2. Secondary Assessment (1 of 3)
• Completes the full patient assessment
• Goals:
– Identification and treatment of previously
unrecognized life-threatening injuries
– Identification and treatment of
non-life-threatening injuries
3. Secondary Assessment (2 of 3)
• Secondary assessment is completed only
when time and situation permits
– Critical patients
• Focus remains on primary assessment until all life-
threatening conditions are identified and managed
• May need to postpone secondary assessment and
return to primary assessment based on changes in
the patient’s condition
7. Vital Signs (2 of 6)
• First set of vital sign measurements are
used as a baseline for that patient
• Repeat (at least) every time the patient’s
condition changes
• Repeat vital signs should be compared to
previous set(s)
– Trending
11. Vital Signs (6 of 6)
• Skin parameters
– Color
– Temperature
– Moisture
– Capillary refill
• May or may not provide accurate information
• Age of patient
• Underlying medical conditions
– The environment may affect findings
13. Physical Examination
• Physical examination directed by scene
assessment, primary assessment, history,
MOI/kinematics, and patient complaints
• Detailed versus focused examination
– Detailed involves all areas of the body
• Head-to-toe
– Focused involves limited areas of the body
• Systematic approach
14. Monitors
• Utilized as indicated by patient condition
– Pulse oximetry
– Cardiac monitor
– End tidal CO2
(ETCO2)/capnography
– Continuous blood pressure
Courtesy Masimo
15. Treatment Options (1 of 4)
• Immobilization
– Selective spinal immobilization
– Extremities
• Open wounds
– Control of external hemorrhage
– Prevent infection/contamination
16. Treatment Options (2 of 4)
• Re-evaluate need for:
– Supplemental oxygen
– IV access and fluid administration
– Prevention of body heat loss
17. Treatment Options (3 of 4)
• Comfort Measures:
– Pain control
– Positioning
– Padding
19. Decision-Making Time
• Considerations:
– Situation
– Assessment
– History
– MOI/kinematics
– Patient severity
– Treatment available
– Additional resources required
• Transport decision
20. Transportation (1 of 2)
• The receiving facility decision
– Level of care needed
– Notification
• The decision to transport as soon as
possible is based on:
– Situation
– Severity of injuries
21. Transportation (2 of 2)
• Other considerations:
– Prioritizing multiple patients
– Distance to receiving facility
– Weather conditions
– Traffic conditions
22. Communication (1 of 2)
• Receiving facility
– Timely notification
• Allows receiving facility to prepare
– Brief description of scene
– Number of patients arriving
– Current patient status
– Treatment provided
– ETA
24. Summary (1 of 3)
• If the patient is critical, secondary
assessment might not be completed
• Continue to monitor and reassess the
components of the primary assessment
• Repeat vital signs are compared to
previous sets for changes (trending)
25. Summary (2 of 3)
• The extent of the secondary assessment
is based on the patient’s complaints and
condition as time permits
• Transport decisions are based on the
patient’s assessment and needs
26. Summary (3 of 3)
• Communicate findings with receiving
facility
– Prior to arrival
– Upon arrival
• Verbal
• Written
Instructor Notes
Lesson 8 will provide participants with an overview on how to perform a secondary assessment on a trauma patient.
Instructor Notes
Expand on the following points:
The secondary assessment is a head-to-toe evaluation of a patient.
The secondary assessment is performed only after:
The primary assessment is completed
All life-threatening injuries have been identified and treated
Resuscitation has been initiated
The secondary assessment completes the full assessment of the patient.
The goals of the secondary assessment are:
Identify and treat previously unrecognized life-threatening injuries
Identify and treat non-life-threatening injuries
Instructor Notes
Expand on the following points:
The secondary assessment is completed only when time and the situation permits.
With critical patients, the focus remains on the primary assessment until all life-threatening conditions are identified and managed.
The prehospital care provider may need to postpone the secondary assessment and return to primary assessment based on changes in the patient’s condition.
Instructor Notes
Expand on the following points:
Never delay in transporting a critical patient in order to complete a secondary assessment.
Instructor Notes
Expand on the following points:
The component of the secondary assessment are:
Taking the patient’s vital signs.
Obtaining the patient’s medical history.
Performing a head-to-toe physical examination.
Initiating appropriate treatment based on the results of the full patient assessment.
The information obtained from the secondary assessment will be used during the decision-making process.
Determining how to transport the patient.
Determining which receiving facility to transport the patient.
Initiating communication with the receiving facility.
Instructor Notes
Expand on the following points:
The first part of the secondary assessment is the reassessment of vital functions.
A set of complete vital signs includes the multiple components of blood pressure, pulse rate and quality, ventilatory rate (including breath sounds), and skin color and temperature.
All components in combination give an overall picture of the patient’s condition.
Instructor Notes
Expand on the following points:
Emphasize to the participants the importance of repeat vital sign determinations as a measure of the patient’s improvement or deterioration.
The first set of vital sign measurements are used as a baseline for the patient.
For the critical trauma patient, a complete set of vital signs are evaluated and recorded every 3 to 5 minutes, as often as possible, or at the time of any change in condition or a medical problem.
Repeat vital signs should be compared to previous set(s) of vital signs.
By comparing the sets of vital signs, trends in the patient’s condition will become apparent.
Instructor Notes
Expand on the following points:
The following factors should be considered when evaluating the patient’s pulse:
The location of the pulse.
The strength of the patient’s pulse.
