Primary & Secondary Assessment
Primary Assessment & Secondary Assessment
Information Covered:
- Primary Survey/Primary Assessment
- Initial General Impression – Based on the Patient’s Age-Appropriate Appearance
- Appears stable
- Appears stable but potentially unstable
- Appears unstable
- Level of Consciousness
- While approaching the patient or immediately upon patient contact attempt to establish level of consciousness
- Speak to the patient and determine the level of response
- EMT should identify himself or herself
- EMT should explain that he or she is there to help
- Patient response
- Alert
- the patient appears to be awake
- the patient acknowledges the presence of the EMT
- Responds to verbal stimuli
- the patient opens his/her eyes in respond to the EMT’s voice
- the patient responds appropriately to a simple command
- Responds to painful stimuli
- the patient neither acknowledges the presence of the EMT nor responds to loud voice
- patient responds only when the EMT applies some form of irritating stimulus
- when an irritating stimulus is encountered, the human body will either attempt to move away from the stimulus or will attempt to move the stimulus away from the body
- acceptable stimuli
- pinch the patient’s ear
- trapezius squeeze
- others
- Unresponsive – the patient does not respond to any stimulus
- Alert
- While approaching the patient or immediately upon patient contact attempt to establish level of consciousness
- Airway Status
- Unresponsive patient
- Medical patients
- open and maintain the airway with head-tilt, chin-lift technique
- see the current American Heart Association guidelines for the steps in performing this procedure for victims of all ages
- Trauma patients
- open and maintain the airway with modified jaw thrust technique while maintaining manual cervical stabilization
- see the current American Heart Association guidelines for the steps in performing this procedure for victims of all ages
- Medical patients
- Responsive patient
- If the patient speaks, the airway is functional but may still be at risk -- foreign body or substances in the mouth may impair the airway and must be removed
- finger sweep (solid objects)
- suction (liquids)
- If the upper airway becomes narrowed, inspiration may produce a high-pitched whistling sound known as stridor
- foreign body
- swelling
- trauma
- Airway patency must be continually reassessed
- If the patient speaks, the airway is functional but may still be at risk -- foreign body or substances in the mouth may impair the airway and must be removed
- Unresponsive patient
- Breathing Status
- Patient responsive
- Breathing is adequate (rate and quality)
- Breathing is too fast (>24 breaths per minute)
- Breathing is too slow (<8 breaths per minute)
- Breathing absent (choking)
- Patient unresponsive
- Breathing is adequate (rate and quality)
- Breathing is inadequate
- Breathing is absent
- Patient responsive
- Circulatory Status
- Radial pulse present (rate and quality)
- Normal rate
- Fast
- Slow
- Irregular rate
- Radial pulse absent
- Assess if major bleeding is present
- Perfusion status
- Skin color
- Skin temperature
- Skin moisture
- Capillary refill (as appropriate)
- Radial pulse present (rate and quality)
- Identifying Life Threats
- Assess patient and determine if the patient has a life-threatening condition
- Unstable – if a life threatening condition is found, treat immediately
- Stable – assess nature of illness or mechanism of injury
- Assess patient and determine if the patient has a life-threatening condition
- Assessment of Vital Functions
- Initial General Impression – Based on the Patient’s Age-Appropriate Appearance
- Integration of Treatment/Procedures Needed to Preserve Life
- Evaluating Priority of Patient Care and Transport
- Primary Assessment: Stable
- Primary Assessment: Potentially Unstable
Primary Assessment: Unstable
- Techniques of Physical Examination
- General Approach
- Examine the patient systematically
- Place special emphasis on areas suggested by the present illness and chief complaint
- Keep in mind that most patients view a physical exam with apprehension and anxiety—they feel vulnerable and exposed
- Maintain professionalism throughout the physical exam while displaying compassion towards your patient
- Respiratory System
- Expose the chest as appropriate for the environment
- Chest shape and symmetry
- Respiratory effort
- Accessory muscle use
- Retractions
- Auscultation
- Technique – medical versus trauma
- Presence of breath sounds
- Absence of breath sounds
- Cardiovascular System
- Pulse
- Rate
- Rhythm
- Predictable
- Adjust timing for irregularity
- Strength
- Location
- common locations
- pelationto perfusion
- Perfusion
- Blood pressure
- equipment size
- placement of cuff
- position of patient
