NREMT EMT 3: Secondary Assessment - Rapid Head-to-Toe Physical Exam, Inspection, Palpation, Auscultation

What This Is

A rapid head-to-toe physical exam is a quick assessment of a patient's vital signs and overall condition. It's like a "snapshot" of their health, taken in a short amount of time. This skill is crucial in emergency situations, such as when a patient is unconscious or experiencing severe symptoms. For example, imagine you're at a concert and someone suddenly collapses. You need to quickly assess their condition to help the paramedics when they arrive.

Key Steps / Core Facts

• Airway: Check if the patient's airway is clear (no blockages). If not, it's like a drinking straw – if it's blocked, nothing else works. (AVPU)
  • Check for a patent airway (open) by listening for breath sounds and feeling for air on your cheek.
  • If the airway is blocked, use the Heimlich maneuver (5-10 quick thrusts).
• Breathing: Check the patient's breathing rate and depth. A normal breathing rate is 12-20 breaths per minute. (AVPU)
  • If the patient is not breathing, start CPR (30 chest compressions, 2 breaths).
• Circulation: Check the patient's pulse and blood pressure. A normal pulse is 60-100 beats per minute. (OPQRSTI)
  • If the patient has no pulse, start CPR.
• Disability: Check the patient's level of consciousness (AVPU). A normal level of consciousness is awake and alert.
  • If the patient is unresponsive, start CPR.
• Exposure: Check the patient's clothing and body position. Make sure they're not in a position that could cause further injury.
  • Remove any constricting clothing or jewelry.
• Pain: Ask the patient about their pain level (0-10). A normal pain level is 0-3.
  • If the patient is in severe pain, provide pain relief (e.g., morphine).
• Mental Status: Check the patient's mental status (AVPU). A normal mental status is awake and alert.
  • If the patient is confused or disoriented, provide reassurance and support.
• Vital Signs: Check the patient's vital signs (temperature, pulse, breathing rate, blood pressure). A normal temperature is 97.7-99.5°F (36.5-37.5°C).
  • If the patient has a fever, provide antipyretics (e.g., acetaminophen).
• Head: Check the patient's head for any injuries or abnormalities.
  • If the patient has a head injury, provide cervical spine protection (e.g., a collar).
• Neck: Check the patient's neck for any injuries or abnormalities.
  • If the patient has a neck injury, provide cervical spine protection.
• Back: Check the patient's back for any injuries or abnormalities.
  • If the patient has a back injury, provide spinal immobilization (e.g., a board).
• Abdomen: Check the patient's abdomen for any injuries or abnormalities.
  • If the patient has an abdominal injury, provide pain relief and monitor for signs of peritonitis.
• Extremities: Check the patient's extremities (arms and legs) for any injuries or abnormalities.
  • If the patient has an extremity injury, provide splinting and immobilization.

What Laypeople Can Do

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder.
• If someone is choking, stand behind them and use the Heimlich maneuver (5-10 quick thrusts).
• If someone is bleeding, apply pressure to the wound with a clean cloth or gauze.
• If someone is having a seizure, clear the area of any objects that could cause injury and turn them onto their side.
• If someone is experiencing severe pain, provide reassurance and support, and try to keep them calm.

Common Mistakes

• Mistake: Not checking the patient's airway first.
  • Fix: Always check the airway first, as a blocked airway can lead to cardiac arrest.
• Mistake: Not providing cervical spine protection for a head or neck injury.
  • Fix: Always provide cervical spine protection for head or neck injuries, as they can lead to spinal cord damage.
• Mistake: Not monitoring the patient's vital signs regularly.
  • Fix: Always monitor the patient's vital signs regularly, as changes can indicate a worsening condition.
• Mistake: Not providing pain relief for a patient in severe pain.
  • Fix: Always provide pain relief for a patient in severe pain, as it can help reduce suffering and improve treatment outcomes.
• Mistake: Not keeping the patient calm and reassured.
  • Fix: Always keep the patient calm and reassured, as it can help reduce stress and improve treatment outcomes.

Quick Practice Scenarios

1. A patient comes in with a severe headache and is vomiting. What should you do first?

Answer: Check the patient's airway and breathing rate.

Reason: A severe headache and vomiting can indicate a serious condition, such as a stroke or meningitis, which requires immediate attention.

1. A patient is experiencing severe chest pain and is short of breath. What should you do first?

Answer: Check the patient's airway and breathing rate.

Reason: Severe chest pain and shortness of breath can indicate a heart attack or pulmonary embolism, which requires immediate attention.

1. A patient is unconscious and has no pulse. What should you do first?

Answer: Start CPR.

Reason: An unconscious patient with no pulse requires immediate CPR to restore blood flow and oxygenation to the brain and other vital organs.

Last-Minute Exam Cram

• Normal vital signs: temperature (97.7-99.5°F), pulse (60-100 beats per minute), breathing rate (12-20 breaths per minute), blood pressure (90-140/60-90 mmHg).
• Drug doses: morphine (2-4 mg IV), acetaminophen (650-1000 mg PO).
• Mnemonics: AVPU (Alert, Verbal, Pain, Unresponsive), OPQRSTI (Onset, Provocation, Quality, Region, Severity, Time, Insurance).
• Assessment sequences: Airway, Breathing, Circulation, Disability, Exposure, Pain, Mental Status, Vital Signs.
• Common "trick" questions: Agonal breathing is NOT normal breathing – start CPR. A normal pulse is 60-100 beats per minute. A normal breathing rate is 12-20 breaths per minute.