The skin can tell you a lot about the patient's wellbeing and allow you to evaluate how well the blood is circulating and reaching the tissues (perfusion), presence or absence of sweating (diaphoresis), and any temperature abnormalities that might indicate fever (hyperthermia) or cold exposure (hypothermia). Your first observation of skin signs typically happens when you are forming your general impression, in the secondary assessment you are working through them more methodically.
- Capillary Refill/perfusion: Perfusion is observed both with baseline color and with a capillary refill test. Independent of the patient's general pigmentation, the skin of the palms, nail beds, inside of the lips, and eye lids can be examined and with normal circulation they should be "pink" from the presence of oxygenated blood. In the presence of hypoxia, these areas may appear bluish or "cyanotic". To perform a capillary refill test on the fingers briefly press the nail bed. Observe the return of blood back into the nail bed. It should be under 2 seconds for male adults and children, 3 seconds for females, and 4 in the elderly, but can be significantly delayed if the extremities are cold. Capillary refill has been proven to be less effective at describing a patient's perfusion if the patient is greater than 6 years old.
- Diaphoresis: Profuse sweating (diaphoresis) in the absence of heat or exercise can be a response to shock or emotional distress. Absence of sweating on a hot day can be a sign of heat stroke. At baseline, most people have fairly dry skin. Take note of the character of the skin, and if it is out of step with what you would expect from conditions.
- Temperature: Even without a thermometer, abnormally high or low body temperatures can be detected by the first responder in reference to your own body temperature. When checking warmth, you should use the back of your hand on the patient's forehead. It's also common to assess several areas on the body as exposed extremities may be a different temperature as circulation problems, temperature of the environment, and/or the patient's clothing can alter this finding.
Document any abnormalities found throughout your assessment as deviations from normal skin signs of "skin is normal colored, warm and dry with normal capillary refill".
