Second Assessment: Diagnose & Treat

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Secondary Diagnosis and Treatment

After you have progressed through ABCDE method and have discovered a treatable cause, and the child or infant has not deteriorated to a more severe clinical (life-threatening) situation, move on to performing a more thorough survey. This includes a focused history and physical examination involving the individual, family, and any witnesses as relevant. In terms of history, you could follow the acronym SPAM: Signs and symptoms, Past medical history, Allergies, Medications (Table 8).

The focused examination will be guided by the answers to the focused history. For example, a report of difficult breathing will prompt a thorough airway and lung examination. It may also prompt a portable chest x-ray study in a hospital setting. Key point is that it is best to work from head to toe to complete a comprehensive survey. Make use of diagnostic tools when possible to augment the physical examination.

S: Signs & Symptoms
• Evaluate recent events related to
current problem
-Preceding illness, dangerous activity
• Examine patient from head to toe for
the following:
-Consciousness, delerium
-Agitation, anxiety, depression
-Fever
-Breathing
-Appetite
-Nausea/vomiting
-Diarrhea (bloody)
P: Past Medical History
• Complicated birth history
• Hospitalizations
• Surgeries
A: Allergies
• Any drug or environmental allergies
• Any exposure to allergens or toxins
M: Medications
• What medications is the child taking
(prescribed and OTC)?
• Could she have taken any inappropriate
medication or substance?

Table 8

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