I do not own this content. It is a slide show presented by John Senior.

1. 08/08/2012
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Initiating a clinical assessment
Part 2
AIMS to discuss
1. Physical Assessment – what you can learn
2. Primary Assessment
3. Secondary Assessment
Preparation:
Rapid visual assessment - ABC
You walk into the patient’s room and ask them
how they are and they respond appropriately.
What have you learnt?
1.Their airway is patient
2.They are breathing
3.Their brain is still perfused
Thus indicating no life-threatening
emergency
You need to do a more in-depth
assessment

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Before commencing a physical
assessment:
Discuss assessment process and obtain
verbal consent; privacy; correct ID
(legal considerations) ; and, if possible,
allow adequate time.
PPE; standard precautions; safe
environment (infection control
considerations)
Stooped
posture
Tremour
Mask-like face
Rigidity
Arms flexed
at elbows
and wrists
Tremour
Hips and
knees
slightly
flexed
Short, shuffling steps
Parkinsonism:
•Bradykinesia,
rigidity, tremour
•May be an
extrapyramidal
side effect of
medication
What can
you tell
from the
way a
patient
walks?
Ataxic gait in cerebellar
ataxia.
Poor balance and a broad
based - lurching and
staggering and
exaggeration in all
movements.
Because the patient can’t
feel the feet they slap
them down and look down
while walking

3. 08/08/2012
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What can you tell by shaking hands with someone?
Eg
Perfusion
Hydration
Strength
Pain
Disfigured hands/wrists
Finger nails / abnormal
When dealing with debilitated patients Consider:
Nutrition
Dentition
Podiatry
Eyesight and hearing
Primary Survey, also called primary
care and primary assessment
Followed by precise reporting and
documentation
Information is conveyed using
common terminology

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Dangers (check for hazards, risks, safety)
Depending upon the circumstances safety must
be considered:
If outside the hospital is the scene secure e.g.,
shooting scene, fire, contamination
Occasionally it may be necessary to delay
treatment
When this is completed then the
assessment/treatment can commence
RESPONSIVE
CARE: Patient may startle or act aggressively, approach
from feet.
Squeeze the patient’s hand and gently squeeze the patient’s
shoulders.
If no response CALL FOR HELP
In hospital this means pressing the red emergency button
which automatically calls the Medical Emergency Team
(MET)
The hospital also has an emergency number ***
Out of hospital call an ambulance on 000 (or 112 if using a
mobile)
Send for help
If no response SEND FOR HELP
In hospital this means pressing the red emergency button
which automatically calls the Medical Emergency Team
(MET)
The hospital also has an emergency number ***
Out of hospital call an ambulance on 000 (or 112 if using a
mobile)

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AIRWAY
“In an unconscious victim, care of the airway
takes precedence over any injury” ARC
Guideline 4 2006
Step 1
Clear the airway
Step 2
Ensure airway patency
If breathing commences the victim can be left on
the side with appropriate head tilt. If not the
victim should be rolled onto their back and
resuscitation commenced
•Determine whether the airway is patent.
Are there any gurgles, snoring or obvious
bronchospasm?
•Does air appear to be going in and out?
Trauma:
If the patient has been subjected to trauma that
may have damaged the cervical spine care should
be taken not to hyperextend the neck. In this
case the ‘jaw thrust’ manoeuvre may be used

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Children (1 to 8 years) and
Infants (younger than one year)
“…in infants the head should be kept in neutral and
maximum head tilt should not be used”
Head position for children
Airway obstruction
Can be partial or complete; typical causes include:
•Relaxation of the airway muscles due to
unconsciousness
•Inhaled foreign body
•Trauma to the airway
•Anaphylactic reaction
BREATHING - Normal
•Assessment of Breathing
•Infection Control issues – discuss

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Determine the presence or absence of effective
breathing by assessing:
•Rate (approximate)
•Regularity
•Pattern (e.g. abdominal, Cheyne-Stokes)
•Depth
•Symmetrical paradoxical chest rise
•Accessory muscle use
•Skin colour
Expired air delivers a concentration of 15-18% oxygen
Methods of delivery:
•Mouth to mouth
•Mouth to nose
•Mouth to mouth and nose
•Mouth to mask
CPR - Start
The ARC Guidelines since 2006 does not state feeling for a major
pulse (carotid) but states that if there are no “signs of life” to
commence external cardiac compressions.
However as health professionals one should be able to correctly
palpate for a carotid pulse.
If there is no palpable pulse in the adult immediately commence
compressions.

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Touch the patient’s wrist and evaluate
•Pulse presence
•Rate (approximate)
•Volume
•Regularity
•Skin temperature
•Diaphoresis (clamminess)
•Capillary refill
•Skin / nail-bed colour
If in an emergency
setting assess the
cardiac rhythm and
any ecg
abnormalities
Attach Defibrillator
Post resuscitation
SBP >100 mmHg
SaO2 94-98
BGL 6-8 mmol/L
Control seizures
Treatable causes of cardiac arrest are:
Hypoxaemia
Hypovolaemia
Hyop/Hyperkalaemia (other metabolic disorders include acidosis disturbances Mg and Ca
Tension pneumothorax
Tamponade: pericardial
Toxins/poisons/drugs
Thrombosis

9. 08/08/2012
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The Secondary Assessment / Survey
Exposure / Environment
Can I see everything?
What environment has the patient come from?
Too hot / cold / are they comfortable?
General observations
Appearance
Any obvious problems/injuries
Behaviour
Walk
Pain (the fifth vital sign) assessment (PQRST)
P = Provokes
What provokes the pain? What makes it feel worse/better?
What was the patient doing when the pain began?
Q = Quality
What does the pain feel like? Have the patient describe it.
Words commonly used are dull / sharp / pressure / tearing
R = Radiates
In what direction does the pain radiate? Is it located in one
area?
Does it move?
Pain assessment (PQRST)
S = Severity
How severe is the pain? On a scale of 0 -10
T = Time
When did it start? How long did it last? Has the patient had it
before? Is it constant or intermittent?

10. 08/08/2012
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Head to toe examination
What is happening for the patient?
Has anything been missed any other
injuries or problems the patient may not
have mentioned
Skin colour pallor/cyanosis/flushed
Posture stiff neck/abnormal position
Ears / nose Discharges / ‘Battle’s sign’
Eyes ‘rocoon’s eyes/deviation/pupils
Odour alcohol / ketones
Hydration fever, tachycardia, skin turgor
Face symmetry

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I = Investigations
Are any of the patient’s reports or
results available?
J = jot it down
Has everything been documented
accurately?