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					<h3 class="elementor-heading-title elementor-size-default">EVALUACIÓN SECUNDARIA</h3>				</div>
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									<p style="text-align: justify;">La evaluación secundaria inicia cuando se ha realizado una <span style="color: #3366ff;"><a style="color: #3366ff;" href="https://prevencionsaludproactiv.com/2021/02/22/evaluacion-primaria-soporte-vital-en-trauma-phtls/">evaluación primaria</a></span> exhaustiva y las amenazas a la vida se han corregido. Recuerde que luego de realizar la evaluación secundaria, se deberá repetir constantemente la evaluación primaria.</p><p style="text-align: justify;">La evaluación secundaria es una exploración física, sistemática y segmentaria, céfalo-caudal, que incluye medición de signos vitales y un exhaustivo examen neurológico. Debe adaptarse al tipo de paciente y a su patología.</p><script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-4254951495333536" 
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</script><p style="text-align: justify;">Debe ser realizada en camino al Servicio de Urgencia y, en el paciente crítico, sólo si ya se han manejado las lesiones o fenómenos que amenazan la vida del paciente.<br />Tiene como propósito identificar otras lesiones (sin riesgo vital) que hayan pasado desapercibidas en la Evaluación inicial.<br />Junto con el examen clínico se inicia el registro de datos del paciente y los detalles del evento de trauma (breve historia de lo sucedido y del análisis de la cinemática entregado por el equipo de rescate).<br />El paciente debe ser evaluado a través de la observación visual, palpación y auscultación (MES: Mirar, Escuchar y Sentir).<br />Esta etapa no debe retardar el traslado, especialmente en el caso de pacientes críticos.</p><p> </p>								</div>
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									<h3>Signos Vitales:</h3><p style="text-align: justify;">Lo primero que realizamos en esta etapa es una revisión de los signos vitales del paciente y necesariamente los debemos comparar con los hallazgos encontrados en la evaluación primaria para determinar si nuestro paciente ha ido mejorando o no.</p><p style="text-align: justify;">Durante la evaluación primaria no se determinan (la mayoría de las veces) parámetros exactos de la ventilación y circulación, es en este momento donde realizamos una completa valoración de dichos parámetros, calculando frecuencia. Un conjunto completo de signos vitales incluye:</p>								</div>
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									<p style="text-align: justify;">&#8211; Presión arterial.</p><p style="text-align: justify;">&#8211; Frecuencia y calidad del pulso.</p><p style="text-align: justify;">&#8211; Frecuencia y profundidad ventilatoria.</p><p style="text-align: justify;">&#8211; Saturación de oxígeno.</p><p style="text-align: justify;">&#8211; Color y temperatura de la piel.</p><p style="text-align: justify;">En pacientes con lesiones que amenazan la vida en estado crítico se debe repetir la toma de signos vitales cada 3 a 5 minutos.</p><p style="text-align: justify;">SAMPLE:</p><p style="text-align: justify;">El objetivo es obtener un historial rápido del paciente mediante los siguientes componentes:</p><p style="text-align: justify;">S (Symptoms / Síntomas):</p><p style="text-align: justify;">Síntomas que refiere el paciente.</p><p style="text-align: justify;">A (Allergies / Alergias):</p><p style="text-align: justify;">Verificar si el paciente tiene alguna alergia conocida.</p><p style="text-align: justify;">M (Medications / Medicamentos):</p><p style="text-align: justify;">Identificar los medicamentos que ingiere nuestro paciente y sustancias recreativas (tabaco, marihuana, etc.)</p><p style="text-align: justify;">P (Past medical and surgical history / Historial médico y quirúrgico pasado):</p><p style="text-align: justify;">Identificar problemas médico basales del paciente y si fue sometido a alguna intervención quirúrgica relevante o reciente.</p><p style="text-align: justify;">L (Last meal – Last menstrual period / Última comida – última menstruación):</p><p style="text-align: justify;">Identificar la hora de la última comida del paciente y en el caso de las mujeres verificar último periodo menstrual y si hay posibilidad de embarazo.</p><p style="text-align: justify;">E (Events / eventos):</p><p style="text-align: justify;">Se debe identificar los eventos que antecedieron o condujeron a la lesión. Dicho historial debe ser documentado en la hoja de atención del paciente.</p>								</div>
