EMS 351 Lecture (5) 2014 – 2015 Secondary Assessment DR. Samah Mohammed

LEARNING OBJECTIVE List purpose secondary assessment. Discuss assessment techniques. Explain vital signs. Discuss monitoring devices.

Purpose OF Secondary Assessment Performing a rapid full-body exam from head to toe. Focused assessment of pain. Assessment of vital signs Perform a systematic physical examination of the patient. Often determine through chief complaint.

Secondary Assessment The secondary assessment is done to assess non–life-threatening conditions. INCULDES Assess vital signs . 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 Factors to consider: Location Not every aspect will be completed in every patient. Factors to consider: Location Positioning of the patient The patient’s point of view Maintaining professionalism

Secondary Assessment Inspection: Palpation: Looking at the patient for abnormalities. E.g.: swelling in lower extremity. Palpation: Touching to obtain information as: Pulses: use finger Skull: use palms Skin: use back of hand to measure temperature

Assessment Techniques 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 Auscultation: Listening to sounds with a stethoscope AS: Understanding of what “normal” sounds like Measuring blood pressure

1. Vital Signs 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 Respiration: Check the breathing rate and quality. Count respirations for 30 seconds. The normal adult resting respiratory rate is 12 to 20 B/ M (breath per minute). Note effort of breathing. Listen for noises.

Vital Signs 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 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 Ear Rectal Rectum Axillary 36.6 ºC Axilla

Respirations (breaths/min) 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 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 90 to 140

Monitoring Devices Including: Pulse oximetry. blood pressure cuff (sphygmomanometer). Blood glucose determination. Continuous ECG monitoring. Carbon dioxide monitoring. Basic blood chemistry. Thermometer. Stethoscope Ophthalmoscope Otoscope Scissors Gloves Sheet or blanket

Equipment Used in the Secondary Assessment Stethoscope Amplifies body sounds Earpieces Binaural and tubing 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 Allows you to look into patient’s eyes Consists of concave mirror and battery-powered light 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 Patient should be supine. Prepare the skin. Connect electrodes. Connect and apply the precordial leads. Record the ECG.

Monitoring Devices

Monitoring Devices Blood glucometer:- Cardiac biomarkers:- Can obtain reading in two ways in the field: From the center of an IV catheter. From a finger stick. Most take only a few seconds. Should be scale regularly. Cardiac biomarkers:- Used to assess presence of damage to cardiac muscle. Other blood tests:- Arterial blood gases CBC ( complete blood count)