2. Secondary Assessment
Is brief
Perform after the primary
assessment & resuscitation
Is valuable for discovering
occult problems in patients
with a poor or confusing
history
3. Goal of the secondary
assessment is:-
To discover all other
abnormalities or injuries
that are not life
threatening
4. F- Full set of vital signs /
Focused adjuncts/ Facilitate
family presence
G- Give comfort measures
H- History & head to toe
assessment
I- Inspect posterior surfaces
8. Focused adjuncts
For patients with significant abnormalities in the
primary assessment, consider performing the following
interventions at this assessment and intervention
process.
Cardiac monitoring
Sp O2
End tidal CO2 monitoring
Gastric tube - risk of aspiration
risk of respiratory compromise
Indwelling catheter
Laboratory studies
Imaging studies – X-Rays
CT scan
MRI
Need for tetanus immunization
9. Facilitate family presence
Family presence may reduce anxiety of the
patient
Assess the family’s desire to present at the
bedside
Source for assessment
10. Give comfort measure
Assess pain ( using PQRST )
{ Provocation , quality , region/radiation,
severity , temporal factors }
Position of comfort if not contraindicated
Splint , elevate , injured extremities
Use age-appropriate distraction techniques
Administer pharmacologic therapy as
ordered (analgesics , NSAID , narcotics )
11. History
History of present illness/ injury/ chief
complaint, immunization, allergies,
medications, past medical history, events
surrounding the condition, diet.
Content & time of most recently ingested
food, alcohol
Efforts to relieve symptoms ( home
remedies , medication, physician visits)
12. Past medical history
General health status
Current or pre-existing disease/illness
Respiratory ,neurologic, endocrine, hepatic,
haematological diseases or risk factors
Infections, immunosupre sion, autoimmune,
psychological related conditions.
Recent trauma –blunt/ penetrating
Substance or alcohol use/abuse
Detoxification history
Smoking history
13. Last normal menstrual period –for
female pts
Environmental exposures
Obesity, malnourishment, eating
disorders history
Related situations for present
problem or current event
Previous episodes – No
Yes- duration,
date, Rx
Previous injury
14. Current medications
Allergies – for medication
for food
others
Immunization status – for tetanus
for childhood illnesses
Psychological / social / environmental factors
Collection of a complete social and psychological
history may be limited. However in some situations this
information is essential.
Risk factors- smoking, substance use, psychiatric history
Age appropriate behaviour
Occupation
15. Hobbies
Family & support system
Responsibilities- self, family, occupational,
community
Living accommodations- house, apartment,
homeless
16. Head to toe assessment
A complete head to toe assessment is
necessary for all critically ill or injured
patients .It is not required for patients with
only minor injuries or symptoms related to
one body system.
General appearance
Behaviour
Odours
Acetone-indicative of ketosis
Gasoline-indicative of spilled fuel
Urine
Faeces
31. Motor function
flexion /extension
Symmetry of strength
Range of motion
Sensory function
Sharp/dull
Circulatory status
Colour/skin temperature
Pulses distal to injury
Capillary refill
32. Posterior surfaces
patient’s back and posterior aspects of
arms and legs
Should be evaluated for the presence of
bleeding, abrasions ,wounds,
haematomas, ecchymosis, rashes, lesions,
oedema
The vertebral column
-tenderness ,deformity
Logroll the patient to maintain spinal alignment if there is any potential
for spinal injury
33. Group Assignment
To prepare a history taking format
• Individual Assignment
Physical assessment presentation of an
emergency patient according to given format