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Second Assessment: Diagnose & Treat

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After you have progressed through ABCDE and you have discovered a treatable cause and the patient 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 patient, family, and any witnesses as relevant. In terms of history, you could follow the acronym SPAM.

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

Life-Threatening Issues

If at any time you determine that the patient is experiencing a life-threatening emergency, support breathing and cardiovascular function immediately. This usually means providing HIGH-QUALITY CPR. While it is important to recognize and respond to the particular cause of the problem, the time required to determine the problem should not interfere with perfusion and oxygenation for the patient. As you maintain breathing and circulation for the patient, determine if the patient is primarily experiencing Respiratory Distress/Arrest, Bradycardia, Tachycardia, Shock, or Cardiac Arrest. Individual PALS protocols for each of these clinical situations are provided throughout this handbook.

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?)
  • Complicated birth history?
  • Hospitalizations?
  • Surgeries?
  • Any drug or environmental allergies?
  • Any exposure to allergens or toxins?
  • What medications is the child taking (prescribed and OTC)?
  • Could she have taken any inappropriate medication or substance?
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