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

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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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.

9. Vital Signs

10. 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.

11. 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.

12. 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.

13. Vital Signs Route Normal Range / ºC Sites Oral 37.0 ºC Mouth Tympanic
Ear
Rectal
Rectum
Axillary
36.6 ºC
Axilla

14. 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

15. 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

16. Equipment Used in the Secondary Assessment
Stethoscope
Amplifies body sounds
Earpieces
Binaural and tubing
Chest piece
Bell – low-pitched sounds
Diaphragm – high-pitched sounds

17. 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!

18. 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

19. 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

20. 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.

21. Monitoring Devices 12-lead ECG monitoring Patient should be supine.
Prepare the skin.
Connect electrodes.
Connect and apply the precordial leads.
Record the ECG.

22. Monitoring Devices

23. 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)