Transcript Baseline Vital Signs and SAMPLE History (EMT-B)

Baseline Vital Signs and
SAMPLE History
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Terminal Learning Objective
 Given a patient care scenario and the
proper medical equipment in a clinical
environment or field setting, assess a
baseline set of patient vital signs and obtain
an accurate SAMPLE history IAW Chapter
5, Emergency Care and Transportation of
the Sick and Injured, 9th Edition, American
Academy of Orthopedic Surgeons (AAOS).
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Enabling Learning Objectives
 Given a patient, with a trauma or medically-
related complaint, in a pre-hospital
environment, describe the basic principles,
sequence and components of an accurate
baseline set of vital signs IAW Emergency
Care and Transportation of the Sick and
Injured, 9th Edition, American Academy of
Orthopedic Surgeons (AAOS).
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Enabling Learning Objectives
 Given a patient, with a trauma or medically-
related complaint, in a pre-hospital
environment, demonstrate the proper
technique(s) for obtaining a complete set of
baseline vital signs and a concise patient
history using the acronym SAMPLE IAW
Emergency Care and Transportation of the
Sick and Injured, 9th Edition, American
Academy of Orthopedic Surgeons (AAOS).
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Baseline Vital Signs and
SAMPLE History
 Assessment is the most essential skill
EMT-Bs learn.
 During assessment you
will:
– Gather key information
– Evaluate the patient
– Learn the history
– Learn about the patient’s overall health
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Gathering Key Patient
Information
 Obtain the patient’s name.
 Note the age, gender and
race.
 Look for identification if the
patient is unconscious.
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Baseline Vital Signs
 During the assessment, the EMT-B uses
many senses and a few basic medical
instruments.
 First set is known as
the baseline vitals.
 Repeated vital signs
are compared to the
baseline.
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Baseline Vital Signs and
SAMPLE History
 Chief Complaint (CC); Mechanism of Injury
(MOI):
– Chief complaints are the major signs,
symptoms or events that caused the call or
complaint
– Symptoms: what the patient tells you
– Signs: can be seen, heard , felt, smelled or
Sign or symptom?
measured
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Obtaining a SAMPLE History
 S : Signs and Symptoms of the episode:
– What signs and symptoms occurred at onset?
– Does the patient report pain?
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Obtaining a SAMPLE History
 A : Allergies:
– Is the patient allergic to medications, foods or
other substance?
– What reactions did the patient have to any of
them?
Note: If the patient has no know allergies,
you should note this on the run sheet as
“no known allergies” or “NKA”
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Obtaining a SAMPLE History
 M : Medications:
– What medications was the patient prescribed?
– What dosage was prescribed?
– How often is the patient supposed to take the
medication?
– What prescription, over-the-counter (OTC)
medications, and herbal medications has the
patient taken in the last 12 hours?
– How much was taken and when?
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Obtaining a SAMPLE History
 P : Pertinent past history:
– Does the patient have any history of medical,
surgical, or trauma occurrences?
– Has the patient had a recent illness or injury,
fall or blow to the head?
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Obtaining a SAMPLE History
 L : Last oral intake:
– When did the patient last eat or drink?
– What did the patient eat or drink, and how
much was consumed?
– Did the patient take any drugs or drink alcohol?
– Has there been any other oral intake in the last
4 hours?
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Obtaining a SAMPLE History
 E : Events leading to injury or illness
– What are the key events that led up to this
incident?
– What occurred between the onset of the
incident and your arrival?
– What was the patient doing when this illness
started?
– What was the patient doing when this injury
happened?
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O-P-Q-R-S-T
 Mnemonic device to help you remember
questions you should ask to obtain a
patient history.
– O : Onset: When did the problem begin and
what caused it?
– P : Provocation or Palliation: Does anything
make it feel better? Worse?
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O-P-Q-R-S-T
– Q : Quality: What is the pain like? Sharp, dull,
crushing, tearing?
– R : Region/Radiation: Where does it hurt?
Does the pain move anywhere?
– S : Severity: On a scale of 1 to 10, how would
you rate your pain?
– T : Timing of pain: Has the pain been constant
or does it come and go? How long have you
had the pain?
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Baseline Vital Signs
 Baseline vital signs always include
– Respirations, Pulse & Blood Pressure
 Other key indicators:
– Skin: color, condition, temperature (CCT)
– Capillary refill time (in children)
– Pupillary response
– Level of Consciousness (LOC)
– Sometimes Temperature (medical patients)
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Respirations
 A patient who is breathing without
assistance: spontaneous respirations.
