Trauma Assessment Assistance

[obesemuffins]

Hey,
I've been going through the nremt Trauma Assessment sheet. However, I've been running into some issues between "History Taking" and "Secondary Assessment"

During our training labs so far, we don't seem to be following the sheet. We just complete a Rapid Trauma Assessment, History Taking, and then Vital Signs -- in that order. We do not complete a Secondary Assessment/Detailed Assessment at all.

Can someone clarify the difference between the Rapid Assessment and Secondary Assessment for me, relating to the Psychomotor Exam?

My feeling is that we complete a Head-to-Toe Rapid Assessment (30 secs), attempt SAMPLE History, and while en route complete a Secondary Asessment/Detailed Assessment. Is this correct? Thanks.

 

[FDJohn]

A had a couple of recruits with the same problem only last semester. The first thing you will do no matter the circumstances is have your partner (imaginary or not) take c-spine. If you can wear gloves put them on before you get into the room.
You have a 21 yom who fell from the roof while hanging shingles.
Scene safe?
Yes.
Number of patients?
1
Do I have additional resources?
No.
Mechanism of injury?
Fall
*puts on gloves*
PARTNER MAN! Come forth. My patient needs his c-spine protected.
At this point the rapid trauma assessment becomes rapid. Is he alert? No. Does he hear me? No. Does he flinch when I pinch? No. He is now U. Is he protecting his own airway? No. Is he breathing on his own? Let's make our partner earn his paycheck and say it's irregular. First intervention is BVM, high flow o2, ventilating at 10-12 breaths a minute. C-spine, A, and B are taken care of. C time. Check for a corotid pulse, check a radial too if you're feeling froggy. You're going to find that he indeed has one but it's a little slow today. Check his skin, it's pale and clammy. Now look deep into his eyes and I'm sure you'll notice they are dilated.
Your primary is now done. Now you take your gloved hands and dip them into fictional buckets of paint. Now you can start touching the pt. all over. Head to toe, and make sure every square inch of that guys body is blue. Make sure every distal pulse is felt for. When it comes time to log roll the pt. feel his c-spine. You're feeling for that nasty crunch feeling or that equally nasty oatmeal feeling. Place your c-collar, place your back board, and re check your pulses. It's time to go.
Once you're on the truck en route emergency traffic to the nearest ED you can take vital signs. Oh no! He has HTN, bradycardia, and irregular respirations. You may now ventilate your pt. at 20 times a minute.
Reassessment: Re-take vital signs. Check your interventions ( breathing 20 times a minute, c-collar, long spine board, BVM)
It sounds like a lot. But look at your critical criteria and look at where most of your points come from. If you do a good primary and a good physical exam the proper interventions will come to you. The bucket of paint thing really works.

 

[Handsome Robb]

Disregard.

 

[shademt]

The way I learned it was like this:
After performing the primary assessment, if you have a major trauma patient or unresponsive medical patient, your perform the rapid physical exam from head-toe and front to back, utilizing DCAPBTLS and taking the proper precautions(C-spine and log-rolling rules). Then load into ambulance and complete the SAMPLE/OPQRST and vitals en route to hospital.

The rapid assessment is part of the secondary assessment. You can incorporate the detailed physical exam into the rapid assessment since you are just adding a few things to the rapid anyways(Ex-checking for CSF or or basilar skull fracture of the head). If the patient is conscious enough, attempt the SAMPLE and just get vitals.

The more you practice, the more it just flows.