Chapter 10 Baseline Vital Signs and SAMPLE History.

Chapter 10Baseline Vital Signs and SAMPLE History

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Baseline Vital Signs Reassessment of Vital Signs History Taking SAMPLE History

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Baseline Vital Signs

The first measurement of vital signs is sometimes referred to as the baseline vital signs.

Subsequent readings, or values, are compared against the baseline vital signs.

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Respiration: Quantity– Does the patient seem to be breathing

very fast or slow?– For exact respiratory rate, count number

of breaths taken in 1 minute

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Respiration: Quantity– Acceptable to count breaths taken in

30 seconds and multiply by 2– If patient’s breathing is irregular, count

respirations for 1 full minute

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Respiration: Quality– In addition to the respiratory rate, note quality of

the respiration– Observe respiration: depth, regularity, and any

unusual noise or effort– Normal breathing quality: moderate depth,

regular, and quiet

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Respiration: Quality– Labored breathing

• Discomfort• Increased use of chest and neck

muscles (accessory muscle use)• Nasal flaring

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Respiration: Quality– Labored breathing

• Abnormal noises– Stridor– Snoring– Gurgling– Wheezing– Grunting

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Pulse– The rate, strength, and regularity of a

patient’s pulse can indicate the severity of an illness or injury.

– Following these values over time will indicate any change in the patient’s condition or health.

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Pulse– Common sites for a pulse check

• Adults: over the radial, femoral, and carotid arteries• Infants: brachial pulse (because it is usually easier to

find)

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A. Radial

B. Femoral

C. Carotid

D. Brachial

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Pulse: Quantity– Place the pads of two fingers on the

wrist, just below the base of the thumb– Count the number of pulse beats felt in

30 seconds, then multiply by 2

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Pulse: Quality– Strength of pulse can be strong,

bounding, weak, or thready– Regularity of pulse can be regular

or irregular

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Blood pressure– Measured by two methods:

• Auscultation, using a sphygmomanometer and a stethoscope

• Palpation

– Measured at both the contraction and relaxation phases

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– Reported in two numbers:• First (top) number is the systolic pressure• Second (lower) number is the diastolic pressure.


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Blood pressure– Cuff application

• Select a proper-sized cuff • Fit properly to the patient’s bare upper arm

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Blood pressure measurement– Auscultation

• Apply cuff; then find brachial pulse

• Inflate cuff 20 mm Hg beyond where pulse disappears

• Place stethoscope on brachial pulse, then slowly release pressure in cuff

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Blood pressure measurement– Auscultation

• Read number on dial upon return of the pulse (systolic)

• Read number on dial when the pulse disappears (diastolic)

• Report blood pressure as systolic over diastolic

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Blood pressure measurement– Palpation

• When blood pressure cannot be heard due to noise interference, estimate it by the palpation method

• Confirm blood pressure by auscultation as soon as possible since palpation gives only an estimate

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Blood pressure measurement– Palpation

• Palpate the return of the radial pulse during deflation of cuff and note number on gauge as the systolic pressure

• Diastolic pressure is not available with this method

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Stop and Review

Where do you assess for pulse in an infant? Define systolic pressure. Define diastolic pressure.

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Skin: Temperature and moisture – Skin condition can indicate the patient’s

circulatory status– Use skin-to-skin contact to measure the

temperature on the patient’s forehead or abdomen

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Skin: Temperature and moisture– A healthy person normally has warm, dry skin– Temperature: hot, warm, cool, or cold– Moisture: cool and clammy or moist or sweaty

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Skin: Color– Determine skin color by assessing the nail beds,

oral mucosa, or conjunctiva – Normal skin is a healthy pink color from good

blood flow – Pallid skin indicates a decreased blood supply

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Skin: Color– A bluish discoloration, or cyanosis, indicates

a state of poor oxygenation – Other skin colors may give clues about

underlying disease states

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– A flush can occur from embarrassment or disease

– Jaundiced skin can be caused by liver disease.

– Note the pallor, a sign of shock

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Skin: Capillary refill– Time it takes for the blood to return to the skin

when the skin is compressed

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Skin: Capillary refill– In children

• Capillaries of a healthy child have a constant supply of oxygenated blood

• Refill time of less than 2 seconds • If more than 2 seconds, the child’s skin is

hypoperfused, indicating the child may be in shock

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Pupil– Black part in the center of the eye – Usually round and changes size in reaction to

changing light conditions – Changes in pupillary reaction may mean

improvement or deterioration of the patient’s neurologic status, or brain function

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Pupil – When checking pupil response, shield patient’s

eyes from the room light, and use a handheld penlight to assess size, shape, and reaction

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Pupil: Size and shape– Describe pupil diameter by exact

measurement or general terms– Pupil of the eye is normally round

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Pupil: Size and shape– Consensual response: both pupils are usually the

same size and tend to react together when one is exposed to light

– Anisocoria: pupils are not of equal size

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– Constricted pupils

– Dilated pupils

– Anisocoria

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Pupil: Reactivity– Normal and reactive pupil: constricts briskly when

exposed to light and dilates when light is removed– Nonreactive pupil: responds slowly to light or not

at all– PERRL: pupils, equal, round, and reactive to light

(normal response of the pupils)

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Pulse oximetry– Normal, 96% to 100%: blood is well oxygenated

and respirations are effective– Less than 96%: blood is poorly oxygenated and

there may be problems with breathing or circulation

– Less than 90%: serious oxygenation problem

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Pulse oximetry– Accuracy requires an adequate sample of

capillary blood– Device should have a lighted bar meter or a

green or yellow light indicator that visually confirms that the sample is adequate

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Reassessment of Vital Signs

Reassess vital signs to determine changes in the patient’s condition

Initial vital signs are normal and patient is stable: reassess every 10 to 15 minutes

Initial vital signs are abnormal or patient is unstable: reassess every 5 minutes

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Reassessment of Vital Signs

Medication is administered (including oxygen): reassess within 5 minutes

Carefully document all measurements of vital signs, including the times they were taken

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Stop and Review

Describe normal and abnormal pupil size, shape, and reaction.

Describe normal and abnormal skin color, temperature, and condition.

Why is reassessment of vital signs important?

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History Taking

Obtaining an accurate history is vitally important The history often describes the reason for the

patient’s present health crisis as well as past successful treatments

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History Taking

Patient rapport– Remember, the call may be very stressful for the

patient

– The EMT should provide: • Proper introduction of the crew• Proper etiquette• Comforting touch

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SAMPLE History

Obtain basic information as soon as possible after all life threats have been properly addressed

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SAMPLE History

SAMPLE questions:– Signs and symptoms– Allergies– Medications– Past medical and surgical history– Last oral intake– Events leading up to incident or illness

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SAMPLE History

Watch this video of an EMT asking SAMPLE questions of a patient

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Stop and Review

Identify the components of the SAMPLE history.

Chapter 10 Baseline Vital Signs and SAMPLE History.

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Transcript of Chapter 10 Baseline Vital Signs and SAMPLE History.