secondary assessment

Secondary Assessment

Detailed evaluation of the patient to find additional injuries or conditions not found in the primary assessment

When Secondary Assessment Is Done

Only for stable patients or during transport; may be skipped if life threats require continuous care

Types of Secondary Assessment

Head-to-toe exam (trauma) OR focused exam (medical or isolated complaint)

Inspection

Visual examination of the patient for abnormalities using DCAP-BTLS

Palpation

Touching body to find tenderness, deformity, temperature changes, or swelling using hands/fingertips

Auscultation

Listening to internal body sounds (lungs, heart, bowel) using a stethoscope

Comparison Rule

Always compare left vs right side of body for differences

DCAP-BTLS

Trauma assessment checklist: Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling

Head-to-Toe Assessment

Full systematic exam to find hidden injuries in unconscious or trauma patients

Face Assessment

Look for DCAP-BTLS, symmetry, swelling, bleeding, and deformities

Eye Assessment

Check pupils (PERRL), eye movement, redness, contacts, and unequal pupils (possible brain injury)

Battle’s Sign

Bruising behind ear; indicates possible skull fracture

CSF Leak

Clear fluid from nose/ears; indicates skull fracture and brain injury risk

Zygomatic Arch

Check cheekbone for fractures or tenderness

Maxilla Assessment

Checks upper jaw and facial bone stability

Mandible Assessment

Checks lower jaw for fracture or misalignment

Neck Assessment

Check for DCAP-BTLS, tracheal position, and jugular vein distention (JVD)

JVD (Jugular Vein Distention)

Sign of heart failure, fluid overload, or obstructive shock

Chest Assessment

Look for chest rise symmetry, deformities, paradoxical movement (flail chest)

Flail Chest

Segment of rib cage moves opposite normal breathing; severe trauma, causes poor ventilation

Breath Sounds Assessment

Listen in multiple lung fields (anterior, lateral, posterior) to compare both sides

Abdomen Assessment

Check for DCAP-BTLS and tenderness; rigid abdomen may indicate internal bleeding

Abdominal Rigidity

Sign of internal bleeding or peritonitis (medical emergency)

Pelvis Assessment

Gently compress to check stability; instability may indicate major internal bleeding

Pelvic Fracture Danger

Can cause massive internal hemorrhage → treat as life-threatening

Extremity Assessment

Check circulation, movement, sensation (CMS/PMS), and signs of injury

PMS (Pulse, Motor, Sensory)

Checks circulation, nerve function, and movement in extremities

Back Assessment

Check for hidden injuries; maintain spinal precautions if trauma suspected

Spinal Precautions

Prevent movement of spine using stabilization during log roll and transport

Vital Signs

Pulse, respiratory rate, blood pressure, oxygen saturation, temperature, and mental status

Blood Pressure (BP)

Force of blood against artery walls; measured using cuff and stethoscope or automated device

Korotkoff Sounds

Sounds heard during BP measurement; used to determine systolic and diastolic pressure

Systolic BP

First sound heard; pressure when heart contracts

Diastolic BP

When sounds disappear; pressure when heart relaxes

Pulse Oximetry

Measures oxygen saturation (SpO2) in blood

Normal SpO2

94–99% in healthy individuals

Hypoxia Risk

Low oxygen in tissues even if pulse oximeter appears normal

False Low/High SpO2 Causes

Poor perfusion, anemia, carbon monoxide poisoning, dark nail polish, cold extremities

Blood Glucose Testing

Measures sugar level in blood; used for altered mental status or suspected diabetes issues

Hypoglycemia

Low blood sugar → confusion, sweating, weakness, seizures, unconsciousness (can mimic stroke)

Hyperglycemia

High blood sugar → dehydration, nausea, fruity breath, altered mental status

Capnography

Measures carbon dioxide (CO2) in exhaled air; shows breathing effectiveness

ETCO2

End-tidal CO2; normal range ~35–45 mmHg

Low ETCO2

Poor perfusion, hyperventilation, metabolic acidosis, shock

High ETCO2

Hypoventilation, COPD/asthma exacerbation, respiratory failure

Capnography Uses

Confirms airway placement, monitors ventilation quality, evaluates CPR effectiveness

Respiratory Rate

Number of breaths per minute; measured by chest rise

Normal Adult RR

12–20 breaths per minute

Tachypnea

Abnormally fast breathing (>20/min in adults)

Bradypnea

Abnormally slow breathing (<12/min in adults)

Apnea

No breathing; requires immediate intervention

Breath Sounds (Normal)

Clear airflow in both lungs without abnormal sounds

Wheezing

High-pitched sound (usually expiration); asthma, bronchospasm, COPD

Rales (Crackles)

Crackling sound from fluid in alveoli; pneumonia, pulmonary edema

Rhonchi

Low, gurgling sound from mucus in larger airways; may clear with coughing

Stridor

High-pitched inspiratory sound; upper airway obstruction (life-threatening)

Snoring Sounds

Partial airway obstruction from tongue relaxing; common in unconscious patients

Airway Priority

Any abnormal upper airway sound (stridor/snoring) = immediate airway intervention