Lesson 8
Secondary 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 lifethreatening 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
© Kevin Norris/ShutterStock, Inc.
Components
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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
© WizData, Inc./ShutterStock, Inc.
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
© Robert Byron/Dreamstime.com
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?