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									<h3 style="text-align: justify;">Examen segmentario:</h3><p style="text-align: justify;">1. Cabeza:</p><p style="text-align: justify;">Para efectos de la evaluación, divida la cabeza en cráneo y región facial. Proteja a columna cervical hasta que se haya descartado una lesión.</p><p style="text-align: justify;">Cráneo: palpe toda la superficie con los dedos, buscando protrusiones o depresiones y heridas del cuero cabelludo; examine frecuentemente sus guantes en busca de sangre u otros fluidos.</p><p style="text-align: justify;">Observe signos de fractura de la base del cráneo:</p><p style="text-align: justify;">Signo de Battle: hematoma detrás de los pabellones auriculares,</p><p style="text-align: justify;">Signo de Mapache: hematoma bajo los ojos.</p><p style="text-align: justify;">Salida de líquido claro o sangre en canales auditivos y orificios nasales.</p><p style="text-align: justify;">Facial: palpe los relieves óseos buscando posibles fracturas, examine la cavidad oral y la articulación témporomandibular (apertura). Busque quemaduras por inhalación. Olfatee halitosis.</p>								</div>
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									<p style="text-align: justify;">2. Cuello:</p><p style="text-align: justify;">En los pacientes con trauma cráneo-encefálico, máximo-facial o bien por sobre la clavícula, existe mayor riesgo de lesión de columna cervical. Evalúe presencia de dolor crepitaciones o deformidad de columna cervical. Busque heridas, desviaciones de la tráquea, traumatismos de laringe (ronquera, afonía, voz bitonal) ingurgitación yugular, enfisema subcutáneo.</p>								</div>
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									<p style="text-align: justify;">3. Tórax:</p><p style="text-align: justify;">Especialmente en este segmento examine al paciente por su cara anterior y posterior:</p><p style="text-align: justify;">Inspeccione, palpe, ausculte y percuta. Observe erosiones u otras huellas anatómicas de trauma, patrón respiratorio, disnea, respiración paradojal, uso de musculatura accesoria. Palpe, utilizando compresión toráxica uní o bilateral, descarte fractura de clavícula, esternón, costillas, tórax volante, enfisema subcutáneo. Percuta buscando timpanismo o matidez (neumotórax o hemotórax).</p><p style="text-align: justify;">Ausculte ruidos respiratorios y tonos cardíacos. La palpación de la columna dorsal debe hacerse al inmovilizar al paciente. Abombamiento toráxico, ausencia de murmullo vesicular timpanismo, disnea, ingurgitación yugular; cianosis y angustia son signos claros de un neumotórax hipertensivo. Tonos cardíacos apagados, taqui o bradicardia, hipotensión arterial e ingurgitación yugular bilateral nos hacen pensaren taponamiento cardíaco.</p>								</div>
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									<p style="text-align: justify;">4. Pelvis:</p><p style="text-align: justify;">Evalúe la estabilidad de la pelvis palpando sobre ambas crestas ilíacas antero- superiores en dirección caudal y medial. (Cerrando el libro). Repita la palpación caudal sobre el pubis del paciente. Si existe inestabilidad, recuerde que ese paciente está sangrando. Si la cinemática del trauma despierta sospechas de una lesión a nivel pélvico, se debe visualizar la zona.</p>								</div>
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									<p style="text-align: justify;">5. Abdomen:</p><p style="text-align: justify;">Busque heridas, equimosis o abrasiones. La presencia de marcas del cinturón cerca del ombligo, &#8220;signo del cinturón de seguridad&#8221;, puede indicar trauma abdominal por un cinturón técnicamente mal colocado. La incidencia de fracturas lumbares aumenta cuando este signo está presente. Palpe los cuadrantes y busque dolor y/o rigidez. Si los encuentra, no continúe palpando ya que sólo incomodará más al paciente y su especificidad diagnóstica no mejorará.</p>								</div>
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									<p style="text-align: justify;">6. Extremidades:</p><p style="text-align: justify;">Palpe las extremidades en toda su extensión en busca de deformidades, dolor, crepitación. Evalúe color, pulsos distales, sensibilidad y motilidad, presencia de posturas patológicas y anormalidades en los reflejos. El examen de las extremidades se realiza también con el propósito de pesquisar daño neurológico y vascular periférico.</p>								</div>
