Primary and Secondary Assessments Shelley Westwood, RN, BSN
I can describe the skills necessary in primary and secondary assessments. Learning targets
First and foremost, check the scene for safety In primary assessment check for life-threatening conditions. Check for Responsiveness Breathing Bleeding Give immediate care for any life-threatening condition found Overview
In secondary assessment Obtain victim s history Perform physical examination of responsive victim Monitor for any changes while giving first aid and waiting for professional help to arrive Overview
Check for responsiveness, normal breathing and severe bleeding Should only take a few seconds DO NOT MOVE VICTIM unless absolutely necessary Victim is in immediate danger You cannot give life-saving care because of their location or position Primary Assessment
Check for responsiveness by tapping person on the shoulder and loudly asking Are you okay? DO NOT MOVE THEM IN ANY WAY UNLESS ABSOLUTELY NECESSARY! A victim who is speaking, coughing, crying or moving is responsive A paralyzed victim may show responsiveness through purposeful eye movements Responsiveness
Unresponsiveness may be a sign of life-threatening condition Call 9-1-1 immediately Responsiveness
At the same time as you are checking for responsiveness, look for normal breathing. An unresponsive victim who is only gasping is not breathing normally A victim who can speak or cough is breathing Do not immediately roll a victim onto the back to open the airway check first in the position found If victim is breathing normally, leave him/her in that position while continuing assessment. Breathing
Check for severe bleeding Control serious bleeding with direct pressure Bleeding
Check simultaneously for responsiveness and normal breathing If victim unresponsive, call 9-1-1 If victim unresponsive and not breathing, call for an AED and provide CPR If victim is breathing, check for severe bleeding and other threats to life Care for any life-threatening conditions before progressing to secondary assessment Recap of primary assessment
If a victim is breathing but unresponsive, position victim in the Recovery position if not suspected of having a spinal injury. Recovery position
Extend victim s arm that is farther from you above the victim s head Position the victim s other arm across the chest Bend the victim s nearer leg at the knee Put your forearm under the victim s shoulder with your hand around the back of the neck to support head and neck Recovery position
Carefully roll victim away from you by pushing on the victim s flexed knee and lifting with your forearm while your hand stabilizes the head and neck. The victim s head is now supported on the raised arm. Bend both legs so victim s position is stabilized. While in recovery position, check the airway and open mouth to allow drainage. Recovery position
You encounter a victim lying quietly on the floor. Number the following actions in the correct order A. Look around his body for a pool of blood B. Check to see if victim responds to your voice or touch C. Look for normal breathing Learning checkpoint
You encounter a victim lying quietly on the floor. Number the following actions in the correct order A. Look around his body for a pool of blood B. Check to see if victim responds to your voice or touch C. Look for normal breathing Answer: B, C, A Learning Checkpoint
When should you not immediately proceed to the secondary assessment from the primary assessment? Learning checkpoint
When should you not immediately proceed to the secondary assessment from the primary assessment? *When the victim has any life-threatening conditions give first aid for those conditions. Learning checkpoint
When do you do it??--performed only for victims without life-threatening conditions Why do you do it??--provides additional information about the injury or illness Usually performed with responsive victims ask for consent first. Includes the history and physical examination Focused primarily on the injured area Secondary Assessment
Talk to responsive victim and/or bystanders Consider the mechanism of injury and forces involved Obtaining patient history
Use the S.A.M.P.L.E format S=Signs and symptoms A=Allergies M=Medications P=Previous problems L=Last food or drink E=Events Obtaining patient history
In unresponsive victims Ask family members or bystanders what they know Check the scene for clues about what may have happened Consider the effects of environmental extremes Consider the victim s age Obtaining patient history
Only done if not giving first aid for a serious condition Examine a responsive victim from head to toe looking for anything out of the ordinary such as: Pain when an area is touched Bleeding or wounds An area that is swollen or deformed Skin color, temperature and condition Abnormal sensation or movement of the area Physical examination
Keep unresponsive victims without a possible spinal injury in the recovery position until EMS professionals arrive Continue to monitor victim s breathing and observe the victim for bleeding and other signs of serious injury. Allow a responsive victim to remain in a position of comfort while conducting the physical exam. Position of victim
This acronym guides what you what to look for while doing a physical exam: D=Deformities O=Open injuries T=Tenderness (pain) S=Swelling D.O.T.S
If you find any problems in any body area, do not let the victim move. Wait for help. Being careful not to move the victim s head or neck, check the: Head Neck Skin Chest/abdomen Pelvis/hips Extremities Skills steps in physical examination
Simple questions to gather history Talk with child s parents or guardians to involve them in the examination. Perform exam from toe to head rather than the opposite Talk calmly and soothingly before starting exam. Examining a child or infant
Give first aid for any injuries or illnesses discovered during the assessment While waiting for help to arrive: Monitor the victim to keep condition from worsening With an unresponsive victim, repeat your assessment of breathing at least every 5 seconds. Monitor the victim
When is the secondary assessment performed? A. Immediately before giving CPR when needed B. In all victims, right after the initial assessment C. After checking for responsiveness. D. After determining there are no life-threatening conditions. Learning checkpoint
When is the secondary assessment performed? D. After determining there are no life-threatening conditions Learning checkpoint
What does each letter in the acronym S.A.M.P.L.E. mean? Learning checkpoint
What does each letter in the acronym S.A.M.P.L.E. mean? S=Signs and symptoms A=Allergies M=Medications P=Previous problems L=Last food and drink E=Events Learning checkpoint
What signs and symptoms are you looking for as you examine each part of a victim s body? Learning checkpoint
What signs and symptoms are you looking for as you examine each part of a victim s body? D=Deformities O=Open injuries T=Tenderness (pain) S=Swelling Learning checkpoint