Secondary Assessment

The secondary assessment aims to narrow down the diagnosis of a patient. It includes:

1. Taking baseline vitals
2. Patient history - SAMPLE, OPQURST, 1ST STEP
3. A physical exam

Baseline Vitals

HR - Heart Rate

• Read for 15 seconds and multiply by 4.
• Normal HR is between 60 and 100 bpm
• Note pulse quality, is it strong, weak, slow, irregular, or thready?

RR - Respiratory Rate

• Pretend to take the HR reading again so the patient doesn't change breath pattern
• Read for 15 seconds and multiply by 4.
• Normal RR is between 12 and 24 bpm
• Listen for abnormal sounds, note coughing, wheezing, and labored breathing

BP - Blood Pressure:

• Feel for radial pulse in wrist or top of foot
• Is it strong, weak, or none

LOR - Level of Responsiveness - use APVU scale

• Alert and Oriented (A&O 1-4).
  • If they are alert ask who they are, where they are, what time it is, and what they were doing. Note:
    • Person, place, time, event (A&O x 4)
    • Person, place, time (A&O x 3)
    • Person, place, (A&O x 2)
    • Person (A&O x 1)
• Verbally Responsive - If they are not alert, do they respond to verbal stimuli?
• Pain responsive - If they are not verbally responsive, do they respond to a sternum rub or skin pinch?
• Unresponsive - The patient does not respond to any of the above.

SCTM Skin color, temperature, moisture

• Skin color - check skin color for irregularities:

  • Pink - look for normal colored skin at nail beds, and mucus membranes, palms, soles
  • Red or "flushed" - indicates vasodilation, can be caused by allergic reactions, fever, or hypothermia
  • Pale - Indicates vasoconstriction of blood vessels, can be caused by shock or hypothermia.
  • Blue - Indicates lack of oxygen, can be caused by asphyxiation

• Temperature - Check the skin for warmth, hot skin can indicate fever, allergic reaction, or heat stroke/exhaustion

• Moisture - Check for normal sweating

  • Dry skin can be a sign of dehydration
  • Profuse sweating at rest can indicate some types of shock

CSM - Circulation, Sensory, Motor

• Circulation - assess distal pulses and capilary refill (how quickly a thumb-press on the hands and feet refills with color)
• Sensory - Touch fingers and toes and ask if feeling is present
• Motor - Ask patient to wiggle fingers and toes, and push and pull against pressure

PERRL - Eye quality

Assess that the Pupils are Equal, Round, Reactive to light

Patient History - SAMPLE, OPQRST, 1ST STEP

SAMPLE

Always ask about patient history

• Signs and symptoms
• Allergies
• Medications
• Pre-existing conditions
• Last in's and out's
• Events prior

OPQRST

Ask when confused about a patient's pain

• Onset
• Provoke
• Quality
• Radiate
• Severity
• Time/treatments

1ST STEP

Ask when a you are confused about a patient's level of responsiveness (LOR)

• Sugar
• Temperature
• Salt
• Toxins
• Electricity/elevation
• Pressure

Head-to-toe Physical Exam

Use a head-to-toe exam to discover any underlying injuries

• Head: check for deformations, blood, pain
• Cervical spine: check for cerebral spinal fluid (CSF), pain
• Eyes: check for deformations and PERRL
• Mouth: check for blood, broken teeth
• Ears: check for blood, CSF
• Neck: check for inline trachea and distended jugular vein
• Chest: check by palpating clavicle, sternum, ribs, listen for abnormal breathing.
• Abdomen: check by palpating each quadrant for pain, tenderness, rigidity, and contusions
• Back: if patient can move palpate as much of spine as possible. Feel for deformity and listen for pain stimuli
• Pelvis: carefully and only once - check with inward compression of iliac crests to assess for stability
• Legs and Feet: palpate each leg, joint, and foot. Check CSM.
• Arms and Hands: palpate each leg, joint, and foot. Check CSM.

Reassessment

Reevaluate:

• Chief complaint: has it changed? How?
• Primary assessment: is there anything new?
• Vitals: any changes?
• Interventions: are splints, bandages, medications still working?

Record:

• On athletic tape
• Write out SOAP notes
• Transfer to incident report form