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									<h3 style="text-align: justify;">Evaluación neurológica:</h3><p style="text-align: justify;">Este es el momento de realizar la <span style="color: #3366ff;"><a style="color: #3366ff;" href="https://prevencionsaludproactiv.com/2018/08/22/escala-de-glasgow/">Escala de Coma de Glasgow</a></span> y repetir la evaluación de la respuesta pupilar a la luz y reflejo corneal, si no fue necesario hacerlo antes. Recuerde que, aunque el paciente se encuentre claramente bajo los efectos del alcohol o drogas, no debe adjudicarse a estos factores el deterioro de su condición neurológica.</p><p style="text-align: justify;">Transporte:</p><p style="text-align: justify;">Si el paciente tiene mecanismo de lesión que indiquen inmovilización en tabla espinal, ésta se deberá realizar lo más rápida y cuidadosamente posible y si el tiempo lo permite se realizarán las siguientes medidas.</p>								</div>
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									<p style="text-align: justify;">Estabilización cuidadosa de fracturas en extremidades.</p><p style="text-align: justify;">En un paciente en condición crítica, inmovilización rápida de las fracturas mientras se coloca en una tabla espinal larga.</p><p style="text-align: justify;">Vendaje de las heridas importante (tales como hemorragia activa, evisceración abdominal).</p><p style="text-align: justify;">El transporte en general se deberá iniciar tan pronto como el paciente sea extraído y las amenazas a la vida sean abordadas. En este momento realizaremos una reevaluación primaria y la evaluación secundaria de ser posible. Por otra parte, se iniciará la reanimación con fluidos. El centro de destino deberá ser el apropiado para las lesiones que tiene nuestro paciente por lo que es fundamental conocer la red de salud disponible en el sector, las capacidades de cada centro y los números de emergencia de cada uno.</p>								</div>
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									<p style="text-align: justify;">Duración del transporte:</p><p style="text-align: justify;">Corresponde al tiempo transcurrido desde que el equipo de respuesta recibe el llamado hasta que se aplican los cuidados definitivos en el hospital por un equipo especializado.</p><p style="text-align: justify;">Comunicación con el centro receptor:</p><p style="text-align: justify;">La comunicación entre el personal pre-hospitalario y hospitalario cuenta con 3 fases importantes: notificación previa al arribo (generalmente radial o telefónica), al lado del paciente en la entrega en el hospital y el informe escrito (hoja de atención del paciente). La comunicación temprana es de vital importancia para la preparación del centro receptor y consta de a lo menos lo siguiente:</p><ul><li style="text-align: justify;">Género del paciente y edad.</li><li style="text-align: justify;">Mecanismo de lesión.</li><li style="text-align: justify;">Lesiones que amenazan la vida, otras lesiones y ubicación anatómica.</li><li style="text-align: justify;">Signos vitales actuales.</li><li style="text-align: justify;">Intervenciones realizadas y respuesta al tratamiento.</li><li style="text-align: justify;">Tiempo estimado de arribo.</li></ul>								</div>
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							<h4>Prevención en Salud Proactiva</h4> 
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							<p>Paula Rojas Hormazábal</p><div class="fa2752738c61f2593e5755f4d15b4d9c" data-index="2" style="float: none; margin:0px 0 0px 0; text-align:center;">
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							<p>Nuestra misión es proteger la vida y la salud de las personas, con enfoque en el entorno laboral. A través de programas especializados en primeros auxilios y maniobras críticas (RCP, DEA, SVB y Heimlich), educamos y capacitamos a personas y equipos para responder con seguridad ante emergencias. Además, garantizamos la continuidad y el bienestar organizacional mediante una gestión de riesgos alineada con la Ley 16.744 y los más altos estándares ISO.</p> 
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2022/08/06/carro-de-paro-o-reanimacion/" class="_blank" target="_blank" >Carro de Paro o Reanimación</a></h4>
