EMS 351 Lecture (5)

SECONDARY ASSESSMENT

DR. SAMAH MOHAMMED 2014 – 2015

LEARNING OBJECTIVE

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

Assessment Techniques

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 Signs2. Respiration:

3. Check the breathing rate and quality.

4. Count respirations for 30 seconds.

5. The normal adult resting respiratory rate is 12 to 20

B/ M (breath per minute).

6. Note effort of breathing.

7. Listen for noises.

Vital Signs3. 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 Signs4. 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

Age Respirations (breaths/mi

n)

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

Vital Signs

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. Stethoscope9. Ophthalmoscope10. Otoscope11. Scissors12. Gloves13. 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 battery-

powered 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)