EMS 351 Lecture (5)
1. List purpose secondary assessment.
2. Discuss assessment techniques.
3. Explain vital signs.
4. Discuss monitoring devices.
Purpose OF Secondary Assessment
1. Performing a rapid full-body exam from head to toe.
2. Focused assessment of pain.
3. Assessment of vital signs
4. Perform a systematic physical examination of the
patient.
5. Often determine through chief complaint.
Secondary Assessment
• The secondary assessment is done to assess
non–life-threatening conditions. INCULDES
1.Assess vital signs .
2.The physical examination.
– A sign: is something about the patient you
can see or feel for yourself.
– A symptom: is something the patient tells
you about his or her condition
Secondary Assessment
• Not every aspect will be completed in every patient.
– Factors to consider:
1. Location
2. Positioning of the patient
3. The patient’s point of view
4. Maintaining professionalism
Secondary Assessment
1. Inspection:
– Looking at the patient for
abnormalities.
E.g.: swelling in lower
extremity.
2. Palpation:
– Touching to obtain
information as:
• Pulses: use finger
• Skull: use palms
• Skin: use back of hand
to measure temperature
3. Percussion:
A methods of “tapping” of body parts during physical
examination with fingers, hands, or small instruments to evaluate
the size, consistency, borders and presence of fluid in body organs
4. Auscultation:
•
Listening to sounds with a stethoscope AS:
•
Understanding of what “normal” sounds like
•
Measuring blood pressure
1. Vital Signs
1. Pulse
 Assess rate, location, quality, rhythm, regularity and
force of the heartbeat.
 Count for 1 minute.
 Take the radial pulse of a conscious patient.
 Take the carotid pulse of an unconscious patient.
 When examining an infant, use the brachial pulse.
 In a normal adult, the resting pulse rate is 60 to 100
beats / m.
Vital Signs
Vital Signs
2. Respiration:
1. Check the breathing rate and quality.
2. Count respirations for 30 seconds.
3. The normal adult resting respiratory rate is 12 to 20
B/ M (breath per minute).
4. Note effort of breathing.
5. Listen for noises.
Vital Signs
3. Blood pressure:
The pressure against a blood vessel wall, usually measured in an
artery in the arm
• Systolic: force or highest exerted against the arterial wall.
ventricle contracts & pumps blood into the aorta. – max.
called the Systolic pressure
• Diastolic: arterial pressure during ventricular relaxation, when
the heart is filling, minimum pressure in arteries. Called the
Diastolic pressure.
• Average blood pressure is recorded at about 120/80 mmHg
(systolic/diastolic)
– Hypotension: Blood pressure is lower than normal.
– Hypertension: Blood pressure is higher than normal.
Vital Signs
4. Temperature:
 temperature of the body tissues, is controlled by the
hypothalamus.
 Temperature is lowest in the morning, highest
during the evening.
 Check for skin color, temperature, and moisture.
 Normal body temperature is (37°C).
 Normal skin conditions are described as warm, pink,
and dry.
Vital Signs
Route
Normal Range / ºC
Sites
Oral
37.0 ºC
Mouth
Tympanic
37.6 ºC
Ear
Rectal
37.6 ºC
Rectum
Axillary
36.6 ºC
Axilla
Vital Signs
Age
Respirations
(breaths/min)
Pulse
(beats/min)
Blood Pressure
(mm Hg)
Newborn: 0 to 1 mo
30 to 60
90 to 180
50 to 70
Infant: 1 mo to 1 yr
25 to 50
100 to 160
70 to 95
Toddler: 1 to 3 yr
20 to 30
90 to 150
80 to 100
Preschool : 3 to 6 yr
20 to 25
80 to 140
80 to 100
School : 6 to 12 yr
15 to 20
70 to 120
80 to 110
Adolescent: 12 to 18 yr
12 to 16
60 to 100
90 to 110
Older than 18 yr
12 to 20
60 to 100
90 to 140
Monitoring Devices
• Including:
1. Pulse oximetry.
2. blood pressure cuff (sphygmomanometer).
3. Blood glucose determination.
4. Continuous ECG monitoring.
5. Carbon dioxide monitoring.
6. Basic blood chemistry.
7. Thermometer.
8. Stethoscope
9. Ophthalmoscope
10. Otoscope
11. Scissors
12. Gloves
13. Sheet or blanket
Equipment Used in the Secondary
Assessment
• Stethoscope
A. Amplifies body sounds
B. Earpieces
C. Binaural and tubing
D. Chest piece
• Bell – low-pitched
sounds
• Diaphragm –
high-pitched sounds
Equipment Used in the Secondary
Assessment
• Blood pressure cuff
 Measurement of blood
pressure
 Consists of inflatable
cuff and manometer
(pressure meter)
 Use the appropriate
size!
Equipment Used in the Secondary
Assessment
• Ophthalmoscope
1. Allows you to look into
patient’s eyes
2. Consists of concave
mirror and batterypowered light
3. Requires dilation of
pupils and diagnostic
expertise
Equipment Used in the Secondary
Assessment
• Otoscope
– Evaluates ears of a patient
– Consists of head and handle
• Pulse oximetry
– Should never be used as an absolute indicator of the need for
oxygen.
– Measures percentage of hemoglobin saturation
Monitoring Devices
• Continuous ECG
monitoring
– Purpose is to establish a
baseline
– Electrodes must be placed
properly.
• The leads are usually
colored and labeled to
help with placement.
– Bipolar leads consist of two
electrodes.
• Placed on different limbs.
Monitoring Devices
• 12-lead ECG monitoring
A. Patient should be
supine.
B. Prepare the skin.
C. Connect electrodes.
D. Connect and apply the
precordial leads.
E. Record the ECG.
Monitoring Devices
Monitoring Devices
• Blood glucometer:a) Can obtain reading in two ways in the field:
i. From the center of an IV catheter.
ii. From a finger stick.
b) Most take only a few seconds.
c) Should be scale regularly.
• Cardiac biomarkers:a. Used to assess presence of damage to cardiac
muscle.
• Other blood tests:1. Arterial blood gases
2. CBC ( complete blood count)