<div class="pt-cv-content">El carro rojo, de paro o de reanimación es una unidad ...<br /><div class="pt-cv-rmwrap"><a href="https://prevencionsaludproactiv.com/2022/08/06/carro-de-paro-o-reanimacion/" class="_blank pt-cv-readmore btn btn-success" target="_blank">Leer Más</a></div></div></div></div>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2022/05/12/rcp-en-tiempos-de-covid-19/" class="_blank" target="_blank" >RCP en Tiempos de COVID-19</a></h4>
<div class="pt-cv-content">REALIZAR RCP El paro cardíaco es una alteración eléctrica del ...<br /><div class="pt-cv-rmwrap"><a href="https://prevencionsaludproactiv.com/2022/05/12/rcp-en-tiempos-de-covid-19/" class="_blank pt-cv-readmore btn btn-success" target="_blank">Leer Más</a></div></div></div></div>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2022/02/25/tendinitis-2/" class="_blank" target="_blank" >Tendinitis</a></h4>
<div class="pt-cv-content">La tendinitis es una afección médica que se produce por ...<br /><div class="pt-cv-rmwrap"><a href="https://prevencionsaludproactiv.com/2022/02/25/tendinitis-2/" class="_blank pt-cv-readmore btn btn-success" target="_blank">Leer Más</a></div></div></div></div>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2022/02/24/superficies-de-trabajo/" class="_blank" target="_blank" >Superficies de Trabajo</a></h4>
<div class="pt-cv-content">CHARLA DE 5 MINUTOS Personas que han visualizado la charla ...<br /><div class="pt-cv-rmwrap"><a href="https://prevencionsaludproactiv.com/2022/02/24/superficies-de-trabajo/" class="_blank pt-cv-readmore btn btn-success" target="_blank">Leer Más</a></div></div></div></div>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2022/02/24/riesgo-electrico/" class="_blank" target="_blank" >Riesgo Eléctrico</a></h4>
<div class="pt-cv-content">Los riesgos eléctricos son situaciones en las que existe la ...<br /><div class="pt-cv-rmwrap"><a href="https://prevencionsaludproactiv.com/2022/02/24/riesgo-electrico/" class="_blank pt-cv-readmore btn btn-success" target="_blank">Leer Más</a></div></div></div></div>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2022/02/24/primeros-auxilios-2/" class="_blank" target="_blank" >Primeros Auxilios</a></h4>
<div class="pt-cv-content">CHARLA DE 5 MINUTOS Personas que han visualizado la charla ...<br /><div class="pt-cv-rmwrap"><a href="https://prevencionsaludproactiv.com/2022/02/24/primeros-auxilios-2/" class="_blank pt-cv-readmore btn btn-success" target="_blank">Leer Más</a></div></div></div></div>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2022/02/20/rcp-solo-con-las-manos/" class="_blank" target="_blank" >RCP Solo con las Manos</a></h4>
<div class="pt-cv-content">CHARLA DE 5 MINUTOS La reanimación cardiopulmonar (RCP) es una ...<br /><div class="pt-cv-rmwrap"><a href="https://prevencionsaludproactiv.com/2022/02/20/rcp-solo-con-las-manos/" class="_blank pt-cv-readmore btn btn-success" target="_blank">Leer Más</a></div></div></div></div>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2022/01/18/maniobra-de-heimlich-charla-de-seguridad/" class="_blank" target="_blank" >Maniobra de Heimlich</a></h4>
<div class="pt-cv-content">Maniobra de Heimlich en casos de atragantamiento La Maniobra de ...<br /><div class="pt-cv-rmwrap"><a href="https://prevencionsaludproactiv.com/2022/01/18/maniobra-de-heimlich-charla-de-seguridad/" class="_blank pt-cv-readmore btn btn-success" target="_blank">Leer Más</a></div></div></div></div>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2021/12/22/aspectos-destacados-de-actualizacion-en-primeros-auxilios-aha/" class="_blank" target="_blank" >Aspectos Destacados de Actualización en Primeros Auxilios AHA</a></h4>
<div class="pt-cv-content">Actualizaciones AHA Actualización detallada para primeros auxilios del 2020 de ...<br /><div class="pt-cv-rmwrap"><a href="https://prevencionsaludproactiv.com/2021/12/22/aspectos-destacados-de-actualizacion-en-primeros-auxilios-aha/" class="_blank pt-cv-readmore btn btn-success" target="_blank">Leer Más</a></div></div></div></div>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2021/02/01/fractura/" class="_blank" target="_blank" >Fracturas</a></h4>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2023/05/11/cuidados-de-enfermeria-en-cateterismo-vesical/" class="_blank" target="_blank" >Cuidados de Enfermería en Cateterismo Vesical</a></h4>
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Evaluación Secundaria Soporte Vital Prehospitalario en Trauma PHTLS
