Second Assessment: Diagnose & Treat
Secondary Diagnosis and Treatment
After you have progressed through the 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, and 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 child have taken any inappropriate medication or substance? |
Table 8