The rate of the patient’s pulse.
The rhythm of the patient’s pulse.
Instructor Notes
Expand on the following points:
The following factors should be considered when evaluating the patient’s respirations:
The patient’s ventilatory rate
The depth and expansion of the patient’s chest
The effort it takes the patient to breathe
Is the patient using accessory muscles to help breathe?
Is the patient breathing through the mouth or through the nose?
The patient’s breath sounds and their location
Instructor Notes
Expand on the following points:
Even if an automated, noninvasive blood pressure device is available, the initial blood pressure should be taken manually.
Automated blood pressure devices may be inaccurate in patients in shock.
Auscultation of a blood pressure while in a moving ambulance may be difficult.
Palpated blood pressures may be used to follow trends in the patient’s blood pressure.
Instructor Notes
Expand on the following points:
The patient’s skin parameters include:
Color
Temperature
Moisture
Capillary refill
May or may not provide accurate information depending on the age of patient and underlying medical conditions.
Capillary refill is helpful in children but less reliable in adults.
The environment may affect findings on the condition of the patient’s skin.
Instructor Notes
Expand on the following points:
A quick history is obtained on the patient.
This information should be documented on the patient care report and passed on to the medical personnel at the receiving facility.
Depending on the patient’s condition, a verbal history can be taken from the patient, family members, or bystanders.
Additional information can be gathered from on-scene observation.
The mnemonic SAMPLE serves as a reminder of the key components of the patient history:
Signs / symptoms
Allergies
Medications
Pertinent past medical history
Last oral intake
Events leading to the injury
Instructor Notes
Expand on the following points:
The physical examination is directed by the results of the scene assessment, primary assessment, patient history, MOI/kinematics, and patient complaints.
Based on these components, the prehospital care provider will determine whether to perform a detailed versus focused physical examination.
The detailed physical examination is a head-to-toe examination that involves all areas of the body.
The focused physical examination involves limited areas of the body.
Both types of physical examination take a systematic approach.
Instructor Notes
Expand on the following points:
Monitors are utilized as indicated by the patient’s condition.
These devices potentially include:
Pulse oximetry
Cardiac monitor
End tidal CO2/capnography
Continuous blood pressure
Discuss the limitations of various monitors with participants and the importance of correlating the results displayed by the monitors with the patient’s actual condition.
Instructor Notes
Expand on the following points:
Included in assessment and management are the skills of packaging, transporting, and communicating.
When indicated, stabilization of the spine should be an integral component of packaging the trauma patient.
The entire length of the spine needs to be immobilized, based upon the patient assessment and mechanism of injury.
If time is available, the following measures are accomplished:
Careful stabilization of extremity fractures using specific splints
If the patient is in critical condition, immobilization of all fractures as the patient is stabilized on a long backboard
Bandaging of major wounds as necessary and appropriate (i.e., wounds with active hemorrhage)
This will also help to prevent infection or contamination from entering the open wound.
Instructor Notes
Expand on the following points:
Reconsider the need for:
Supplemental oxygen
IV access and fluid administration
Prevention of body heat loss
Instructor Notes
Expand on the following points:
Consider providing the following comfort measures:
Administering pain control
The positioning of the patient
Padding to prevent pressure sores
Instructor Notes
Expand on the following points:
Consider providing the following comfort measures:
Giving emotional support (reassurance) to both the patient and the patient’s family members
Instructor Notes
Expand on the following points:
Review all of your findings, including:
The situation
The full patient assessment
The patient’s history
The MOI/kinematics
The severity of the patient’s condition
The treatments available
If any additional resources are required
How should the patient be transported based on these considerations?
Determine if the patient will be transported ground versus air.
Determine if ALS providers should be requested for transport.
Determine if this is an emergency versus non-emergent situation.
Instructor Notes
Expand on the following points:
Determine which receiving facility to transport the patient.
The following questions are weighed:
The closest facility or trauma center?
What level of care will the patient require at the receiving facility?
Notify the receiving facility so the staff may prepare to treat the patient.
The decision to transport as soon as possible is based on:
The situation
The severity of the patient’s injuries
Instructor Notes
Expand on the following points:
Other transport considerations include:
Prioritizing multiple patients
The distance to the receiving facility
The weather conditions
The traffic conditions
Instructor Notes
Expand on the following points:
Provide the receiving facility with:
Timely notification to allow the receiving facility to prepare
A brief description of scene
The number of patients arriving
The patient’s current status
Any treatments provided to the patient
The estimated time of arrival
Instructor Notes
Expand on the following points:
Provide the receiving facility with:
A verbal and written hand-off report
A good patient care report is valuable for the following two reasons:
It gives the receiving facility staff a thorough understanding of:
The events that occurred
The patient’s condition
It helps ensure quality control throughout the prehospital system by making case review possible.
Instructor Notes
Expand on the following points:
If the patient is critical, secondary assessment might not be completed.
Continue to monitor and reassess the components of the primary assessment.
Repeat vital signs are compared to previous sets for changes (trending).
Instructor Notes
Expand on the following points:
The extent of the secondary assessment is based on the patient’s complaints and condition as time permits.
Transport decisions are based on the patient’s assessment and needs.
Instructor Notes
Expand on the following points:
Communicate findings with receiving facility:
Prior to arrival
Upon arrival
Both verbally and written via the patient care report
Instructor Notes
Allow time for a question and answer session to answer any questions about the topics presented in the lesson.
