Secondary Assessment

Question 1

What is the main objective of the Secondary assessment, compared to the Primary?

Answer 1

Primary is used to determine immediate life threatening conditions.

Secondary is a slowed, more thorough survey to determine any injuries or conditions that CAN become life threatening without treatment.

Question 2

Secondary Assessment Part 1: Interview

Answer 2

Interview:
Ask patient or bystanders to determine MOI/chief complaint
- SAMPLE questions
- OPQRST

Pain can ONLY be determined by the patient!

Question 3

Secondary Assessment Part 2: Vital Signs

Answer 3

Vital Signs:
- Skin condition
- Respiratory status
- Heart Rate
- Blood Pressure
- Pupils (PEARL)
- LOR (Glasgow)
- Pulse Oximetry

Should be reassessed every 5 mins for an unstable patient and every 15 mins for a stable patient.

First set of vitals establishes a baseline. Every reassessment should be compared to the first set of results.

Question 4

Secondary Assessment Part 3:
Head-to-Toe physical examination

Answer 4

1) Explain to patient & gain consent / ask for feedback

2) Scanning for MSK abnormalities (DCAP BLS TIC)

3) Head
- Foreign fluids in orifices
- Periauricular & Periorbital ecchymosis
- Reassess airway
- Assess facial bone integrity

4) Neck
- Tracheal Deviation
- Jugular vein distention
(Head/neck must be aligned to assess these 2)
- C-spine

5) Thorax & Back
- Paradoxical breathing
- Clavicle, shoulders, sternum & ribs

6) Abdomen
- Expose and palpate (4 quadrants around umbilicus)

7) Pelvis
- Check for incontinence
- Compress & gap
- Check femoral pulse (Pubic symphysis -> ASIS)

8) Check PMSC on all distal limbs

9) Check for medical tattoos / bracelets if not already done.

Question 5

Average Vital Signs by age

Answer 5

0-28 days:
Pulse 120-160
Resp: 40-60
BP: 80/40

1-12 months:
Pulse:100-120
Resp: 30-40
BP: 80/40

1-8 years:
Pulse: 80-120
Resp: 16-24
BP: 90/50

8+ years:
Pulse: 60-100
Resp: 12-20
BP: 120/80

Question 6

Glasgow Coma Scale

Answer 6

1) Eye opening:
Spontaneous = 4
To voice = 3
To pain = 2
No response = 1

2) Best verbal response:
Oriented and converses = 5
Disoriented & converses = 4
Inappropriate words = 3
Inappropriate sounds = 2
No Response = 1

3) Best Motor response:
Obeys verbal command = 6
To painful stimulus:
Localizes pain = 5
Withdrawal = 4
Abnormal flexion = 3
Abnormal extension = 2
No response = 1