EMR – Secondary Assessment — Quick Review

When gathering a SAMPLE history, what does the letter ‘A’ represent?

A 58-year-old male complains of chest pain. During the SAMPLE history you ask about his pertinent past medical history. Which response is MOST relevant to his current complaint?

You are assessing a 44-year-old female with shortness of breath. She states she takes a daily inhaler but cannot recall the name. Which component of the SAMPLE history are you addressing?

During a SAMPLE history for a patient with abdominal pain, the ‘L’ component prompts you to ask about last oral intake. Why is this information important in the prehospital setting?

You respond to a 67-year-old male who collapsed at home. His wife reports he seemed confused this morning and then lost consciousness. She is unsure of his current medications. Which SAMPLE component, if missing, poses the GREATEST immediate clinical concern?

When using OPQRST to evaluate a patient’s pain, what does the letter ‘R’ stand for?

A patient rates her abdominal pain as 7 out of 10. Which part of OPQRST does this rating address?

A 50-year-old male describes his chest pain as feeling like crushing pressure, as if something is sitting on his chest. Which element of OPQRST does this description address?

Using OPQRST, you ask a patient whether anything makes her flank pain better or worse. She states the pain worsens when she tries to urinate. This finding is MOST consistent with which condition?

A 72-year-old female with diabetes presents with nausea and mild upper abdominal discomfort for the past hour. She denies chest pain. Using OPQRST, which finding would MOST increase your suspicion for an acute cardiac event?

A conscious patient reports pain only in her right ankle after rolling it during a run. There is no other mechanism of injury. What is the MOST appropriate secondary assessment approach?

You arrive at a scene where a 35-year-old male is conscious, alert, and complaining of difficulty breathing after being stung by a bee. Which focused exam finding would MOST warrant immediate intervention?

A 60-year-old male presents with sudden onset of a severe headache he describes as the worst of his life. During the focused physical exam, which finding would be MOST concerning?

You assess a 48-year-old female who reports left-sided flank pain radiating to her groin, with nausea and an inability to find a comfortable position. Her skin is sweaty and she is writhing on the stretcher. Which focused exam technique is MOST appropriate to help distinguish a kidney stone from a possible aortic emergency?

During a rapid head-to-toe trauma assessment, you note an open wound to the front of the neck. Besides controlling bleeding, what is a MAJOR immediate concern with this type of injury?

When performing a rapid head-to-toe trauma assessment on an unresponsive patient, what should be assessed when examining the chest?

You are performing a rapid trauma assessment on a 22-year-old unrestrained driver involved in a high-speed collision. When you reach the pelvis, you note instability with gentle compression. What should you do NEXT?

During a rapid head-to-toe trauma assessment, you use the mnemonic DCAP-BTLS. What does this mnemonic prompt the EMR to look and feel for at each body region?

You arrive at a construction site where a worker fell about 20 feet from scaffolding. He is unconscious and breathing. During the rapid head-to-toe assessment you note bruising over the bony area just behind one ear. What does this finding most likely indicate?

When interviewing a responsive medical patient, which approach is BEST for encouraging the patient to describe their symptoms in their own words?

During a patient interview, your patient pauses and looks away when you ask about her alcohol use. Which interviewing technique is MOST appropriate at this moment?

On a 55-year-old male with chest pain you obtain a blood pressure of 132/84 mmHg, a heart rate of 92, and a respiratory rate of 16. Five minutes later his blood pressure is 108/70 mmHg, his heart rate is 110, and his respiratory rate is 20. How should you interpret this trend?

A 78-year-old female taking a beta-blocker presents with general weakness and altered mental status. Her first vitals show a blood pressure of 106/68 mmHg and a heart rate of 58. Five minutes later her blood pressure is 100/64 mmHg and her heart rate is still 58. Why is this vital sign trend particularly difficult to interpret in this patient?

An EMR is caring for a 58-year-old male with a sprained ankle who is alert, has stable vital signs, and is in mild pain. How often should the EMR reassess this patient while awaiting EMS arrival?

A 72-year-old woman has chest pain radiating to her left arm, diaphoresis, and a blood pressure of 88/60 mmHg. She is conscious but confused. Which reassessment interval is most appropriate?

An EMR is monitoring a 34-year-old construction worker who sustained a laceration to the forearm. Bleeding is controlled, the patient is alert and oriented, and vital signs are within normal limits. During transport preparation, the patient becomes pale, reports feeling dizzy, and begins sweating. What should the EMR do regarding the reassessment interval?

Which of the following patients would be classified as STABLE and appropriate for a 15-minute reassessment interval?

