The secondary assessment takes place once vital functions have been assessed and the initial treatment of life threat to those vital functions has been started. It includes a medical history, a clinical examination and specific investigations. It differs from a standard medical history and examination in that it is designed to establish which emergency treatments might benefit the child. Time is limited and a focused approach is essential. At the end of secondary assessment, the practitioner should have a better understanding of the illness affecting the child and may have formulated a differential diagnosis. Emergency treatments will be appropriate at this stage - either to treat specific conditions (such as asthma) or processes (such as raised intracranial pressure). The establishment of a definite diagnosis is part of definitive care.
The history often provides the vital clues that help the practitioner identify the disease process and provide the appropriate emergency care. In the case of children, the history is often obtained from an accompanying parent, although a history should be sought from the child if possible. Do not forget to ask the paramedic about the child's initial condition and about treatments and response to treatments that have already been given.
Some children will present with an acute exacerbation of a known condition such as asthma or epilepsy. Such information is helpful in focusing attention on the appropriate system but the practitioner should be wary of dismissing new pathologies in such patients.The structured approach prevents this problem. Unlike trauma (which is dealt with later), illness affects systems rather than anatomical areas. The secondary assessment must reflect this and the history of the complaint should be sought with special attention to the presenting system or systems involved. After the presenting system has been dealt with, all other systems should be assessed and any additional emergency treatments commenced as appropriate.
The secondary assessment is not intended to complete the diagnostic process, but rather is intended to identify any problems that require emergency treatment.
The following gives an outline of a structured approach in the first hour of emergency management. It is not exhaustive but addresses the majority of emergency conditions which are amenable to specific emergency treatments in this time period.
The symptoms, signs and treatments relevant to each emergency condition are elaborated in the relevant chapters of Part III.
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If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.