma assessment.


Thanks for input,
ScoopAndRun, Pennsylvania


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## Aprz (Apr 25, 2012)

Ugh, I don't like doing this... It feels like a homework question especially with your directions I feel like you are more interested in getting an answer for the question rather than a reasoning, but since it's only one, I'll do it for you.

*FALSE*

In the beginning, you size-up the scene and when you do your initial assessment, you'll determine whether the patient is a low/high priority (or in EMS slang "load 'n go"/"scoop 'n go" or "stay 'n play") based on their ABCs and mentality (some people are taught ABCD, D for disability which I guess is there way of saying mentality also, lol). For trauma with a significant mechanism of injury (MOI) or altered "unreliable" patients, your school would likely want you to do a rapid assessment, but for trauma patients without a significant MOI that aren't altered or medical patient that is reliable, you will do a focus assessment.

A focus assessment would be just looking at only the areas that would relate to their chief complaint. For example, for a chest pain patient with shortness of breath, the student may want to look for nasal flaring, pursed lips, anxious face, platysmal indrawing, JVD, tracheal deviation, subcutaneous emphysema, clavicular indrawing, symmetry of the chest, breath sounds, i/e ratio, chest trauma, intercostal retraction, pedal edema, and note their position (if they are tripoding)/clutching their chest. You are forming a differential diagnosis and doing a FOCUSED (your focusing only on what relates to the complaint) physical exam based on your differential. If the chest pain with shortness of breath patient pain radiated somewhere else, you'd check that too (e.g. radiates to the left arm, check the left arm too). The list I included for the chest pain with shortness of breath patient would be looking for mainly physical findings for or against CHF, pneumothorax, and chest trauma. By the way, a weak student would only look at the chest in my opinion.

If the patient is unreliable (e.g. altered) or there is a significant MOI, your school would likely want you to do a rapid.

Doing a full physical exam may be excessive, but Steve Whitehead from the EMTSpot recommends it and so did the community college I attended (Chabot College in Hayward, CA). They would have you do a rapid/focus assessment, and during transport and if time permit, you'd do a full physical.



> *12) Start Doing Full Head-to-Toe Patient Assessments*
> 
> I know you’ve been faking it. I know this because most EMT’s fake it. Regardless of how good or talented they are, most EMTs don’t have a good, smooth, thorough head-to-toe assessment that they can perform with confidence in front of other people.
> 
> ...


http://theemtspot.com/2012/02/26/17-ways-to-become-an-awesome-emt-in-2011/

Obviously in a full physical, you'd assess the distal extremities too (in a rapid, you check: head, neck, chest, abdomen, pelvis, and proximal extremities... if a focus was a rapid plus whatever extra, the only extra you could do would be distal extremities).


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## DesertMedic66 (Apr 25, 2012)

I agree with Aprz. That is how we teach it at the college. I can't add any else to Aprz post.


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## Veneficus (Apr 25, 2012)

*Depends*

The purpose of a rapid trauma is to identify life threats.

The purpose of focused assessment is to treat a specific injury.

It could be argued you do a rapid trauma assessment on every patient you see.

Is there a big pool of blood visible?

Are they conscious and oriented?

Breathing?

Pulse?

If I see a patient anywhere, who is sitting up, greets me, tells me their complaint and how it happened, and doesn't look like they are sitting in a pool of blood or have a major physical defect, that concludes my rapid trauma assessment.

Their airway and breathing are intact, they are adequetly perfusing thier brain, heart is beating, and there is no obvious life threatening hemorrhage. 

All of this in just a few seconds and often without even touching the patient.

However, it is important to realize what exacly the difference between all of these rapid, focused, detailed, assessments really are.

They are not 3 different exams.

They are a physical exam that has been prioritized for you and given a name. 

These names also change from time to time and publication to publication as somebody thinks they have a more accurate way to describe them.

It was designed to be a memory aid, not a skill. 

"Not so" you say?

Is evaluating an airway part of a rapid exam or a detailed exam?

When I evaluate an airway, I look for obstructions or potential obstructions, like, positioning the airway, inflammation which causes swelling, broken or loose teeth, foreign bodies, etc. 

I don't simply see breathing and call the airway clear.

It would look rather bad to decide the airway was clear and by the time you were done palpating somebody's feet came back and found the blood in the mouth from the broken teeth and vomit had clotted into some congealed mass which occluded the airway Wouldn't it?

No way would I look at the rest of a person's body before I looked in their mouth, like is suggested on the NR skill sheet. 

Of course, on said sheet, you get a point for doing it, not the order in which it was done.