An EMR is caring for a 51-year-old female found unresponsive. After airway management and rescue breathing, she begins breathing spontaneously and becomes responsive to verbal stimuli. Her radial pulse is weak but present. Which reassessment interval and rationale are MOST appropriate?

An EMR applies direct pressure to a leg wound that was bleeding heavily. Two minutes later, what is the most important finding to document during reassessment?

A patient was found confused and breathing shallowly at a rate of 6 per minute. The EMR begins assisted ventilations with a bag-valve mask. After 2 minutes of ventilation support, which finding would indicate the patient’s condition has IMPROVED?

An EMR places an unresponsive patient in the recovery position to manage secretions. On reassessment 3 minutes later, the patient is making gurgling sounds and appears to be gagging. What does this MOST likely indicate?

An EMR applied a tourniquet to a patient’s arm for severe hemorrhage from a traumatic amputation. During reassessment, the patient reports feeling more pain in the arm distal to the tourniquet and the EMR notes the wound site is no longer bleeding. Which interpretation is MOST accurate?

After opening a patient’s airway with a head-tilt chin-lift, the EMR observes the patient’s chest rising with each breath and the breathing rate has normalized to 14 per minute. What does this indicate?

An EMR applied direct pressure and a pressure bandage to a forearm laceration 5 minutes ago. On reassessment, blood has soaked through the bandage and pooled on the ground. What is the BEST next action to evaluate and address the intervention?

An EMR performed a jaw-thrust maneuver on a trauma patient with suspected spinal injury who was making snoring sounds. On reassessment, the patient’s skin is pink and warm, breathing is 16 per minute with normal depth, and snoring has resolved. A bystander suggests the EMR can now let go. Which response is MOST appropriate?

During a rapid head-to-toe physical exam on a trauma patient, the EMR notices the skin over the patient’s lower left ribs is scraped raw with surface bleeding. Which DCAP-BTLS finding does this represent?

While palpating a patient’s chest during a physical exam, an EMR feels a crackling sensation under the fingertips over the right side. Which DCAP-BTLS finding is described?

During a secondary assessment of a fall victim, the EMR notes the patient’s upper arm has a visible bend midshaft where no joint exists. On palpation, the patient winces and the EMR feels a grinding sensation. Which two DCAP-BTLS findings are present?

An EMR is assessing a motorcyclist thrown from his bike. During the physical exam of the abdomen, the patient reports pain when the EMR presses gently, and the EMR notes the abdomen is rigid. Which DCAP-BTLS component most directly corresponds to the pain elicited by palpation?

An EMR completes a secondary assessment on a pedestrian struck by a vehicle. The chest exam reveals bruising over the sternum, no paradoxical movement, equal breath sounds, and tenderness on palpation. The acronym DCAP-BTLS is used to organize findings. Which two separate DCAP-BTLS findings are present at the sternum?

An EMR shines a penlight into a patient’s eyes and notes both pupils are equal, round, and each constricts when exposed to light. How should these findings be documented?

A 66-year-old male was found slumped in his chair. On assessment, he responds only to painful stimuli, his skin is cool and clammy, and his lips are pale. Which combination of findings is MOST consistent with hemodynamic compromise?

During reassessment, an EMR notices a previously alert patient is now only responding to voice, has unequal pupils with the left pupil larger than the right and sluggishly reactive, and has flushed dry skin. Which condition do these findings MOST suggest?

An EMR assesses a 22-year-old who collapsed at an outdoor festival on a hot day. The patient is alert but confused, skin is hot and DRY, and pupils are equal and reactive. Temperature is estimated to be very high. Which interpretation and action are MOST appropriate?

An EMR is gathering a patient history using the SAMPLE mnemonic. The patient states she takes metformin and lisinopril daily. Under which SAMPLE component would the EMR record these medications?

An EMR is gathering history on a 78-year-old male with sudden onset difficulty speaking and left-sided facial drooping. The patient’s wife states he takes warfarin daily. Why is this medication information critical to relay to incoming EMS providers?

An EMR is interviewing a 58-year-old man who called because of chest discomfort. When gathering a SAMPLE history, which component captures when the patient last ate or drank?

A responsive 44-year-old woman reports she is having difficulty breathing. During the SAMPLE history, the EMR asks what medications she currently takes. The patient mentions she uses an albuterol inhaler. This information belongs to which SAMPLE component?

An EMR responds to a 67-year-old male complaining of sudden onset of right-sided weakness and slurred speech. During the SAMPLE history, the patient’s wife states that he had a similar episode about six months ago that resolved on its own. Which SAMPLE component does this information represent?

