EMR Module 6. Using a pocket mask.
EMR Module 7. Patient History
EMR Module 8. Secondary Asessment

Assess the patient from head to toe.

Head and Face

  1. Inspect the head and face for wounds, deformities, discolorations, or bloody or serous drainage from the nose or ears. Palpate the entire head and face for wounds, deformities, or tenderness.

  2. In the conscious and cooperative patient, evaluate gross vision, and dental occlusion.

  3. Note any unusual odors, for example, gasoline, fruity breath, or ethanol.

Neck

  1. Inspect the anterior neck for wounds, jugular venous distention, discolorations, or deformities. Palpate the anterior neck for deformities, crepitus, tenderness, or tracheal deviation (best palpated in the notch above the manubrium).

  2. Gently palpate the posterior neck from the base of the skull to the upper back for wounds, deformities, tenderness, or muscle spasms.

Chest

  1. Inspect the anterior and lateral chest for wounds, deformities, discolorations, respiratory expansion, symmetry, and paradoxical movement. Palpate the anterior and lateral chest for deformities, tenderness, or crepitus.

  2. Auscultate breath sounds to determine whether they are present and equal bilaterally and note any abnormal sounds, such as crackles and wheezes.

  3. Auscultate heart sounds to determine whether they are clear or muffled.

Abdomen and Flanks

  1. Inspect the abdomen and flanks for wounds, discolorations, or distention.

  2. Auscultate all quadrants for the presence of bowel sounds.

  3. Gently palpate the abdomen and flanks for tenderness, guarding, rigidity, or masses.

    To facilitate patient cooperation, palpate known painful areas last.

Pelvis and Perineum

  1. Inspect the pelvic area and perineum for wounds, deformities, discolorations, or bleeding from the urinary meatus, vagina, or rectum.

  2. Palpate for pelvic tenderness, crepitus, or instability by gently pressing in on the anterosuperior iliac crests bilaterally and pushing down on the pubic symphysis.

Extremities

  1. Inspect all extremities for wounds, deformities, or discolorations.

  2. Palpate all extremities for tenderness, deformities, muscle spasms, skin temperature and moisture, and distal pulses.

  3. If the patient is conscious, determine gross motor and sensory function by having the patient wiggle the toes and fingers and asking whether he or she can feel your touch.

Inspect Posterior Surfaces

  1. In the injured patient, obtain assistance to maintain cervical spine alignment and support injured extremities while log rolling the patient to the side.

    Avoid rolling the patient onto an injured extremity or side if possible. If necessary, for adequate assessment of posterior surfaces, roll the patient to both sides.
    There is evidence that the log roll maneuver can result in spinal and pelvic movement. Carefully consider the risks and benefits of performing this maneuver, especially if the potential for spinal cord injury or pelvic fracture is significant.3
    When spinal or pelvic injuries are suspected, radiographs are recommended before logrolling the patient.5
  2. Inspect the posterior surfaces for wounds, deformities, or discolorations. Palpate all posterior surfaces for wounds, deformities, or muscle spasms.