Secondary Assessment following trauma
This assessment is done in a trauma setting where the patient is either Stable or Potentially unstable. According to the PNIC, it is to be performed after the LABCDE and after vitals, since these assessments will help you determine the level of stability of the patient.
- When palpating, it is important to slide your hands and not tap. Verify for blood, and or other fluids on your gloves constantly. Ask the patient if he feels any pain whatsoever, if they do, record and CONTINUE the assessment.
- Make sure to explain to the patient what exactly you are doing and why.
- When checking the extremities, make sure to ask your patient if he/she feels your hand equalling on both sides and test for strength either via push/pull or squeezing.
- When doing the extension test with the clenched fist against the chest pushing outwards, make sure the patient spreads his fingers and extends his/her arms straight upward and not sideways. This effectively verifies for any possible spinal lesions and motor/coordination deficiencies.
- When performing the head rotation test, the patient should follow your hand and the paramedic should immediately stop if an odd sound is produced or if the patient complains of pain. Also, this test is done without a c-collar, if its on, simply open it up and then close it back again once done.
- Keep C-spine alignment when logrolling the patient
- Checking the back requires that the paramedic spreads his fingers a minimum of 2 inches on each side of the spinal processes. The patient is asked if any pain is felt after EVERY process.
This assessment will allow you to note any deformities, bleeding, or pain that may not be visible to the naked eye, which can indicate immobilization or not.