As well if somebody is not breathing, I am going to start searching for why, which may or may not be in the mouth or even chest.  (like respiratory depression/arrest from damage to the CNS, both pharmacological and mechanical) 

Most trauma patients I have seen have been intoxicated by something. Which in addition to other things causes respiratory depression from both the CNS, relaxation of the tongue, and suppresion of the gag reflex. 

(more to come have to go do some work emergently)


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## ScoopAndRun (Apr 25, 2012)

Thank you very much!


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## d0nk3yk0n9 (Apr 25, 2012)

Veneficus said:


> *Depends*
> 
> The purpose of a rapid trauma is to identify life threats.
> 
> ...



While I agree with the idea behind what you're saying in general (that the first part of your assessment is to find immediate life threatening problems and that the assessment is an overall process and not just a skills checklist), at least in my EMT course, this part of the assessment (what I quoted) was referred to as the "initial assessment" and was then followed up by either a rapid or focused assessment. 

I just want to point this out so that anyone who is studying for an EMT class and reads this doesn't get their terms mixed up and end up failing a test because of it; Veneficus makes some good points, but just make sure that you call your assessments whatever your instructor/state/agency/etc. wants you to.


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## ScoopAndRun (Apr 25, 2012)

Regarding the thought process Veneficus described, I think my text lumps that sort of thing under the "general impression" to be formed prior to making the decisions about priority transport, and whether to do a "rapid trauma assessment" or "focused assessment". 

Turns out my text did answer my own question for one who reads straight thru, and Aprz was right on the money (of course).  I feel I should apologize for taking up your time, Aprz, because the answer was under my nose the whole time and just like you said.  The layout of my text doesn't exactly help the student in this respect, so I'm sending some constructive feedback to the publisher.  I choose to not name the text at this time.

Thanks for all the replies.


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## mycrofft (Apr 25, 2012)

*You are looking for the Holy Grail of medicine: the Ultimate Diagnostic Algorithm*

I bet NASA still has theirs for the Space Shuttle crews somewhere and is working on ones for Mars missions.

----Also, "How long is a piece of string?". Are we talking about what you do before heading to definitive care, or enroute, or at a casualty collection point triage station, or what? Or in the ED?


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## Christopher (Apr 25, 2012)

As far as an exam goes Veneficus is correct: the Rapid Trauma Exam and a Focused Assessment are two separate exams.

The "Rapid Trauma Exam" is part of your ABCs (ABCDE). NREMT-B doesn't acknowledge it as a separate exam, merely part of the Initial Assessment. PHTLS acknowledges it as part of the ABCs and tweaks the order of your physical exam from most EMT-B texts.

The Focused Assessment occurs once you've identified all of the ancillary injuries during a Detailed Exam.


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## ScoopAndRun (Apr 25, 2012)

My last comment should have quoted the part of V's remark I was talking about:


> It could be argued you do a rapid trauma assessment on every patient you see.
> 
> Is there a big pool of blood visible?
> 
> ...



That part I believe is part of the "general impression" in my textbook, and would lead one to the line on my state practical exam checklist:  "_Select appropriate assessment (focused or rapid trauma)_"   For example, in my  text, every rapid trauma exam will include DCAPBTLS of head-neck-chest-ab-pelvis.   Given the patient V described in the above quote, and lacking any significant MOI, that is not indicated.

If it sound like I'm an argumentative ***, I apologize.  For me this is a very useful study session because I need to adopt the lingo my text and state examiners use, and the debate is a good way to drive it into my brain.   Your jurisdictions mileage may vary.  Thanks for the help


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## mycrofft (Apr 25, 2012)

Not arguing. Just parsing closely!


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## Veneficus (Apr 25, 2012)

_If I see a patient anywhere, who is sitting up, greets me, tells me their complaint and how it happened, and doesn't look like they are sitting in a pool of blood *or have a major physical defect,* that concludes my rapid trauma assessment_.



Christopher said:


> PHTLS acknowledges it as part of the ABCs and tweaks the order of your physical exam from most EMT-B texts.



Because it was put out by the American College of surgeons, people who actually know a lot about trauma and examining patients. 

BUt as I said, the words of these exams change by the publication you are reading and the word considered the most popular of the day.

Memory aides for fools, by fools.


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## mycrofft (Apr 26, 2012)

*Ps:*

My comment above about NASA algorithm was not facetious. They did a BIG amount of work before launch in 1980 of the shuttles to allow medical procedures inflight, probably because it was anticipated some missions were to be entirely military and the need to stay on station for national interests might outweigh personal illness or discomfort (or death).


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