NREMT EMT 3: Secondary Assessment - Focused Physical Exam Based on Chief Complaint, Medical vs Trauma

What This Is

A focused physical exam is like taking a snapshot of a patient's condition. It's a quick, targeted assessment to identify the most critical issues. Imagine you're a detective trying to solve a mystery – you need to gather clues to figure out what's going on. In an emergency, every second counts, and a focused exam helps you prioritize treatment.

Key Steps / Core Facts

• Chief Complaint: The patient's main problem or symptom (e.g., "I have chest pain"). This guides the exam.
• Vital Signs: Check pulse (heart rate), breathing rate, blood pressure, temperature, and oxygen saturation. These numbers help you understand the patient's overall condition.
• Airway: Check for obstruction (blockage) or respiratory distress. A clear airway is essential for breathing.
• Breathing: Listen for abnormal sounds (e.g., wheezing) and check for respiratory rate. A normal rate is 12-20 breaths per minute.
• Circulation: Check for pulse and blood pressure. A normal blood pressure is 90/60 to 120/80 mmHg.
• Neurological: Check for level of consciousness (AVPU: Alert, Verbal, Pain, Unresponsive) and motor function (e.g., can the patient move their limbs?).
• SAMPLE: A mnemonic to remember key questions to ask the patient:
  • S: Symptoms (what's happening)
  • A: Allergies (medications or substances that can cause reactions)
  • M: Medical history (previous conditions or surgeries)
  • P: Pain (location and severity)
  • L: Last meal (time and type of food)
  • E: Events leading up to the emergency (what happened)
• OPQRSTI: A mnemonic to remember key questions to ask the patient about their pain:
  • O: Onset (when did the pain start?)
  • P: Pain location (where is the pain?)
  • Q: Quality (what does the pain feel like?)
  • R: Radiation (does the pain spread?)
  • S: Severity (how bad is the pain?)
  • T: Timing (when does the pain occur?)
  • I: Influencing factors (what makes the pain better or worse?)
• Red Flags: Danger signs that require immediate attention, such as:
  • Severe head trauma
  • Difficulty breathing
  • Chest pain or pressure
  • Severe abdominal pain
  • Severe allergic reactions

What Laypeople Can Do

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder to try to rouse them.
• If someone is bleeding, apply gentle pressure with a clean cloth or bandage to the wound.
• If someone is having a seizure, turn them onto their side to prevent choking and clear the area around them.
• If someone is having a heart attack, call 911 and try to keep them calm.
• If someone is having a severe allergic reaction, call 911 and try to administer epinephrine (if available).

Common Mistakes

• Mistake: Not checking the patient's airway first.
• Fix: Always check the airway before moving on to other parts of the exam, as a blocked airway can be life-threatening.
• Mistake: Not asking the patient about their medical history.
• Fix: A patient's medical history can provide critical clues to their condition, so always ask about previous conditions or surgeries.
• Mistake: Not checking for red flags.
• Fix: Red flags are danger signs that require immediate attention, so always check for them during the exam.

Quick Practice Scenarios

• A patient comes in with severe chest pain and difficulty breathing. What should you do first?
  • Answer: Check the patient's airway to ensure it's clear.
  • Reason: A blocked airway can be life-threatening and needs to be addressed immediately.
• A patient comes in with a severe head injury and is unresponsive. What should you do first?
  • Answer: Call for help and start CPR.
  • Reason: A severe head injury can be life-threatening, and CPR may be necessary to restore circulation and breathing.
• A patient comes in with severe abdominal pain and is vomiting. What should you do first?
  • Answer: Check the patient's vital signs and look for signs of dehydration.
  • Reason: Severe abdominal pain and vomiting can lead to dehydration, which needs to be addressed quickly.

Last-Minute Exam Cram

• Normal vital sign ranges:
  • Pulse: 60-100 beats per minute
  • Breathing rate: 12-20 breaths per minute
  • Blood pressure: 90/60 to 120/80 mmHg
  • Temperature: 97.7-99.5°F (36.5-37.5°C)
• Drug doses:
  • Epinephrine: 0.1-0.3 mg IV
  • Atropine: 0.5-1 mg IV
• Mnemonics:
  • AVPU: Alert, Verbal, Pain, Unresponsive
  • SAMPLE: Symptoms, Allergies, Medical history, Pain, Last meal, Events leading up to the emergency
  • OPQRSTI: Onset, Pain location, Quality, Radiation, Severity, Timing, Influencing factors
• Assessment sequences:
  • Airway, Breathing, Circulation, Neurological, SAMPLE
• Common "trick" questions:
  • Agonal breathing is NOT normal breathing – start CPR.
  • A patient with a severe head injury may have a decreased level of consciousness – check for AVPU.