Lesson 8Secondary Assessment

Secondary Assessment (1 of 3)

• Completes the full patient assessment• Goals:

– Identification and treatment of previously unrecognized life-threatening injuries

– Identification and treatment of non-life-threatening injuries

Secondary Assessment (2 of 3)

• Secondary assessment is completed only when time and situation permits– Critical patients

• Focus remains on primary assessment until all life-threatening conditions are identified and managed

• May need to postpone secondary assessment and return to primary assessment based on changes in the patient’s condition

Secondary Assessment (3 of 3)

• Never delay transporting a critical patient in order to complete a secondary assessment

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Components

• Vital signs• History• Physical examination• Treatment• Decision-making• Transportation• Receiving facility• Communication

Vital Signs (1 of 6)

• First part of the secondary assessment– Reassessment of vital functions

• Multiple components– Pulse, ventilatory rate,

blood pressure, skin parameters

– All components in combination give an overall picture

© Jones & Bartlett Learning. Photographed by Darren Stahlman.

Vital Signs (2 of 6)

• First set of vital sign measurements are used as a baseline for that patient

• Repeat (at least) every time the patient’s condition changes

• Repeat vital signs should be compared to previous set(s)– Trending

Vital Signs (3 of 6)

• Pulse– Location– Strength– Rate– Rhythm

© Jones & Bartlett Learning. Photographed by Darren Stahlman.

Vital Signs (4 of 6)

• Respirations– Ventilatory rate– Depth/expansion – Effort

• Use of accessory muscles

• Mouth breathing versus nose breathing

– Breath sounds and location

© Jones & Bartlett Learning. Courtesy of MIEMSS.

Vital Signs (5 of 6)

• Blood pressure– Systolic and diastolic measurements

• Automated• Manual

– Auscultation– Palpation

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Vital Signs (6 of 6)

• Skin parameters– Color – Temperature– Moisture– Capillary refill

• May or may not provide accurate information• Age of patient• Underlying medical conditions

– The environment may affect findings

History

• Verbal history from patient, family members, bystanders– Clues from on-scene observation

• S-A-M-P-L-E

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Physical Examination

• Physical examination directed by scene assessment, primary assessment, history, MOI/kinematics, and patient complaints

• Detailed versus focused examination– Detailed involves all areas of the body

• Head-to-toe– Focused involves limited areas of the body

• Systematic approach

Monitors

• Utilized as indicated by patient condition– Pulse oximetry– Cardiac monitor– End tidal CO2

(ETCO2)/capnography– Continuous blood pressure

Courtesy Masimo

Treatment Options (1 of 4)

• Immobilization– Selective spinal immobilization– Extremities

• Open wounds– Control of external hemorrhage– Prevent infection/contamination

Treatment Options (2 of 4)

• Re-evaluate need for:– Supplemental oxygen– IV access and fluid administration – Prevention of body heat loss

Treatment Options (3 of 4)

• Comfort Measures:– Pain control– Positioning– Padding

Treatment Options (4 of 4)

• Comfort Measures:– Emotional support

(reassurance)• Patient• Family members

© Jones and Bartlett Learning. Courtesy of MIEMSS.

Decision-Making Time

• Considerations:– Situation – Assessment– History – MOI/kinematics– Patient severity– Treatment available– Additional resources required

• Transport decision

Transportation (1 of 2)

• The receiving facility decision – Level of care needed– Notification

• The decision to transport as soon as possible is based on: – Situation – Severity of injuries

Transportation (2 of 2)

• Other considerations:– Prioritizing multiple patients– Distance to receiving facility– Weather conditions– Traffic conditions

Communication (1 of 2)

• Receiving facility– Timely notification

• Allows receiving facility to prepare– Brief description of scene– Number of patients arriving– Current patient status– Treatment provided– ETA

Communication (2 of 2)

• Hand-off report– Verbal and written

Summary (1 of 3)

• If the patient is critical, secondary assessment might not be completed

• Continue to monitor and reassess the components of the primary assessment

• Repeat vital signs are compared to previous sets for changes (trending)

Summary (2 of 3)

• The extent of the secondary assessment is based on the patient’s complaints and condition as time permits

• Transport decisions are based on the patient’s assessment and needs

Summary (3 of 3)

• Communicate findings with receiving facility– Prior to arrival– Upon arrival

• Verbal• Written

Questions?