- position of arm
- methods of measurement
- auscultation
- palpation
- relation to perfusion
- Blood pressure
- Pulse
- Neurological System
- Mental status
- Appearance and behavior
- assess for level of consciousness (AVPU)
- alert
- response to verbal stimuli
- drowsiness
- stupor
- state of lethargy
- person seems unaware of surroundings
- response to painful stimuli
- unresponsive
- coma
- state of profound unconsciousness
- absence of spontaneous eye movements
- no response to verbal or painful stimuli
- patient cannot be aroused by any stimuli
- coma
- observe posture and motor behavior
- facial expression
- anxiety
- depression
- anger
- fear
- sadness
- pain
- assess for level of consciousness (AVPU)
- Speech and language
- rate
- appropriateness
- slurred
- garbled
- aphasia
- Mood
- nature
- intensity
- suicidal ideation
- Thought and perceptions
- assess thought processes
- logic
- organization
- assess thought content
- unusual thoughts
- unpleasant thoughts
- assess perceptions
- unusual
- hearing things
- seeing things
- assess thought processes
- Memory and attention
- person
- place
- time
- purpose
- Appearance and behavior
- Mental status
- Musculoskeletal System
- Pelvic region
- Symmetry
- Tenderness
- Lower extremities
- Overview
- symmetry
- surface findings
- General physical findings
- range of motion
- sensory
- motor function
- circulatory function
- Peripheral vascular system
- tenderness
- temperature of lower legs
- distal pulses
- Overview
- Upper extremities
- Overview
- symmetry
- strength
- surface findings
- General physical findings
- range of motion
- sensory
- motor function
- arm drift
- Overview
- Back
- Overview
- symmetry
- contour
- surface findings
- General physical findings
- flank tenderness
- spinal column tenderness
- Overview
- Pelvic region
- All Anatomical Regions
- Head
- Scalp
- Skull
- Face
- symmetry of expression
- appropriate facial expression
- Eyes
- pupil size, shape, and response
- normal – equal and reactive to light
- abnormal
- constricted
- dilated
- unequal
- conjunctiva color and hydration
- pupil size, shape, and response
- Ears – fluids
- Nose
- symmetry
- fluid in nares
- Mouth and pharynx
- odor
- hydration
- condition of teeth
- Neck
- Physical findings
- Symmetry
- Masses
- Arterial pulses
- Chest
- Overview
- expose appropriately
- chest shape and symmetry
- respiratory effort
- surface findings – inspection
- Auscultation
- technique – medical versus trauma
- lung sounds
- absence of breath sounds
- Anterior chest
- auscultation findings – lungs
- intercostal muscle use
- retraction
- Posterior chest
- auscultation
- spinal column
- Overview
- Abdomen
- Overview
- position patient for examination
- shape and size
- palpation method
- four quadrants
- palpate affected area last
- Physical findings
- symmetry
- masses
- organ margins
- contour
- softness
- tenderness
- findings associated with pregnancy – physical changes of contour and shape
- Overview
- Head
- General Approach
- How and When to Reassess
- Identify and Treat Changes in the Patient’s Condition in a Timely Manner
- Monitor the patient’s condition
- Monitor the effectiveness of interventions
- Identify trends in the patients vital signs
- Reassessments Should Be Performed at Regular Intervals
- Unstable Patients – Every Five Minutes, or as Often as Practical Depending on the Patient’s Condition
- Stable Patients – At Least Every 15 Minutes or as Deemed Appropriate by the Patient’s Condition
- A Reassessment Includes:
- Primary Assessment
- Vital Signs
- Chief Complaint
- Interventions
- Compare to the Baseline Status of That Component
- Level of Consciousness – Is the Patient Maintaining the Same Level of Responsiveness or Becoming More/Less Alert?
- Airway – Recheck the Airway for Patency
- Breathing – Reassess the Adequacy of Breathing by Monitoring Both Breathing Rate and Tidal Volume
- Circulation – Reassess the Adequacy of Circulation by Checking Both Central and Peripheral Pulses
- Vital Signs
- Repeat Vital Signs as Necessary
- Attention Should Be Paid to:
- Respirations
- Pulse
- Blood pressure
- Pupils
- Chief Complaint
- Constantly Reassess the Patient’s Chief Complaint or Major Injury
- Determine If Their Pain/Discomfort Is Remaining the Same, Getting Worse, or Getting Better
- Be Sure to Ask If There Are Any New or Previously Undisclosed Complaints
- Interventions – Reassess the Effectiveness of Each Intervention Performed and Consider the Need for New Interventions or Modifications to Care Already Being Provided
Age-Related Considerations for Pediatric and Geriatric Assessment and Management
Content Creator: James Stone
CAPCE Course Number: 20-EMTP-F3-8302
Total CE Hours: 1.5
Level: Basic
NJ Course Number: 1992263604378
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.