Part of the big picture is how you're going to get out of the woods
If Patient Assessment were a day at Disneyland, then the Primary Assessment would be the early morning run to all of the most crucial rides and attractions, and the Secondary Assessment would be the rest of your day. In other words, Primary Assessment takes care of what is most urgent (immediate threats to life), and the Secondary Assessment addresses the entire picture and is an ongoing process.
You cannot move to the Secondary Assessment without first first conducting the Primary. How would you feel spending a day hanging around It’s a Small World and Peter Pan knowing you missed your key opportunity to ride Indiana Jones? But enough with the analogies…
Head to Toe Exam
Moving head to toe, press gently but firmly on major body parts while observing and asking questions. Places to avoid: obvious injured areas (until to treat them), and genitals (unless that’s where the injury is.
Observe for DOTS: Deformities, Open Injuries, Tenderness, and Swelling. Ask about pain. If you find an injury, expose it but take into consideration the environment and outside temperature.
Check the eyes, pupils, ears, nose, jawbone, scalp, nose, and cheekbones. CAREFULLY check the neck, including the top 7 (cervical) vertebrae. Press on each shoulder. Squeeze the upper ribcage and lower, each time asking the patient to inhale deeply. Press on the sternum. Move down to the abdomen and GENTLY press on each quadrant, noting any tenderness, distention, or guarding/wincing. Press downward on the two pelvis crests, then inward. Check each arm and leg independently. Check for Circulation, Sensation, and Movement (CSM) in each hand and foot. Checking the back is an important step which is better explained in a classroom setting. (Here’s where you sign up for class)
Check vitals early, often, and document them. Start with the time they are taken and then note: the patient’s level of responsiveness, respiratory rate, heart rate, and the skins color, temperature, and moisture.
Here is where you get to hear from the patient, in their own words. Use the mnemonic SAMPLE to guide you through your interview, but don’t be afraid to ask additional questions.
S- signs and symptoms. What hurts? How bad does it hurt? Can you describe the pain?
A- allergies. Are you allergic to anything (drugs, food, bites/stings)? Have you come in contact with that allergen today?
M- medications. What are you currently on (prescription, over-the-counter, recreational)?
P- pertinent history. Have you hurt this foot in the past?
L- last “ins and outs.” What have you had to eat and drink today? Have you have normal bathroom trips?
E- events leading up to illness/injury. Can you tell me again what happened? What were you doing right before you started feeling this way?
Getting the Big Picture
Once again, the purpose of the Secondary Assessment is to identify everything that is wrong and start thinking about a long-term solution. While taking one set of vitals provides a snapshot of the patient’s condition, 10 sets provides a movie. Check vitals every 5 minutes for an unstable patient and every 15 for a stable patient. Continue to provide compassion and support to the person who is injured or ill. Monitor your surroundings: is it getting dark? Is weather moving in? Is the tide or current changing?
Stay tuned for the “Arts and Crafts” of wilderness first aid…wilderness first aid kits!