Learn how to give a complete first aid secondary survey. This post includes how to take and record a patients SAMPLE history and vital signs. It also goes through how to give a full body physical exam and the use of SOAP notes to record your findings. In a secondary survey, look for injuries unseen during the primary assessment (DRABC).
The information in this post is from the book “Wilderness and Travel Medicine” by Sam Fury.
Wilderness and Travel Medicine is a comprehensive handbook with a minimalist approach. It contains prevention, diagnoses, and treatments for a wide range of ailments using modern and “survival” medicines.
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- Recording your findings (SOAP Notes)
- SAMPLE secondary assessment
- How to take a patients vital signs
- How to give a full body physical exam
How to Give a Complete First Aid Secondary Survey
IMPORTANT: No amount of reading can compare to a medical course with a professional trainer. A standard first aid course is good. A Remote Area First Aid Course or higher is best.
After stabilizing your patient using DRABC, do the first aid secondary assessment. To give a first aid secondary examination means to check your patient from head to toe. Do it in a methodical way so you do not miss anything.
In critical first aid (DRABC), you treat the problems as you find them. With the secondary exam, you complete the full assessment first. Then you treat what you find in order of priority.
SAMPLE History, vital signs, and the full body exam make up the secondary survey steps. A secondary survey should start with whichever is most appropriate for the situation. For example, if the patient is incoherent then taking a SAMPLE History will have to wait.
Recording Your Findings (SOAP Notes)
While doing the secondary assessment of a medical patient, record your findings with SOAP notes. Record your findings of the primary and secondary assessment of a patient. Use the luxury of time during the secondary examination to “catch up on your paperwork”.
Recording your findings in first aid is very important. Give the information you find to all caretakers of the patient.
- Use the acronym SOAAP to record your findings.
- Subjective information: History, scene, story and symptoms.
- Objective information: Exam findings, vital signs.
- Assessment: All the problems you found.
- Anticipated Problems: Any problems that may arise.
- Plan: What you are going to do.
Write the patient’s personal details at the top. Include his/her name, age, sex, birth date, weight, phone number, etc.
There are many SOAAP (SOAP) Note templates on the internet, but a pencil and paper will suffice if that’s all you have. Using an actual SOAP note is best. They are like a secondary survey checklist.
SAMPLE Secondary Assessment
The best/easiest way to extract your patient’s history is to talk to him. It is important that the patient feels comfortable with you. If not, he/she might be too embarrassed to tell you what may be important information. Ensure them that everything they tell you is confidential and not to leave anything out.
Use the acronym SAMPLE to make sure you do not miss anything.
- Symptoms: What are the patient’s symptoms?
- Allergies: Does the patient have any known allergies? This includes medication.
- Medications: Is the patient on any medication?
- Past History: Is the problem reoccurring? Does the patient or the patient’s family have a history of a suspected ailment?
- Last: A history of the last things that went in and out of the person’s body.
- Events: A detailed description of the events that led up to the problem.
How to Take a Patient’s Vital Signs
Assessing and monitoring your patient’s vital signs will provide you with important information. It will help you decide on a treatment and then track the effectiveness.
- Count the pulse for 15 seconds and multiply it by 4.
- 60 to 100 beats per minute is normal.
- Check for an entire minute.
- Normal rate of breaths per minute (BPM) for an adult at rest is 12-18 breaths per minute. Over 20 is a sign of distress.
- The younger a child, the faster their respiratory rate. An infant may have between 30 to 60 breaths per minute whereas a school age child (6 to 12 years) may have 18 to 30.
- Note any unusual noises, e.g., wheezing or gurgling.
- Check blood pressure if the equipment is available.
- Blood pressure measures the amount of work the heart has to do to pump blood through the body.
- A reading less than 140/90 at rest is normal. It may be high after extreme physical exertion but goes back down after a short while.
- High blood pressure may be a medical condition and low blood pressure may mean hemorrhage or shock.
- Check color (red, pale), temperature (hot, cold) and moisture (clammy, dry, moist etc.).
- A normal temperature ranges between 36.1 °C (97 °F) and 37.2 °C (99 °F).
- Above 38 °C (100.4 °F) or below 35 °C (95 °F) and there is something wrong. Hyper or hypothermia may be an issue.
- Gauge with AVPU.
- If there is a problem with the patient’s mental status, use the acronym STOPEATS to discover the cause:
- Sugar: Hypo or hyperglycemia.
- Temperature: Hypo or hyperthermia.
- Oxygen: Abnormal levels of oxygen.
- Pressure: Increasing ICP.
- Electricity: Trauma from electric shock or problems in the brain.
- Altitude: High altitudes can result in various altitude related illnesses. Very low altitudes (i.e., underwater) can result in various diving related illnesses.
- Toxins: Drugs, alcohol, poisons, etc.
- Salts: Low sodium or potassium levels.
How to Give a Full Body Physical Exam
Examine the areas about which the patient has a specific complaint about. Compare any outer physical complaints to the patient’s non-injured side.
Check the range of motion, circulation, motor skills, sensation etc. Be very careful about forcing something to move.
Do this in a systematic manner, from head to toe. Use only as much physical pressure as is necessary to discover an injury or lack thereof. Check the whole body for obvious signs of injury, e.g., bruises, bleeding, etc.
A stethoscope, penlight, gloves and tongue depressor will be useful.
- Head. Bumps, bruises, bleeding from orifices, etc.
- Eyes. Redness, whether the pupils respond equally to light.
- Mouth. Inside and outside. Redness, sores, dental issues.
- Neck. All around neck and back of the head, neck bones (vertebrae).
- Chest. Use a stethoscope if available. Check lungs for abnormal sounds. Wheezing, gurgles, crackles, etc.
- Heart. Rhythm of heart beat, e.g., fast, slow regular, irregular.
- Ribs. Possible fracture.
- Armpits. Injury, parasites (lice, ticks etc.), tenderness.
- Breast. Move your fingers in a circular motion over the breast tissue. Start from where the arm connects to the shoulder and end at the nipple.
- Press on the abdomen with your open hand. Check for pain, tenderness, swelling, abnormal masses, etc.
- Listen for bowel sounds and note if there is too much or too little.
- Check percussion. Place your open hand on the different quadrants of the abdomen and tap on your middle finger. It should sound hollow.
- Liver and Spleen. Press down on the patient’s right side below the rib cage to determine an enlarged liver. You won’t feel it if it isn’t. An enlarged spleen will appear as a mass on the left side under the bottom of the rib cage.
- Spine. Check along the patient’s spine for evidence of pain or injury. Never press on the vertebrae. Learn how to give a proper spinal assessment in this post.
- Kidneys. Pound lightly with a closed hand on each side of the back below the last rib. An injury or infection of the kidneys will result in pain.
- Examine each extremity by feeling the muscle groups for pain or decreased range of motion.
- Check perfusion.
- Check for sensation by lightly tapping with sharp and dull sensations on the hands and feet. A safety pin works well.
- General Strength.
- Place your hands on their thighs and ask them to lift up.
- Ask them to grasp your fingers with each hand then try to pull your hand away; if you can’t, that’s good.
- Strength should be about equal on both sides of the body.
Photo Credit: Mass Communication Specialist 3rd Class Justin W. Galvin
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