OPQRST characterizes the complaint; SAMPLE gathers the history.
Before you read
Test yourself first: 5 questions
Question 1 of 5
You placed a stable patient on oxygen five minutes after your last full reassessment. The next reassessment should occur:
Answer: A. Reassessment intervals of about every 15 minutes for a stable patient and every 5 minutes for an unstable one are minimums; every intervention also triggers a reassessment to see whether it helped or caused harm. Waiting for the clock delays recognition of a poor response, and relying on the patient to report worsening misses changes he cannot feel or describe.
Question 2 of 5
You have assessed a trauma patient's pelvis once, and it moved under your hands. Regarding that assessment:
Answer: A. An unstable pelvis is already bleeding, and each further assessment disturbs whatever clot has formed, so the finding is obtained once, gently, and then reported rather than re-demonstrated. Confirmation by a second pair of hands is exactly the repetition being warned against — what travels to the next provider is your description of the first and only assessment.
Question 3 of 5
An alert 30-year-old cut one hand on a kitchen knife, has no other complaint and has normal vital signs. The appropriate secondary assessment is:
Answer: A. A patient who is alert, has an isolated complaint and a minor mechanism can direct you to the problem, so the exam is focused on the region involved and the function distal to it. Running a full head-to-toe survey here spends time on regions no mechanism ever touched, and it delays the wound care that is the only thing this patient actually needs.
Question 4 of 5
A man is found unresponsive in a park with no witnesses, no jewelry and nobody who knows him. Your secondary assessment should be:
Answer: A. When the patient cannot tell you where it hurts, your hands have to ask the question instead, so the whole body is surveyed quickly for findings he cannot report. Examining only the head assumes a diagnosis nobody has made yet, and waiting for a relative leaves a treatable finding undiscovered for as long as it takes someone to show up.
Question 5 of 5
When you examine each extremity during the secondary assessment you check distal:
Answer: A. Pulse, movement and sensation test the three structures that an injury to a limb threatens — the artery, the nerve supply to the muscles and the sensory nerves — and they are checked before and after anything you do to that limb. Nail length and tattoos are descriptive detail that says nothing about whether the limb is still perfused and innervated.
Keep the streak going with more questions like these, each with a full rationale.
What is secondary assessment?
It is the smallest domain on the entry-level exams, but it is where the history that explains the presentation is gathered — and where a trend first becomes visible.
Key points to remember
- OPQRST characterizes the complaint; SAMPLE gathers the history.
- Rapid full-body when the mechanism is significant or the patient cannot direct you.
- Focused exam when the patient is alert with a localized complaint.
- Serial vital signs exist to expose trend, which a single set cannot show.
Coaching the patient
- Events leading up to the episode is the SAMPLE element that most often reveals mechanism.
Secondary Assessment: FAQs
What do I need to know about Secondary Assessment for the NREMT?
OPQRST characterizes the complaint; SAMPLE gathers the history. Rapid full-body when the mechanism is significant or the patient cannot direct you. Focused exam when the patient is alert with a localized complaint. Serial vital signs exist to expose trend, which a single set cannot show.
What should the crew communicate or document for Secondary Assessment?
Events leading up to the episode is the SAMPLE element that most often reveals mechanism.
