Lesson 3: Secondary Assessment Emergency Reference Guide p. 20-22

1. Lesson 3: Secondary AssessmentEmergency Reference Guide p. 20-22

2. 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

3. 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

4. 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.) • Document signs & symptoms • Look for signs of injury • Listen to victims words & responses • Feel body parts

5. 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?

6. 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)?

7. 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

8. 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

9. 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?

10. 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

11. Performing Hand OnPhysical 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”

12. DOTS • DOTS stands for: • D = Deformities, depressions, indentations and discoloration • O = Open injuries, penetrating wounds, cuts, scrapes • T = Tenderness • S = Swelling

13. Performing Hands OnPhysical 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

14. Head to Toe Assessment

15. Head to Toe Assessment(cont’d)

16. Physical Exam Practice Session • Form into groups of 3: • One victim • 2 rescuers • Perform SAMPLE • Head to toe check

17. 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: • Level of Responsiveness • Breathing Rate • Pulse • Skin Color, Temp, Moisture (SCTM)

18. Level of Responsiveness • AVPU: • Alertness • 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

19. 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)

20. 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

21. Practice Session • Form into groups of 3 • One victim • One takes vital Signs • One records

22. 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?

23. Questions???What else could you add to your First Aid Kit?