Lesson 6- Secondary Assessment and Vitals

when should you perform a secondary assessment

if the rapid assessment does not reveal any immediately life-threatening conditions

what should you remember before performing a secondary assessment

a person who is aware and alert must give consent before you assess them or give care

what is the purpose of the secondary assessment

provides additional information about injuries or conditions that may require care and could become life-threatening if not addressed

what do you do if life threatening conditions develop or are found during the secondary assessment

immediately stop the assessment, instruct someone to call EMS and get emergency equipment, care for the condition according to the level of your training

what is a SAMPLE history

S- signs and symptoms

A- allergies

M- medications

P- past medical history

L- last oral intake

E- events

what are the important parts of assessing someones pulse

• presence

• strength

• BPM

  • 60-80 for adults

  • 80-100 for children

  • 100-120 for infants

  • may vary based of training/activity level

what are the important parts of assessing respiration

• respiration rate

  • adults- 12-20 BPM

  • infants- 25-50 BPM

  • children- 15-30 BPM

• shallow or deep

• irregular or regular

• gasping

• coughing blood

what are the important parts of assessing blood pressure

• systolic/diastolic

  • ideal is 120/80

• systolic

  • pressure created by ventricle contraction

    • normal- 115-120mmHg

    • high- >135mmHg

    • low- <110mmHg

• diastolic

  • residual pressure between beats

    • normal- 60-80mmHg

what are the steps for taking someones blood pressure

measured with a sphygmomanometer

1. apply rubber cuff and inflate with air until there are no audible sounds and the brachial artery is closed

2. release pressure in cuff until audible sounds can be heard through the stethoscope and pressure is between 70-120

3. release all pressure from cuff

what are the important parts of assessing respiration

• normal- <98.6, low- <95, low grade fever- 100-102, fever- >104

• can be measured through mouth, armpit, ear, rectum

  • rectum is most accurate

• change in temp may be due to disease, cold/heat exposure, pain, fear, nervousness

• cold temp can look like chattering teeth, blue lips, change in skin color

what are the important parts of assessing skin color

• red and flushed

  • heat stroke, high BP, high temp

• pale, ashen, or white

  • lack o fO2

  • indicates shock, circulation issues, etc

• cyanotic

  • primarily in nail beds and lips

    • large lack of O2

what does PEARL stand for

P- pupil

E- equal

A- and

R- reactive to

L- light

pupil response is more important than size

what is the ideal BPs based on victim age

adult- 110-135/ 60-90

children- 80-110/60-90

infants- 70-95/60-90

what are the important parts of assessing consciousness

• continually assess

  • alertness and awareness of

    • environment

    • AVPU scale

• may be altered with head injury, heat stroke, or diabetic coma

what are the two main types of assessments

• on the field

• off the field

  • use this when possible

what are the important parts of a musculoskeletal assessment

• knowledge is critical

  • anatomy

  • MOI

  • major signs and symptoms

• HOPS

what is the HOPS acronym

major steps of a musculoskeletal assessment

H- history

O- observation

P- palpitation

S- special tests

what is the purpose of getting a history

obtaining information about the injury

what are the keys to a good history

• be calm and reassuring

• ask open ended questions

• listen carefully

• maintain eye contact

• record without interruption

• obtain as early as possible

what are the parts of a history

• MOI

• injury location

• pain characteristics

• joint responses

• determine if acute or chronic

• history of injury

what are the parts of an observation

• deformity

• bilateral comparison

• limp

• swelling

• facial expression

• postural malalignment

• imflammation

what are the important parts of palpation

• obtain consent

• start with the healthy side first to build trust and get a comparison

• start away from the injury and works towards it

• determine

  • point tenderness

  • anatomical structures affected

  • non-visual deformities

what are the types of special tests

• range of motion

• strength

• joint stability

• functional performance

range of motion test

• with a goniometer and inclinometer

• active vs. passive

  • active=they move it

  • passive = you move it for them

what are the decisions to be made following the initial assessment

• seriousness of injury

• type of first aid/ immobilization required

  • need immediate referral?

• type of transport to sideline, ATR, or hospital

what is the RICE principal

for the control of inflammation

R- rest

I- ice

C- compression

E- elevation

rest

healing begins immediately

allow for enough rest before rehab begins

ice

• treatment must last for 20 minutes

• repeat every 1-1.5 hours for 72 hours

• put something between ice and tissue to avoid damage

• reduces pain and increases vasoconstriction

compression

• decrease space

• absorption of swelling facilitated

• may be most important factor in limiting swelling

• first 72 hours

elevation

• greater elevation = more effective reduction in swelling

• above the heart