Patient Assessment

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AShaddeau

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I'm getting confused on when to use the different assessments. I've been taking practice tests and there have been a few questions where it asks me what assessment I would use first. Initial assessment, Trauma assessment, secondary assessment... :unsure:
 
This is a common question.

As a test taking tip, never choose "secondary" as the first assessment you would do.
 
I'm familiar with the assessments; as I should be, I'm just confused as to when I use certain ones at certain times.
 
The initial assessment is to identify and correct immediate life threats. The FIRST thing you do. For example, if they aren't breathing, identify it and fix it.

The trauma assessment is to identify traumatic injuries not identified in the initial assessment. Expose, examine and palpate.

The secondary assessment is performed after immediate life threats have been identified and corrected. Also known as the "let's see if we can find anything else wrong" assessment. Usually done while en route.

Does that help?
 
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So, no matter what I perform the initial assessment?
It does help, Thank you!
I think it will be easier once I'm doing ride alongs and seeing/doing it first hand. I appreciate all the help.
 
AShaddeau said:
So, no matter what I perform the initial assessment?
It does help, Thank you!
I think it will be easier once I'm doing ride alongs and seeing/doing it first hand. I appreciate all the help.
Click to expand...

yes, every pt gets an initial assessment

practice on pets, family, friends, lamps.. anything. The more you go through it the easier it will become.
 
AShaddeau said:
So, no matter what I perform the initial assessment?
It does help, Thank you!
I think it will be easier once I'm doing ride alongs and seeing/doing it first hand. I appreciate all the help.
Click to expand...

need to learn the script first...On ride alongs you may see bad habits or you ma think are not doing something, because they have already ruled out stuff in their head
 
GO to your text, assiduously search (at least three Mt Dews) for the answer they want, then learn it. If not found, talk to teacher or most attractive classmate.
 
donkeypuncher said:
need to learn the script first...On ride alongs you may see bad habits or you ma think are not doing something, because they have already ruled out stuff in their head
Click to expand...
True! People that are very good this may appear to skip certain portions of their exams because they've already looked for it and moved on before you're able to keep up, or they're already onto doing a focused assessment because they've already done an initial assessment and are already beginning to focus in on what the problem may be. I generally do a quick "obvious" sick/not-sick assessment every time I make patient contact. From there I move into doing that initial assessment and focus in from there to what the problem seems to be. I've been at this a while, so it might look like I just walked in and started talking to the patient while I get (or have someone get) vital signs... and appear to ignore other areas. Trust me, I haven't. I'm refining that assessment as I go and will add other areas of the assessment as I need to.

Unfortunately, the side effect is that it appears that I'm either doing things out of sequence for how you learned them or that I'm "lazy" or I'm just not doing things right, simply because I'm doing things differently. When I'm training someone, I'll generally take time after the call, or during the call if time permits, to explain what I do, why, and I'll do things the more "textbook" way if the opportunity presents itself.

For you, the new EMT learner, you need to learn the textbook "script" so that you don't miss anything and so that later when you're starting to do more focused assessments, you can just pull from that script the things you need.
 
If you can find an AMLS course, I'd take it; they do a very good job of operationalizing this subtle process of cascading assessment. You can't really execute it until you have the knowledge to know what you're looking for, but at least you can learn the method.

Edit: on a more mundane basis, 90% of your initial general impression, no matter how much people wave their hands about it, is derived through:

1. The patient's level of distress, behavior, and mental status
2. The patient's breathing
3. The patient's skin

In other contexts, they call this the Pediatric Assessment Triangle (PAT), but it really applies to everyone. If you walk in, look at the patient, engage them in conversation, and perhaps feel a peripheral pulse, you know a great deal about their neurological, respiratory, and hemodynamic status.
 
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Brandon Oto said:
If you can find an AMLS course, I'd take it; they do a very good job of operationalizing this subtle process of cascading assessment. You can't really execute it until you have the knowledge to know what you're looking for, but at least you can learn the method.

