Emergency Secondary Assessment (Pediatric)
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Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Do not begin the secondary assessment until the primary assessment is complete and resuscitation procedures are initiated based on the findings of the primary assessment.
Immediately stop the secondary assessment and address any life-threatening conditions if the patient’s condition deteriorates.
The secondary assessment is a rapid and systematic assessment of a critically ill or injured pediatric patient from head to toe to identify all signs of illness and injuries or of a patient who is seriously ill when the cause of signs and symptoms is unclear.undefined#ref2">2
There are two major components of the secondary assessment: the focused history and the focused physical assessment, both based on the presenting signs and symptoms.
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Heart and respiratory rates may be altered by fear, pain, and anxiety, or by physiologic problems such as hypoxia and hypovolemia.
Do not rely on blood pressure alone to assess perfusion. Pediatric patients can maintain a normal blood pressure in the presence of significant hypovolemia. Assess perfusion with level of consciousness, heart rate, capillary refill, skin color, and pulses.
Immediately stop the secondary assessment and address any life-threatening conditions if the patient’s condition deteriorates. Return to the primary assessment and intervene before returning to the secondary assessment.
Do not rely on pulse oximetry readings in a patient with poor perfusion; they may not be accurate. Assess the quality of the plethysmographic waveform if there is any doubt.
The anterior fontanelle does not usually close until 18 months of age. A bulging fontanelle may indicate increased intracranial pressure.2 A sunken fontanelle may indicate dehydration.
Palpate the areas that are known to be painful last to facilitate the patient’s cooperation.
If the patient is uncooperative with palpation of the abdomen, assess for rigidity by palpating the abdomen when the patient inhales, which relaxes the abdominal muscles.
Unilateral pain is a significant finding.
Placement of an indwelling urinary catheter is contraindicated if there is blood at the urinary meatus, perianal ecchymosis, or scrotal ecchymosis.
If there is crepitus or instability when assessing the anterior superior iliac crests, do not assess the symphysis pubis.
There is evidence that the log roll maneuver can result in spinal movement. Carefully consider the risks and benefits of performing this maneuver, especially if the potential for spinal cord injury is significant.1 When spinal or pelvic injuries are suspected, radiographs are recommended before logrolling the patient.2
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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