Lesson 3:
Secondary Assessment
Emergency Reference Guide p. 20-22
Objectives
• State the importance of taking a personal
history from victim & know how to do it
• Demonstrate taking a personal history
• Demonstrate a hands on physical exam
• Demonstrate how to take vital signs
• Demonstrate how to document information
gathered
Getting the Whole Picture
• After primary assessment comes a hands
on secondary assessment
• Goal is to find EVERY problem
• Consider environment when removing
clothing during checks
• Single person does exam, second person
records results – why?
• SAMPLE history taken at this time
Getting the Whole Picture (cont’d.)
• If patient can talk, take SAMPLE first
If patient can’t talk, check with other
members, use medical forms for info (i.e.
allergies, medications, etc.)
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•
•
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Document signs & symptoms
Look for signs of injury
Listen to victims words & responses
Feel body parts
Taking a SAMPLE History
• S = Signs & symptoms: Ask what hurts?
What pain do they have, nausea,
lightheadedness?
• A = Allergies: do they have any? Did they
contact anything they are allergic to?
• M = Medications: on any, last time taken?
• P = Pertinent medical history: anything
like this happened before? Existing
conditions?
Taking a SAMPLE History (cont’d.)
• L = Last intake & output: Last time ate or
drank? Last time urinated or defecated?
• E = Events: What led up to this injury
(Mechanism Of Injury)?
Skill Practice
• Break into pairs, one victim, one care giver
• Scenario:
• “While clearing some downed limbs from
the trail, a person is apparently stung by a
bee.”
• Practice taking, and recording SAMPLE
Why Documentation is
Important?
• Responder’s ability to remember details is
reduced due to stress/confusion
• Specific info helps rescue personnel know
what they are facing
• Retention for legal/medical reasons
• Using a form helps you remember
everything you need to look for/ask about
Documentation (cont’d.)
• SOAP:
• S = subjective info (complaints)
• O = Objective info (i.e. physical exam, vital
signs, SAMPLE
• A = Assess patient & situation, what do
you think is wrong?
• P = Plan, what care do you give & how?
Stay or evacuate?
Performing Hands On
Physical Exam
• Using MOI or SAMPLE record
circumstances & estimate injuries
• Do not make assumptions about MOI
• Systematically check from head to toe
• Ask where it hurts
• Check all body parts, don’t cause
unneeded pain
Performing Hand On
Physical Exam (cont’d.)
• Examples of Signs & Symptoms:
– Pale sweaty skin
– Nervousness
– Unnatural position of limbs
– Patient guarding an area or unable to move
body part
• Looks for “DOTS”
DOTS
• DOTS stands for:
• D = Deformities, depressions, indentations
and discoloration
• O = Open injuries, penetrating wounds,
cuts, scrapes
• T = Tenderness
• S = Swelling
Performing Hands On
Physical Exam
• Check Circulation, Sensation, Motion
– Ask about pain first, then touch
• Note medical ID bracelets, necklaces
• Check pulse away from injury & away from heart
(i.e. on hand or foot)
• Check for circulation in hands & feet
• Pinch & check for capillary refill (nail bed)
• If head/neck/back injury possible, ask patient to
not move, help restrain from moving
Head to Toe Assessment
Head to Toe Assessment(cont’d)
Physical Exam
Practice Session
• Form into groups of 3:
– One victim
– 2 rescuers
• Perform SAMPLE
• Head to toe check
Taking Vital Signs
• Vital signs are a measure of the processes
needed for life
• Changes in time indicate patient condition
changing
• Take & record vital signs regularly
• Basic Set:
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–
–
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Level of Responsiveness
Breathing Rate
Pulse
Skin Color, Temp, Moisture (SCTM)
Level of Responsiveness
• AVPU:
– Alertness
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•
•
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A + Ox4: knows who, where, when, what
A + Ox3: knows who, where, when
A + Ox2: knows who, where
A + Ox1: knows who
– V = Responds to verbal stimuli
– P = Responds to pain
– U = Unresponsive
Respiratory Rate/Heart Rate
• Respiratory: Number breaths/min., note rhythm
and quality:
– Normal 12-20 for adults
– Place hand on chest to measure
– Note any unusual sounds
• Heart Rate (pulse): Measure at wrist, brachial
artery, or neck
– Use 2 fingers (no thumb)
– Count for 30 seconds
– Note rhythm, quality (strength)
Skin Color, Temp, Moisture
• Note any differences from normal:
– Skin Color should be pink (non-pigmented
areas)
– Temperature should be warm
– Moisture: skin should be dry
Practice Session
• Form into groups of 3
– One victim
– One takes vital Signs
– One records
Re-Checking Resources
• After patient assessment:
– Observe changing conditions in environment
– Getting unsafe for patient or you?
– Getting difficult to get help?
– What resources do you have, how can you
use them?
– Do you need to move the patient?
Questions???
What else could you add to your
First Aid Kit?