PREVIEW OF

EMT/EMR SECONDARY ASSESSMENT

POWERPOINT TRAINING PRESENTATION

CHIEF COMPLAINT

Major sign or symptom reported by patientSymptom

What patient tells you is wrongSign

What you can see, hear, feel, smell or measure about patient

MINOR LOCALIZED INJURY

A cut finger would not require a Secondary Exam

PERFORM A PHYSICAL EXAMINATIONTO GATHER ADDITIONAL INFORMATION

Compare one side of the body to the other

BRIEFLY ASSESS THE BODY FROM HEAD TO TOE

Systematically inspect and palpate, look and/or feel for the following examples of injuries or signs of injury

Deformities ContusionsAbrasions Punctures/penetrationsBurns TendernessLacerations SwellingCrepitus

IMMEDIATELY TREAT LIFE-THREATENING PROBLEMS FOUND IN SECONDARY SURVEY

BASELINE VITAL SIGNS

May consist ofBreathingPulseSkin perfusionPupilsBlood pressureLevel of consciousness

BREATHING

Assessed by observing the patient's chest rise and fallRate is determined by counting

the number of breaths in a 30‑second period and

multiplying by 2Care should be taken not to inform the patient, to avoid influencing the rate

NORMAL RATES

Adult 12-20 Respirations/min11-14 years 12-20 Respirations/min6-10 years 15-30 Respirations/min3-5 years 20-30 Respirations/min1-3 years 20-30 Respirations/min6-12 months 20-30 Respirations/min0-5 months 25-40 Respirations/minNewborn 30-50 Respirations/min

BREATHING

Quality of breathing can be determined while assessing the rate Quality can be placed in 1 of 4 categories:

Normal Shallow or deepLaboredNoisy

PULSE

Initially a radial pulse should be assessed in all patients one year or older

In patients less than one year of age a brachial pulse should be assessed

PULSE POINTS Carotid

Radial

Brachial

Femoral

Popliteal

PULSE

If the pulse is present, assess rate and qualityRate is the number of beats felt in

30 seconds multiplied by 2 (or 15 seconds multiplied by 4)

PULSE

If peripheral pulse is not palpable, assess carotid pulseUse caution, avoid excess pressure on geriatricsNever attempt to assess carotid pulse on both sides at one time

SKIN

The patient's color should be assessed in the nail beds, oral mucosa, and conjunctivaIn infants and children, palms

of hands and soles of feet should be assessed

Normal-pink

CAPILLARY REFILL

Normal capillary refill in infants and children is < 2 secondsAbnormal capillary refill in infants and children is > 2 seconds

BLOOD PRESSURE

Should be taken on patients over three years old

The pressure exerted by circulating blood upon the

walls of the blood vessels

Cuff with bladder

Gauge

Squeeze bulb

Ear piece

Bell

Tubing

SYSTOLIC BLOOD PRESSUREForce exerted against the arteries when the heart is contractingThis is the first distinct sound of blood flowing

through the artery as the pressure in the blood pressure cuff is releasedThis is a measurement of the force exerted against the walls of the arteries during contraction of the heartNormal adult systolic blood pressure-120

APPEARANCE & BEHAVIOR

UnresponsiveComaState of profound unconsciousnessAbsence of spontaneous eye movementsNo response to verbal or painful stimuliPatient cannot be aroused by any

stimuli

APPEARANCE & BEHAVIOR

Observe posture and motor behaviorFacial expression

AnxietyDepressionAngerFearSadnessPain

PELVIS

PELVIC REGION

Check for SymmetryTenderness

LOWER EXTREMITIES

OverviewSymmetrySurface findings

General physical findingsRange of motionSensoryMotor functionCirculatory function

BRAVE TRAINING SOLUTIONS

PREVIEW OF EMT SECONDARY ASSESSMENT

POWERPOINT TRAINING PRESENTATION

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LOWER EXTREMITIES

Peripheral vascular systemTendernessTemperature of lower legsDistal pulses

UPPER EXTREMITIESOverview

Symmetry StrengthSurface findings

General physical findingsRange of motion SensoryMotor function Circulatory functionArm drift

ScalpSkullFace

Symmetry of expressionAppropriate facial expression

HEAD

HEAD

Drainage or bleedingNoseEars

Objects or swelling in mouthVomit, bloodTeeth

EARS

DrainageBloodCerebral Spinal Fluid

EYES

Blood in anterior chamberPupil size, shape, and response

Normal – equal and reactive to lightAbnormalConstrictedDilatedUnequalConjunctiva color and hydration

EYES

Reactivity is whether or not the pupils change in response to the lightReactive - change when exposed to lightNon‑reactive - do not change when exposed to lightEqually or unequally reactive

NOSE

Drainage (Blood, Cerebral Spinal Fluid)Symmetry

MOUTH

BurnsOdorsSwollen or lacerated tongueCondition of teeth or denturesHydration

CHEST

Breath SoundsPresentAbsentEqual

BACK

Roll with spinal precautions and assess posterior aspect of body, inspect and palpate for injuries or signs of injury

ABDOMEN

OverviewPosition patient for examinationShape and sizePalpation method

Four quadrantsPalpate affected area last

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