Edit: on a more mundane basis, 90% of your initial general impression, no matter how much people wave their hands about it, is derived through:

1. The patient's level of distress, behavior, and mental status
2. The patient's breathing
3. The patient's skin

In other contexts, they call this the Pediatric Assessment Triangle (PAT), but it really applies to everyone. If you walk in, look at the patient, engage them in conversation, and perhaps feel a peripheral pulse, you know a great deal about their neurological, respiratory, and hemodynamic status.
Click to expand...
I use the PAT concepts all the time on people. Personally, I walk in, see how the patient reacts to change in the environment (me coming in), introduce myself, and offer a handshake... all while watching how the patient is breathing. Like you said: Neuro, Respiratory, Hemodynamic status in a very crude way.

While I've not taken an AMLS course formally, I've read the book more than a few times and done some self-learning along the way using that as a guide. Eventually I'll take it formally and learn some more!
 
Initial= Holy crap how'd you get a golf ball stuck in your throat, never mind lets just get it out.

Trauma= Hey where's all this blood coming from? Crap did anyone remember to pick up the guys fingers?

Secondary= Wow we're still 10 minutes from hospital. Wonder if this guy has bunions.
 
bigbaldguy said:
Initial= Holy crap how'd you get a golf ball stuck in your throat, never mind lets just get it out.

Trauma= Hey where's all this blood coming from? Crap did anyone remember to pick up the guys fingers?

Secondary= Wow we're still 10 minutes from hospital. Wonder if this guy has bunions.
Click to expand...

hahaha, I literally laughed out loud. Thanks for that
 
The primary survey is a quick, initial examination to see the state of ABCD and if there are any life threatening problems. For example, do they have an airay, are they breathing, do they have a pulse, what is their level of consciousness and is there any massive haemmorhage, limbs that are missing, impaled objects in non anatomical places?

The secondary survey is a more detailed, thorough examination; for example it establishes what the respiratory pattern and rate is, what the pulse quality and rate is, GCS, and looks for injuries.

Then you have the system specific examinations for example cardiovascular, respiratory, GI/GU etc.

Personally I think the textbook secondary survey has more of a role in somebody who has been traumatically injured than in somebody with a medical problem and that the secondary survey and system specific examinations sort of blend into one another, at least in somebody who has a medical problem.

Like most things, there is no one right or wrong answer and clinical judgement is required.
 
And general impression is what you see as you're walking/driving up. "My general impression is that there is a man found face down lying in the roadway from an apparent MVA." Or similar.
 
I guess you could call general impression your first take of the patient, i.e. how sick (or how injured) are they, what are their major problems and how time critical is their problem?

For example you could say that a general impression of the person who is unconscious having been ejected from a road crash is going to be very time critically injured, or dead.

Impression (written as I) or "imp") can also be used to describe somebodies impression of the patients problems. For example Imp (1) DKA (2) Hyperglycaemia (3) Dehydration (4) Infection ? cause
 
AShaddeau said:
I'm getting confused on when to use the different assessments. I've been taking practice tests and there have been a few questions where it asks me what assessment I would use first. Initial assessment, Trauma assessment, secondary assessment... :unsure:
Click to expand...

On the skill sheets, the beginning is the same regardless if it is trauma or medical.

THE FOLLOWING STEPS ARE THE SAME:

THE BEGINNING
Scene safety/BSI
MOI/NOI
# of patients
additional resources needed?
C-Spine

Then I remembered GMABCP (I actually remembered these letters)

THE MIDDLE
G-general impression
M- Mental status
A- Airway
B- Breathing
C- Circulation
P- Priority of the patient

The middle part is a little different


The end- Always do your secondary assessment, reassess vitals, and address any secondary wounds en route and you will be golden.
 
VirginiaEMT said:
On the skill sheets, the beginning is the same regardless if it is trauma or medical.

THE FOLLOWING STEPS ARE THE SAME:

THE BEGINNING
Scene safety/BSI
MOI/NOI
# of patients
additional resources needed?
C-Spine
Click to expand...
depending on your service, and if you have an I or P on board, contact ALS if the MOI or chief complaint could be ALS, such as cardiac or MVA with PI.
 
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