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Lecture presentation phtls_lesson08
- 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
- 4. Secondary Assessment (3 of 3) • Never delay transporting a critical patient in order to complete a secondary assessment © Kevin Norris/ShutterStock, Inc.
- 5. Components • Vital signs • History • Physical examination • Treatment • Decision-making • Transportation • Receiving facility • Communication
- 6. Vital Signs (1 of 6) • First part of the secondary assessment – Reassessment of vital functions • Multiple components – Pulse, ventilatory rate, blood pressure, skin parameters – All components in combination give an overall picture © Jones & Bartlett Learning. Photographed by Darren Stahlman.
- 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
- 8. Vital Signs (3 of 6) • Pulse – Location – Strength – Rate – Rhythm © Jones & Bartlett Learning. Photographed by Darren Stahlman.
- 9. Vital Signs (4 of 6) • Respirations – Ventilatory rate – Depth/expansion – Effort • Use of accessory muscles • Mouth breathing versus nose breathing – Breath sounds and location © Jones & Bartlett Learning. Courtesy of MIEMSS.
- 10. Vital Signs (5 of 6) • Blood pressure – Systolic and diastolic measurements • Automated • Manual – Auscultation – Palpation © WizData, Inc./ShutterStock, Inc.
- 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
- 12. History • Verbal history from patient, family members, bystanders – Clues from on-scene observation • S-A-M-P-L-E © Robert Byron/Dreamstime.com
- 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
- 18. Treatment Options (4 of 4) • Comfort Measures: – Emotional support (reassurance) • Patient • Family members © Jones and Bartlett Learning. Courtesy of MIEMSS.
- 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
- 23. Communication (2 of 2) • Hand-off report – Verbal and written
- 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
- 27. Questions?
Editor's Notes
- 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.