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SECONDARY SURVEY The object of a secondary survey is to detect medical and injury-related problems that do not pose an immediate threat to survival but that, if left untreated, may do so. Unlike the primary survey, the secondary survey is not a "treat-as-you-go" process. Instead, you should mentally note the injuries and problems as you systematically complete the survey. Then you must formulate priorities and a plan for treatment. The secondary survey for a patient who presents with medical illness is somewhat different from that of an injured patient. Usually the trauma assessment is about 20 percent patient interview and 80 percent physical exam. On the other hand, the medical assessment is 80 percent patient interview and 20 percent physical exam. Both the physical exam and patient interview should always be done for all medical and trauma patients. NOTE: Remember, if the patient's condition deteriorates, it may not be possible to complete the secondary survey before starting to transport the patient. Subjective Interview Relatives and bystanders at the emergency scene may also serve as sources of information, but you should not interrupt interviewing the patient to gather information from a bystander. If the patient is unconscious, you may obtain information from bystanders and medical identification devices while you are conducting the physical examination. When conducting a patient interview, you should take the following steps: 1. Place yourself close to the patient. Position yourself, when practical, so the patient can see your face. If at all possible, position yourself so that the sun or bright lights are not at your back. The glare makes it difficult for the patient to look at you. 2. Identify yourself and reassure the patient. Identify yourself and maintain a calm, professional manner. Speak to the patient in your normal voice. 3. Learn your patient's name. Once you learn the patient's name, you should use it during the rest of your interview. Children will expect you to use their first name. For military adults, use the appropriate rank. If civilian, use "Mr." or "Ms." unless they introduce themselves by their first name. 4. Learn your patient's age. Age information will be needed for reports and communications with the medical facility. You should ask adolescents their age to be certain that you are dealing with a minor. With minors, always ask how you can contact their parent or guardian. Sometimes this question upsets children because it intensifies their fear of being sick or injured. Be prepared to offer comfort and assure children that someone will contact their parents or guardians. 5. Seek out what is wrong. During this part of the interview, you are seeking information about the patient's symptoms and what the patient feels or senses (such as pain or nausea). Also, find out what the patient's chief complaint is. Patients may give you several complaints, so ask what is bothering them most. Unless there is a spinal injury that has interrupted nerve pathways, most injured individuals will be able to tell you of painful areas. 6. Ask the PQRST questions if the patient is experiencing pain or breathing difficulties. P = Provocation 3/4 What brought this on? R=Recurrence3/4Has this happened before? T =Time3/4When did it begin? A=Allergies 3/4 Are you allergic to any medication or anything else? M=Medications3/4Are you currently taking any medication? P=Previous medical history 3/4 Have you been having any medical problems? Have you been feeling ill? Have you been seen by a physician recently? L=Last meal 3/4 When did you eat or drink last? (Keep in mind, food could cause the symptoms or aggravate a medical problem. Also, if the patient requires surgery, the hospital staff will need to know when the patient has eaten last.) E=Events 3/4 What events led to today's problem (e.g., the patient passed out and then got into a car crash)? |
 
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