# Focused history/physical exam vs. Rapid Trauma??



## highvelocity84 (Dec 9, 2008)

Here's my question.

When getting a scenario, what are good "identifiers" or ways to determine when to use either the Focused History/Physical Exam vs. Rapid Trauma Assessment.

Obviously if they've been hit by a car, being inside the vehicle, or its a vehicle vs. pedestrian, then yes, I'd do the rapid trauma assessment.

I appreciate all the help!!  Just want to pass my final and NRE 

~Kris


----------



## traumateam1 (Dec 9, 2008)

Try this:
http://emtlife.com/showthread.php?t=9594&highlight=history+physical+exam


----------



## traumateam1 (Dec 9, 2008)

If that doesn't help, I'll be willing to give my two cents.


----------



## highvelocity84 (Dec 9, 2008)

*Here's an example...*



traumateam1 said:


> If that doesn't help, I'll be willing to give my two cents.



I've ran into scenarios...where the person is ice skating, falls down, and says her ankle hurts.

I'm thinking ice...what else she possibly injure when falling down...do a trauma assessment and then come back to the area of pain last so you can figure out if she's in pain anywhere else.

Then I run into a scenario where the wife finds her husband unconscious.  When you come to the scene, the husband (patient) is on the bed, unconscious and I can't remember the other factor.   I'm thinking that since he's on the bed, he didn't just fall, get back up and go to bed? Or maybe?  Then I get it wrong b/c I was supposed to do a rapid trauma assessment.

So where's my thinking going lopsided? LOL.


----------



## mycrofft (Dec 9, 2008)

*Just took a two day RN level course for jail medical.*

You start assessing as soon as you can sense the pt and the environment/scene, then contact and VS the pt, ask about primary c/o.

"Focused" is for instances where the primary c/o and your assessment coincide and you sense no greater need or hidden issue, or as a part of a complete assessment when you need to widen your assessment about a particular issue.

If the pt has altered mentation, or the hx is incredible or conflicts with your professional assessment of presence and priority of needs/problems, do the overall assessment.

Note that you will be held to the same standard for each, but "focused" can save time and "cut to the chase" in simple cases.


----------



## highvelocity84 (Dec 9, 2008)

mycrofft said:


> You start assessing as soon as you can sense the pt and the environment/scene, then contact and VS the pt, ask about primary c/o.
> 
> "Focused" is for instances where the primary c/o and your assessment coincide and you sense no greater need or hidden issue, or as a part of a complete assessment when you need to widen your assessment about a particular issue.
> 
> ...



I guess I'm just trying to error on the side of caution.

I have to be able to get the right answer for my final and national registry.

Everyone is going to say that they have pain in a localized area.  So localized being focused history/physical exam.

But is it what the case may be that changes it to Trauma Assessment?

Yes I already talked 'bout vehicles.

But like for abdominal pain, you assess the entire body, then come back to the location of pain LAST so they aren't distracted by the pain you just caused at where they expressed their hurt.

That's where I'm getting at....Maybe I need to know in what types of patients you do focused/physical vs. rapid trauma.  That would be a lot of help.


----------



## traumateam1 (Dec 9, 2008)

> I've ran into scenarios...where the person is ice skating, falls down, and says her ankle hurts.
> 
> I'm thinking ice...what else she possibly injure when falling down...do a trauma assessment and then come back to the area of pain last so you can figure out if she's in pain anywhere else.



Well for this type of situation, you could ask them if they remember falling down. "For every trauma, think medical". Did they pass out which caused them to fall? Or was it just a simple trip on the ice? If it was just a simple trip on the ice do a *modified head to toe.* Examine the injured area. For this instance the affected leg. Take off the skate and assess the toes for numbness/tingling. You don't need to fully assess the entire patient for a situation like this. 



> Then I run into a scenario where the wife finds her husband unconscious. When you come to the scene, the husband (patient) is on the bed, unconscious and I can't remember the other factor. I'm thinking that since he's on the bed, he didn't just fall, get back up and go to bed? Or maybe? Then I get it wrong b/c I was supposed to do a rapid trauma assessment.



If you don't know the MOI/PMHx than why not do a rapid trauma assessment? Do your ABC's with C-Spine if you feel it is needed. Do critical interventions as needed. Do the rapid trauma assessment in your primary survey/assessment and if you see and signs of trauma (grimace of face, moan/groan, etc when palpating a certain area, bleed, deformity) than treat it as a trauma, if the trauma assessment comes up negative for anything than go medical. Diabetic call? Cardiac call? PMHx? etc etc.


----------



## LucidResq (Dec 9, 2008)

Every unconscious patient warrants a rapid trauma assessment. Period. Even if it seems like a medical problem, a rapid trauma assessment will be putting you down the right path. Same goes for most patients with any degree of altered LOC. 

Unless you know exactly what the medical problem is (ie: a diabetic man is found unconscious by his wife in bed, she says he checked his sugar earlier and was pretty low) and have absolute confidence that the patient didn't fall or injure themselves prior to or after losing consciousness, you should do a rapid trauma assessment adapted to the specific situation/patient. 

Besides, it's impossible to do an focused physical assessment when you don't know what the problem is because you have nothing to focus on. \

As far as trauma patients, of course anyone with any alteration in LOC gets a rapid trauma. MVAs, falls, etc - anything that involves the entire body - should get a rapid trauma. I would say that anything involving force to the head or trunk should get a rapid trauma (example: you would want to do a rapid trauma for a kid struck hard in the chest with a baseball bat, but you may forgo a rapid trauma for a kid struck hard in the shin with a baseball bat). I would strongly consider doing a rapid trauma for any shooting or stabbing - even if the pt. believes they've only been shot in the arm, for example - because they may not be aware of other, more serious wounds. 

Just a hint: your trauma patient for the national registry WILL need a rapid trauma assessment. I guarantee it. They will be sick (probably unconscious) and have a life-threatening injury (like a pneumothorax, for example), and at least one minor distracting injury (like a broken tib/fib).


----------



## traumateam1 (Dec 9, 2008)

LucidResq said:


> Every unconscious patient warrants a rapid trauma assessment. Period. Even if it seems like a medical problem, a rapid trauma assessment will be putting you down the right path. Same goes for most patients with any degree of altered LOC.
> 
> Unless you know exactly what the medical problem is (ie: a diabetic man is found unconscious by his wife in bed, she says he checked his sugar earlier and was pretty low) and have absolute confidence that the patient didn't fall or injure themselves prior to or after losing consciousness, you should do a rapid trauma assessment adapted to the specific situation/patient.
> 
> ...



To add to that, I would do a full trauma assessment for any patients with either a major injury (possible broken spine, broken femur, etc) or multiple system injuries. Why? Because the pain, or lack of feeling from an injury can mask other signs symptoms.
For example, you have a pt who repeatedly states "my back snapped!! my back snapped!!" this patient warrants a full trauma assessment. 
Reasoning: this patient could have a loss of feeling/sensation due to a spinal cord injury and/or the pain from the broken back could mask or "over dominate" a broken leg, or arm, or a massive bleed.

Hopefully this made it more clear, and less confusing.


----------

