New โครงการวิจัยและพัฒนาระบบบริการฯ

Rapid Scan

 Chest

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Rapid Scan

 Auscultate chest

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Rapid Scan

 Abdomen

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Rapid Scan

 Pelvis

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Rapid Scan

 Lower extremities

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Rapid Scan

 Assess pedal pulses

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Rapid Scan

 Assess motor and sensory in each
foot

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Rapid Scan

 Upper extremities

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Rapid Scan

 Assess PMS in each upper extremity

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Rapid Scan

 Assess the posterior body

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If Significant Mechanism of Injury
 Assess baseline Vital Signs
 Obtain SAMPLE history
 Reconsider transport decision

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 The Golden Period

◦ Time from injury to definitive care.

 Treatment of shock and traumatic injuries should
occur.

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 The Golden Period

◦ Time from injury to definitive care.

 Treatment of shock and traumatic injuries should
occur.

 Aim to assess,
stabilize, package,
and begin transport
within 10 minutes
(“Platinum 10”).

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 Transport decisions should be made at this
point, based on:

◦ Pt’s condition
◦ Availability of advanced care
◦ Distance of transport
◦ Local protocols

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 Performed

◦ At the scene
◦ In the back of the ambulance en route to the

hospital
◦ Or not at all

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 Purpose is to perform a systematic physical
examination of the Pt

◦ Full-body scan
◦ Focuses on a certain areas of the body

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 Systematic head-to-toe examination
 Goal is to identify injuries or causes missed

during the primary assessment’s rapid
scan.

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Who Needs a Secondary
Assessment

You may never have the time to
perform a secondary physical
exam on a patient with critical
injuries.

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When to Perform a Secondary
Assessment

 If the patient is stable
 After all life threatening

injuries/conditions have been
effectively managed.
 More detailed than the rapid scan

◦ Takes longer to complete

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Secondary Assessment

 look for trauma or other abnormalities.

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Secondary Assessment

 Inspect and palpate the ear

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 Basilar Skull
Fracture

◦ Permits Cerebral
Spinal Fluid to
drain

 Evaluate for
“Target” or
“Halo” sign.

Secondary Assessment

 Inspect behind the ears

Battle’s Signs

Secondary Assessment

 Inspect and palpate the face

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Secondary Assessment

 Assess the pupils

Raccoon’s Eyes

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Secondary Assessment

 Check eye movement

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Secondary Assessment

- Discoloration chamber
- Unequal pupils
- Foreign bodies
- Blood in anterior

chamber.

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Secondary Assessment

Nail gun Blood in anterior

chamber

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Secondary Assessment

 Unequal
pupils

(Anisocoria)

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Secondary Assessment

 Inspect conjunctiva

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Secondary Assessment

 Inspect nose for indications of trauma
or abnormality.

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Secondary Assessment

 Inspect the mouth:

◦ Burns
◦ Trauma
◦ Swelling
◦ Cyanosis
◦ Abnormal smell

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Secondary Assessment

 Assess the neck

◦ Jugular Vein Distension
◦ Tracheal deviation
◦ Subcutaneous

emphysema.
◦ Accessory muscle use

Secondary Assessment

 Inspect and palpate the chest

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Secondary Assessment

 Auscultate breath sounds

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Secondary Assessment

 Inspect and palpate the abdomen:

◦ Guarding
◦ Tenderness
◦ Rigidity
◦ Swelling
◦ Signs of trauma

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Secondary Assessment

 Assess the pelvis

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Secondary Assessment

 Assess the lower extremities

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Secondary Assessment

 Assess the pulses and the skin
characteristics.

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Secondary Assessment

 Assess motor strength and equality

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Secondary Assessment

 Assess sensory perception

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Secondary Assessment

 Assess the upper extremities next

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Secondary Assessment

 Assess pulses and skin characteristics

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Secondary Assessment

 Assess motor strength and equality

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Secondary Assessment

 Reassess vital signs

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Focused Assessment

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 Nonsignificant MOIs or
on responsive medical
patients

 Based on the chief
complaint

 Goal is to focus your
attention on the
immediate problem

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 Blood pressure (BP)

◦ Pressure of circulating blood against the walls of
the arteries

◦ Drop in BP indicates:
 Loss of blood
 Loss of vascular tone
 Cardiac pumping problem

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