Transcript Vitals and History Taking

Vitals and History Taking
Hillcrest Fire Training
December, 2000
Where are we going?
What are vital signs?
How do you take them?
So, what’s normal?
SAMPLE History
What are the vitals
They provide information about the
status of a patient
Breating (Respirations)
Pulse
Skin
Pupils
Blood Pressure
Counting Respirations
Respiration is one inhalation and
exhalation.
Determined by counting for 30 sec, and
multiplying by 2.
A hand on the stomach/chest may help
Normal Respirations
Adult 12-20/min
Child 15-30/min
Infant 25-50/min
Respiration Quality
Normal
Shallow (low tidal volume)
Labored
Use of accessory muscles
 Flaring
 Tripod Breating

Noisy breathing
Pulse
Determined by counting for 30 sec and
multiplying by 2.
Irregular pulse counted for 60 sec.
Provides information about heart, blood
volume and perfusion.
Taken at a pulse point
Don’t use your thumb
Common Pulse Points
Central Pulses


Carotid
Femoral
Peripheral Pulses



Radial
Brachial (children
under 1)
Posterior Tibial,
Dorsalis Pedis
Pulse Quality
Normal
Bounding
Weak
Thready
Regular/Irregular
Normal Pulse Rate
Adult 60-80/min
Child 80-120
Infant 120-150
Skin
Color





Pink (Normal)
Pale
Cyanotic (Oxygen
problems)
Red (CO or heat
problems)
Yellow (Jaundice)
Temperature




Warm (Normal)
Hot
Cool
Cold
Condition


Dry (Normal)
Moist
Practice
Get pulse and
respirations from at
least two people
Try to get pulse from
carotid, radial, and
brachial pulse points
Assessing Skin
Color assessed using lips, nail beds,
inside of mouth, membranes of the eye
Pull back glove to determine temp and
condition
In children under 6 capillary refill is
useful for determining perfusion

Refill should take less than 2 seconds
Pupils
Size
Constricted
 Dilated
 Equal/Unequal

Reactivity to light
Can check with pen light
or by shielding eyes
from light
Blood Pressure
Taken with manual
or automatic BP cuff
Can be taken by
auscultation or
palpation
Key Terms
Systolic

Pressure when heart
is pumping
Diastolic

Pressure when heart
is at rest
BP by Auscultation
Size using guides on cuff
Position on upper arm hoses pointing down
Inflate 30mmHg past pulse
Position stethoscope over brachial artery
Deflate
Note first sound and last sound
Record as systolic/diastolic (140/80)
One last note on Vitals
First set of vitals is the baseline, you are
interested in changes
On not sick patients, repeat every 15
minutes
On sick patients, repeat every 5 minutes
Treat patient, not the vital signs or the
equipment
BP by Auscultation
Size using guides on cuff
Position on upper arm hoses pointing down
Inflate 30mmHg past pulse
Position stethoscope over brachial artery
Deflate
Note first sound and last sound
Record as systolic/diastolic (140/80)
BP by Palpation
Size using guides on cuff
Position on upper arm centered over
brachial artery
Inflate 30mmHg past pulse
Deflate
Record point at which pulse returns
Record as Systolic/P (135/p)
Normal Blood Pressure
Male


Systolic = 100+age
until 50
Diastolic =60-90
Female


Systolic=90+age
until 50
Diastolic = 50-80
Practice
Get BP from two
people
Try at least two
techniques for
obtaining BP

Auscultation,
Palpation, or
Automatic Cuff
History Taking
SAMPLE
Organized technique to obtain pertinent
medical informaiton
Can obtain information from patient,
family or bystanders
SAMPLE is an acronym
SAMPLE
Signs/Symptoms
Allergies
Medications
Past Pertinent Medical Conditions
Last Oral Intake
Events Leading to Injury or Illness
Signs/Symptoms
Signs – things you can see or hear
Symptoms – things the patient reports
Allergies
Environmental and Medical allergies are
important
Medic Alert tags are also useful
Medications
Prescription and OTC

Including vitamins, herbal remedies
Birth Control Pills
Illicit Drugs
Always get a list of meds, or take them
with
Home O2 rate is also important
What did you take, when, how much?
Past Pertinent Medical History
Underlying medical problems
Recent visits to hospitals/doctors
Recent medical procedures
Recent accidents/falls/trauma
Medic Alert tags may be useful
Look for signs of medical equipment in
the house
Last Oral Intake
What, how much, when
Important for trauma patients, diabetics
Events Leading to Call
Get as much information as you can
What happened, what were you doing
Has anything unusual happened?
If this is a chronic problem, what’s
different this time?
Final SAMPLE notes
Try to ask open ended questions (avoid
yes/no questions)
Wait for the patient to respond

5-10 seconds is not out of line
Note pertinent negatives
Write everything down
Practice
Let’s go through a
couple of scenarios