1Lesson 3: Secondary Assessment Emergency Reference Guide p. 20-22
2ObjectivesState the importance of taking a personal history from victim & know how to do itDemonstrate taking a personal historyDemonstrate a hands on physical examDemonstrate how to take vital signsDemonstrate how to document information gathered
3Getting the Whole Picture After primary assessment comes a hands on secondary assessmentGoal is to find EVERY problemConsider environment when removing clothing during checksSingle person does exam, second person records results – why?SAMPLE history taken at this time
4Getting the Whole Picture (cont’d.) If patient can talk, take SAMPLE firstIf patient can’t talk, check with other members, use medical forms for info (i.e. allergies, medications, etc.)Document signs & symptomsLook for signs of injuryListen to victims words & responsesFeel body parts
5Taking 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?
6Taking 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)?
7Skill 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
8Why Documentation is Important? Responder’s ability to remember details is reduced due to stress/confusionSpecific info helps rescue personnel know what they are facingRetention for legal/medical reasonsUsing a form helps you remember everything you need to look for/ask about
9Documentation (cont’d.) SOAP:S = subjective info (complaints)O = Objective info (i.e. physical exam, vital signs, SAMPLEA = Assess patient & situation, what do you think is wrong?P = Plan, what care do you give & how? Stay or evacuate?
10Performing Hands On Physical Exam Using MOI or SAMPLE record circumstances & estimate injuriesDo not make assumptions about MOISystematically check from head to toeAsk where it hurtsCheck all body parts, don’t cause unneeded pain
11Performing Hand On Physical Exam (cont’d.) Examples of Signs & Symptoms:Pale sweaty skinNervousnessUnnatural position of limbsPatient guarding an area or unable to move body partLooks for “DOTS”
12DOTSDOTS stands for:D = Deformities, depressions, indentations and discolorationO = Open injuries, penetrating wounds, cuts, scrapesT = TendernessS = Swelling
13Performing Hands On Physical Exam Check Circulation, Sensation, MotionAsk about pain first, then touchNote medical ID bracelets, necklacesCheck pulse away from injury & away from heart (i.e. on hand or foot)Check for circulation in hands & feetPinch & check for capillary refill (nail bed)If head/neck/back injury possible, ask patient to not move, help restrain from moving
16Physical Exam Practice Session Form into groups of 3:One victim2 rescuersPerform SAMPLEHead to toe check
17Taking Vital SignsVital signs are a measure of the processes needed for lifeChanges in time indicate patient condition changingTake & record vital signs regularlyBasic Set:Level of ResponsivenessBreathing RatePulseSkin Color, Temp, Moisture (SCTM)
19Respiratory Rate/Heart Rate Respiratory: Number breaths/min., note rhythm and quality:Normal for adultsPlace hand on chest to measureNote any unusual soundsHeart Rate (pulse): Measure at wrist, brachial artery, or neckUse 2 fingers (no thumb)Count for 30 secondsNote rhythm, quality (strength)
20Skin Color, Temp, Moisture Note any differences from normal:Skin Color should be pink (non-pigmented areas)Temperature should be warmMoisture: skin should be dry
21Practice Session Form into groups of 3 One victim One takes vital SignsOne records
22Re-Checking Resources After patient assessment:Observe changing conditions in environmentGetting 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?
23Questions??? What else could you add to your First Aid Kit?