1. Lesson 3 Secondary Assessment

2. Objectives
State the importance of taking a personal history from victim and 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 info gathered

3. Getting the Whole Picture
After primary assessment comes a hands on secondary assessment
Goals are to find EVERY problem
Consider environment when removing clothing during checks
Single person does exam, second person records results
SAMPLE history taken at this time

4. Getting the Whole Picture
If patient can talk take SAMPLE first
If patient can’t talk, check with other members, use medical forms for info (allergies, medications, etc)
Document signs and symptoms
Look for signs of injury
Listen to victims words and responses
Feel body parts

5. Taking a SAMPLE history
S = Signs and 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 they took it?
P = Pertinent Medical History, any like this happened before? Any existing conditions?

6. Taking a SAMPLE history
L = Last intake and output? Last time ate or drank? Last time urinated or defecated?
E = Events, What led up to this 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. Documentation
Responder’s ability to remember details is reduced due to stress and confusion
Specific info helps rescue personnel know what they are facing
Retention for legal and medical reasons
Using a form helps you remember everything you need to look for/ask about

9. Documentation SOAP: S = subjective info (complaints)
O = Objective info (physical exam, vital signs, SAMPLE
A = Assess patient and situation, what do you think is wrong?
P = Plan, what care do you give and how? Stay or evacuate?

10. Performing Hands On Physical Exam
Using MOI or SAMPLE record circumstances and 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
Ex of signs and 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
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 and away from heart (ex on hand or foot)
Check for circulation in hands and feet
pinch and check for capillary refill
If head/neck/back injury possible, ask patient to not move

14. Physical Exam Practice Session
Groups of 3
One victim
2 rescuers
Perform SAMPLE
Head to Toe Check

15. Head to Toe Assessment

16. Taking Vital Signs
Vital signs are a measure of the processes needed for life
Changes in time indicate patient condition changing
Take and record vital signs regularly
Basic Set
Level of Responsiveness
Breathing Rate
Pulse
Skin Color, temp, moisture

17. 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

18. 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
HearRate (Pulse): Measure at wrist, brachial artery, or neck
Use 2 fingers (no thumb)
Count for 30 sec
Note rhythm, quality (strength)

19. Skin Color, Temp, Moisture
Note any differences from normal:
Color should be pink (non-pigmented areas)
Temperature should be warm
Dry

20. Practice Session Groups of 3 One victim One takes vital Signs
One records

21. Rechecking 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?