ems 351 lecture (5). 1.list purpose secondary assessment. 2.discuss assessment techniques. 3.explain...
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EMS 351 Lecture (5)
SECONDARY ASSESSMENT
DR. SAMAH MOHAMMED 2014 – 2015
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LEARNING OBJECTIVE
1. List purpose secondary assessment.
2. Discuss assessment techniques.
3. Explain vital signs.
4. Discuss monitoring devices.
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Purpose OF Secondary Assessment
1. Performing a rapid full-body exam from head to toe.
2. Focused assessment of pain.
3. Assessment of vital signs
4. Perform a systematic physical examination of the
patient.
5. Often determine through chief complaint.
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Secondary Assessment
• The secondary assessment is done to assess non–life-threatening conditions. INCULDES
1.Assess vital signs .
2.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
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Secondary Assessment
• Not every aspect will be completed in every patient.
–Factors to consider:
1. Location
2. Positioning of the patient
3. The patient’s point of view
4. Maintaining professionalism
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Secondary Assessment
1. Inspection:– Looking at the patient for
abnormalities.
E.g.: swelling in lower extremity.
2. Palpation:– Touching to obtain
information as:• Pulses: use finger • Skull: use palms • Skin: use back of hand
to measure temperature
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Assessment Techniques
3. 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
4. Auscultation:
• Listening to sounds with a stethoscope AS:
• Understanding of what “normal” sounds like
• Measuring blood pressure
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1. Vital Signs
1. 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.
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Vital Signs
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Vital Signs2. Respiration:
3. Check the breathing rate and quality.
4. Count respirations for 30 seconds.
5. The normal adult resting respiratory rate is 12 to 20
B/ M (breath per minute).
6. Note effort of breathing.
7. Listen for noises.
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Vital Signs3. 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.
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Vital Signs4. 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.
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Vital Signs
Route Normal Range / ºC Sites
Oral 37.0 ºC Mouth
Tympanic 37.6 ºC Ear
Rectal 37.6 ºC Rectum
Axillary 36.6 ºC Axilla
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Age Respirations (breaths/mi
n)
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 80 to 100
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 60 to 100 90 to 140
Vital Signs
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Monitoring Devices
• Including:1. Pulse oximetry.2. blood pressure cuff (sphygmomanometer).3. Blood glucose determination.4. Continuous ECG monitoring.5. Carbon dioxide monitoring.6. Basic blood chemistry.7. Thermometer. 8. Stethoscope9. Ophthalmoscope10. Otoscope11. Scissors12. Gloves13. Sheet or blanket
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Equipment Used in the Secondary Assessment
• Stethoscope
A. Amplifies body sounds
B. Earpieces
C. Binaural and tubing
D. Chest piece
• Bell – low-pitched
sounds
• Diaphragm –
high-pitched sounds
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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!
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Equipment Used in the Secondary Assessment
• Ophthalmoscope
1. Allows you to look into
patient’s eyes
2. Consists of concave
mirror and battery-
powered light
3. Requires dilation of
pupils and diagnostic
expertise
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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
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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.
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Monitoring Devices• 12-lead ECG monitoring
A. Patient should be
supine.
B. Prepare the skin.
C. Connect electrodes.
D. Connect and apply the
precordial leads.
E. Record the ECG.
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Monitoring Devices
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Monitoring Devices• Blood glucometer:-
a) Can obtain reading in two ways in the field:
i. From the center of an IV catheter.
ii. From a finger stick.
b) Most take only a few seconds.
c) Should be scale regularly.
• Cardiac biomarkers:-a. Used to assess presence of damage to cardiac
muscle.
• Other blood tests:-1. Arterial blood gases
2. CBC ( complete blood count)
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