Wilderness and Rescue Medicine 8th Edition

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Section I: General Principles

The Secondary Assessment The secondary assessment involves gathering a rel- evant medical history, investigating the patient’s chief complaint , and systematically assessing the patient. Speed and detail change with circum- stance. It is not necessary or efficient to stop and treat problems as you find them. Get the whole picture, complete your list, and then return to treat each problem in order of priority.

Stabilize the Patient Make sure that the patient’s airway is clear and that there is sufficient respiratory effort to oxygen- ate their lungs. Check for a pulse and perform a quick sweep for severe bleeding or other problems capable of causing shock. While you are doing this, assess brain function by noting mental status and level of consciousness.

General Principles

Primary Assessment

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General Principles

Secondary Assessment

Stabilize the Patient

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Complete Then Treat

Circulatory Respiratory

Pulse Bleeding

Airway Breathing

Physical Exam SAMPLE History

PRIMARY ASSESSMENT

SECONDARY ASSESSMENT

Nervous AVPU Spine

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Vital Signs

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“The initial assessment is your quick check on the status of the patient's three critical body systems.”

“Get the whole picture, complete your list, then return to treat each problem in order of priority.”

© 2018 WMA

Your primary assessment might be as simple as asking, “How do you do?” and getting a “Fine” and a smile. Or, you might be on belay in a crevasse lis- tening for breath sounds and looking inside bulky clothing for blood on an unresponsive climber. Whatever form it takes, the primary assessment is a critical step in your organized approach to the situation. Any serious problems encountered in the primary assessment must be immediately stabilized before worrying about anything else. Your immediate treatment of life-threatening problems found in the primary assessment is referred to as Basic Life Support (BLS) and may include cardiopulmonary resuscitation (CPR), airway control, bleeding control, and protection from extremes of heat or cold. Advanced life support (ALS) adds medications and special- ized tools to manage these same critical system problems. You may not get any further than BLS or ALS with your assessment and treatment if the injury or illness is severe. In most cases, however, you will be able to rule out or stabilize serious problems and go on to the secondary assessment.

© 2018 WMA

Most practitioners in the civilized setting are accustomed to patients sitting quietly on an exam table and prefer to start their exam with the head and neck and then move to the chest, abdomen, pelvis, legs, arms, and back. It is comforting to have a routine, making the process more efficient and reassuring for both the examiner and the patient. A well-rehearsed routine will be even more valuable in the backcountry situation when you are challenged by wind, cold, radio traffic, and scene management. You may not yet know what the problem is, but you know what to do: exam- ine the patient. Conducting your exam will calm you down, focus your attention, and give you the information that you need. Your exam should be as comprehensive as the situation requires and allows. Realistically, the order in which you perform your exammakes no difference. Start where it makes sense to start. If the patient is lying face down, examine their back first. It is not necessary to see or feel every body part if no symptom or MOI suggests involve- ment. It is important that the rescuer go through