While obtaining a SAMPLE history from a 33-year-old woman with abdominal pain, the EMR asks specifically what the patient was doing in the moments before the pain began. Which SAMPLE component does this question most directly address?

An EMR is assessing a 71-year-old man with shortness of breath. He reports a penicillin allergy causing hives and states he takes lisinopril and metformin daily. His wife mentions he had coronary artery bypass grafting three years ago. He last ate breakfast two hours ago. Which element of the SAMPLE history is MOST immediately relevant to his current chief complaint?

A 49-year-old man complains of chest pain. The EMR asks, Does the pain stay in one place or does it move anywhere? Which component of OPQRST does this question address?

An EMR asks a patient with leg pain, On a scale of zero to ten, with ten being the worst pain you have ever felt, how would you rate your pain right now? This question corresponds to which OPQRST component?

A 55-year-old woman describes her abdominal pain as sharp and stabbing. The EMR then asks, Is the pain constant, or does it come and go? Which OPQRST component is being assessed with this follow-up question?

An EMR asks a patient with back pain, Does anything you do make the pain better or worse? The patient responds that leaning forward slightly reduces the discomfort. Which OPQRST component does the patient’s response most directly inform?

A 62-year-old man with hypertension calls 9-1-1 for a headache he rates as 10 out of 10. He describes it as the worst headache of my life, saying it came on suddenly while he was at rest about 45 minutes ago and has not changed in intensity since. Which OPQRST findings in combination are MOST concerning for a life-threatening intracranial event?

An EMR arrives to find a 38-year-old woman who is alert and complaining of right ankle pain after twisting it on a hiking trail. There is no mechanism suggesting multi-system trauma. After the primary assessment, the EMR should perform which type of physical exam?

A 52-year-old man is alert and oriented, complaining of substernal chest pressure that began at rest 20 minutes ago. During the focused physical exam, which assessment finding would MOST change the EMR’s management priority?

An EMR is assessing a 29-year-old woman who reports difficulty breathing after being stung by a bee. During the focused physical exam, which finding is MOST consistent with anaphylaxis rather than a localized allergic reaction?

An EMR responds to a 68-year-old man with a history of COPD who is alert and oriented but in moderate respiratory distress. The focused physical exam reveals accessory muscle use, a prolonged expiratory phase, and diffuse expiratory wheezing bilaterally. His oxygen saturation is 88% on room air. Which assessment finding would MOST indicate that this patient is deteriorating beyond the EMR’s current management capability?

During a rapid head-to-toe trauma assessment on an unresponsive adult struck by a vehicle, the EMR gently palpates the pelvis to check for instability. Detecting instability with this maneuver would most suggest which injury?

An EMR is performing a rapid head-to-toe trauma assessment on a 17-year-old male who fell from a roof and is in severe respiratory distress. When assessing the neck, the EMR finds the trachea deviated to the left, with absent breath sounds and a distended appearance of the neck veins on the right. Which condition do these findings most suggest?

During a rapid head-to-toe assessment of an unresponsive 45-year-old male found at the base of a staircase, the EMR notes bruising around both eyes and bruising behind both ears. These findings most strongly suggest which injury?

An EMR is performing a rapid head-to-toe trauma assessment on an unresponsive 30-year-old woman ejected from a motorcycle. During assessment of the thorax, the EMR finds that one segment of the left chest wall moves inward during inhalation while the rest of the chest expands outward. What is the MOST appropriate immediate action after identifying this finding?

An EMR is interviewing a 72-year-old woman who is alert but anxious after calling 9-1-1 for dizziness. To obtain the most accurate and complete information, which interviewing approach is BEST?

An EMR is interviewing a 55-year-old man with abdominal pain who gives vague, one-word answers. Which technique would BEST encourage the patient to provide more complete information?

An EMR arrives to find a 40-year-old woman in moderate distress who is alert and oriented. She is accompanied by her adult son, who continually answers questions directed at the patient and often contradicts what the patient begins to say. The patient appears to defer to her son. Which approach BEST balances therapeutic communication with accurate history gathering?

An EMR obtains an initial set of vital signs on a 60-year-old man with abdominal pain showing a blood pressure of 126/78 mmHg, a pulse of 88 beats per minute, and a respiratory rate of 16 breaths per minute. Five minutes later, the repeat vital signs show a blood pressure of 104/70 mmHg, a pulse of 112 beats per minute, and a respiratory rate of 22 breaths per minute. How should the EMR interpret this trend?