How is a secondary assessment done in wilderness medicine?

In wilderness medicine, a secondary assessment is a detailed and systematic evaluation of a patient who has already undergone an initial assessment and received any necessary life-saving interventions. The purpose of the secondary assessment is to identify any additional injuries or medical conditions that may not have been immediately apparent during the initial assessment. It involves a comprehensive examination of the patient's vital signs, physical appearance, and medical history.

Here's a general overview of how a secondary assessment is done in wilderness medicine:

1. Initial Observation: Begin by observing the patient's overall appearance and behavior. Note their level of consciousness, respiratory effort, skin color, and body position. Look for any signs of distress or discomfort.

2. Vital Signs: Measure and document the patient's vital signs, including pulse, respiratory rate, blood pressure, and temperature. Pay close attention to any deviations from normal values and compare them to the findings from the initial assessment.

3. Head-to-Toe Examination: Perform a systematic examination of the patient from head to toe. Check for any injuries or abnormalities in the following areas:

- Head and face: Inspect the scalp for lacerations, bruises, or deformities. Check the ears, nose, and mouth for any bleeding, discharge, or foreign objects.

- Neck: Palpate the neck gently to assess for tenderness or swelling. Check for any signs of neck pain or difficulty swallowing.

- Chest and lungs: Auscultate the lungs for any abnormal breath sounds, such as wheezing, rales, or decreased air entry. Inspect the chest for any wounds, deformities, or tenderness.

- Heart: Auscultate the heart for any irregularities in rate or rhythm. Check for signs of heart failure, such as edema, jugular vein distension, or dyspnea.

- Abdomen: Palpate the abdomen for any tenderness, rigidity, or masses. Check for any signs of abdominal pain or distension. Listen for bowel sounds using a stethoscope.

- Pelvis and extremities: Inspect the pelvis and extremities for any fractures, dislocations, or wounds. Check for any signs of pain or deformity.

- Neurological assessment: Assess the patient's level of consciousness, pupillary response, motor function, and sensory perception. Look for any signs of neurological deficits.

- Skin: Check the skin for any rashes, lesions, or signs of infection. Assess for any changes in skin color, temperature, or moisture.

4. Medical History: Ask the patient about their past medical history, current medications, allergies, and any recent illnesses or injuries. This information can help identify any potential underlying medical conditions that may be contributing to their symptoms.

5. Reassessment: Regularly reassess the patient's condition and vital signs throughout the secondary assessment. This helps monitor their progress and identify any changes in their condition.

6. Documentation: Document all findings from the secondary assessment, including vital signs, physical examination findings, and any relevant patient information. This documentation serves as a record of the patient's condition and helps guide further management decisions.

It's important to note that the specific components of a secondary assessment may vary depending on the patient's condition, the available resources, and the environment. The goal of the secondary assessment is to comprehensively evaluate the patient's condition and identify any medical issues that may require further treatment or specialized care.