If the patient is conscious proceed with the secondary survey (Box E). Since the pulse rate and character and the rate and character of respiration have already been determined, assess the blood pressure at this time. Next, correlate the patient’s chief complaint and signs and symptoms to a specific organ system. The goal is to identify those problems that are not immediately life-threatening, but require timely stabilization (e.g., hypoglycemia, angina pectoris, ventilation failure).
Box E. Secondary Survey: Conscious Patient.
|Quickly review history and correlate to signs and symptoms:|
Physical signs and symptoms are produced by physical causes and must be recognized before a physical problem can be diagnosed and treated. Without at least a presumptive or working diagnosis there is nothing to treat. Based on symptoms analysis, medical emergencies can be characterized as altered consciousness; chest pain; and ventilatory, allergic (pruritus, urticaria, angioedema), neurogenic (i.e., sensory, affective, motor), and toxic events (Box F).
Box F. Potential Medical Emergencies Based of Symptom Analysis during Secondary Survey.
|Symptoms||Primary Working Diagnoses||Secondary Working Diagnoses|
|Pruritus, urticaria, angioedema|
|Altered sensory, affective and/or motor function|
*Airway obstruction, respiratory arrest, and cardiac arrest are discussed under primary survey. **Rare office emergencies (e.g., thyrotoxicosis, Addisonian crisis and emergencies that evolve over hours or days (e.g., advanced diabetic ketoacidosis, extreme hyperosmolarity) are mentioned, but no separate protocols are presented.