1. Lesson 3: Secondary Assessment Emergency 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 On Physical 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 On Physical 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 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?