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So now in this segment we’re going to talk about secondary assessment overview for ACLS. Different than primary assessment. And especially different than the primary assessment for BLS. The secondary assessment is a process of differentiating between two or more conditions that share similar signs or symptoms. The assessment included a focused medical history and searching for and treating underlying causes like the H's and the T's. Gathering a focused history of the patient is highly recommended. Ask specific questions related to the patient's presentation and consider using the memory aid SAMPLE for your evaluation. Now SAMPLE stands for: S. Signs and symptoms. A. Allergies. M. Medications (including the last dose taken). P. Past medical history (especially those that may be related to the current illness). L stands for last meal consumed and E, the events that lead up to this condition. The answers that the health care professional can obtain from this assessment may help them decide which suspected diagnoses needs to be treated to try and reverse the symptoms. Now look for and treat the underlying cause by considering the H's and T's to ensure you are not overlooking any possibility. The H's and T's have been proven to be a good reminder to help the practitioner rule out possible the diagnoses and interventions for your patient and their successful survival.
In this lesson, we'll get into some details on performing a secondary assessment for ACLS healthcare providers. And at the end of the lesson, we'll discuss some common questions, with answers, you may encounter during the assessment phase.
Performing a secondary assessment overview in ACLS is different than performing a primary assessment in ACLS. And it's significantly different than performing a primary assessment in basic life support situations.
In a nutshell, a secondary assessment ACLS overview is the process of differentiating between two or more conditions that share similar signs and symptoms. This includes a focused medical history, as well as thoroughly searching through the H's and T's for any intriguing underlying causes that may have contributed to the patient's condition.
Pro Tip: Gathering a focused medical, and non-medical, history of the patient is highly recommended during the secondary survey. Ask yourself specific questions that are related to that history as well as the patient's presentation. To this end, use the following acronym and memory aide during your evaluations – SAMPLE.
S - What are the patient's Signs and Symptoms?A - Does the patients have any Allergies?M - Is the patient taking any Medications, including the last dose?P - Is there anything in the patient's Past medical history that could be related?L - What was the Last meal that the patient consumed?E - What Events may have led to the patient's current condition?
The answers to the above questions during your secondary assessment may help lead you to a correct and informed diagnosis and an appropriate course of treatment to help reverse the patient's condition and restore their health.
Of particular importance are the H's and T's. To help you discover and treat any underlying causes that may have led to this event, consider the H's and T's to ensure you aren't overlooking any likely or dangerous possibilities. The H's and T's can help create a road map for you as you attempt to find possible diagnoses and the ensuing interventions and treatment options for your patient.
The H's and T's are a tried and true reminder that can help you rule out some possibilities and also confirm other possibilities, and it's the focus of the next lesson.
In this section, we'll go over some common questions you may encounter in ACLS and specifically during the assessment phases.
This is where the H's and T's can help you in identifying potential reversible causes of cardiac arrest as well as emergency cardiopulmonary conditions.
The most common causes of cardiac arrest are:
If you aren't sure about the presence of a pulse, you should still begin cycles of compressions and ventilations. Unnecessary compressions are less harmful than failing to provide compressions if the patient needs them, as delaying or failing to start CPR in a patient without a pulse reduces the chance of their survival.
As you know, agonal gasps are not considered normal breathing. And they may be present in the first minutes after sudden cardiac arrest.
A patient with agonal gasps usually appears to be drawing air in very quickly. The mouth may be open, and the jaw, head, and/or neck will sometimes move with the gasps. Gasps can appear forceful or weak.
Some time may pass between each gasp because they usually happen at a slow rate. The sound of the gasp can resemble a snort, snore, or groan. The important thing to remember is that gasping is not normal breathing and, instead, is a sign of cardiac arrest.
As an ACLS provider, you must make every effort to minimize any interruptions in chest compressions. When you do have to interrupt compressions, try to limit those interruptions to no longer than 10 seconds, except in extreme circumstances, such as removing the patient from a dangerous environment.
When you interrupt chest compressions, blood flow to the brain and heart stops. To this end, try and avoid the following:
During basic life support, primary assessments, and secondary assessments, you should be aware of the reasons to stop or withhold resuscitative efforts, such as:
Out-of-hospital providers need to be aware of EMS-specific policies and protocols applicable to these situations. In-hospital providers and high-performance teams should be aware of any directives or specific limits to resuscitation attempts that are in place.
For instance, some patients may consent to CPR and defibrillation but not to intubation or invasive procedures. Many hospitals will record this in the medical record.