 Each complete breath consists of two
distinct phases:
– Inspiration (inhalation): the chest rises up and
out, drawing oxygenated air into the lungs
– Expiration (exhalation): the chest returns to its
original position, releasing air with an increased
carbon dioxide (CO²) level out of the lungs
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Respirations
 Rate:
– The number of breaths in 30 seconds x 2
 Quality: character of breathing:
– Rhythm (regular or irregular)
– Effort (normal or labored)
 Depth:
- Tidal Volume (the amount of air exchanged with each
breath)
-Depth and rate of breathing determines the tidal
volume
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Respiratory Rate
Adults: 12 to 20 breaths/minute
(over age 8)
Children: 18 to 30 breaths/minute
(1 to 8 years of age)
Infants: 30 to 60 breaths/minute
(under 1 year of age)
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Respirations
 Effort (labored):
– Unable to speak more than 2-3 words at a
time
– Assuming a “tripod” position
– Assuming a “sniffing” position (children)
– Noisy breathing:
• Stridor
• Wheezes, snoring
• Coughing (productive?)
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Pulse Oximetry
 Evaluates the effectiveness of oxygenation.
 Normal value: 95% - 100%.
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Pulse
 With each heartbeat, ventricle contract,
forcefully ejecting blood from the heart
and propelling it into the arteries.
 A pulse is the pressure
wave that occurs as
each heartbeat causes
a surge in the blood
circulating through the
arteries.
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Pulse
Carotid Pulse
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Radial Pulse
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Pulse
Brachial Pulse
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Pulse
 Rate:
– Number of beats in 30 seconds x 2
 Strength:
– Stronger than normal (bounding), strong or
weak (thready)
 Regularity:
– Regular or irregular
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Normal Pulse Ranges
Adults:
60 to 100 beats/minute
Children:
70 to 120 beats/minute
Toddlers:
90 to 150 beats/minute
Newborns:
120 to 160 beats/minute
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The Skin
 The condition of the patient’s skin can tell
you a lot about the patient’s:
– Peripheral circulation and perfusion
– Blood oxygen levels
– Body temeperature
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The Skin (CCT)
 Color:
– Pink, pale, blue,
red, or yellow
 Condition:
(moisture)
– Dry, moist or wet
 Temperature:
– Warm, hot or cool
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Capillary Refill
 Evaluates the ability of the circulatory
system to restore blood to the capillary
system (perfusion).
– Evaluated at the nail bed (finger)
– Depress the finger tip, pressure forcing blood
from the capillaries and look for return of blood
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Capillary Refill
– As the capillaries refill,
should return to its
normal deep pink color
– Color should be restored
within 2 seconds (about
the time it takes to say,
“Capillary refill”
– Invalid test in a cold
environment; elderly
– Used for < 6 years old
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Blood Pressure
 Blood pressure is a vital sign.
 Pressure of circulating blood against the
walls of the arteries.
 A drop in blood pressure may indicate:
– Loss of blood
– Loss of vascular tone
– Cardiac pumping problem
 Blood pressure should be measured in all
patients older than 3 years of age.
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Blood Pressure
 Diastolic:
– Pressure during relaxing
phase of the heart’s cycle
 Systolic:
– Pressure during contraction
 Measured as millimeters
of mercury (mmHg).
 Recorded as systolic/diastolic.
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Blood Pressure Equipment
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Auscultation of Blood Pressure
 Place cuff on patient's arm (1” above elbow).
 Palpate brachial artery and place diaphragm
of stethoscope over artery.
 Inflate cuff until you no
longer hear pulse sounds.
 Continue pumping to
increase pressure by
an additional 20 mmHg.
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Auscultation of Blood Pressure
 Note the systolic and
diastolic pressures
as you let air escape
slowly.
 As soon as pulse
sounds stop, open the
valve and release the
air quickly.
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Measuring Blood Pressure
Palpation
Auscultation
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Palpation of Blood Pressure
 Secure cuff.
 Locate radial pulse.
 After the pulse
disappears continue to
inflate another 30mmHg.
 Release air until pulse is
felt.
 Method only obtains
systolic pressure.
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Normal BP Ranges
Age
Range
Adults
90 to 140 mmHg (s)
60 to 90 mmHg (d)
Children (1-8)
80 to 110 mmHg (s)
Infants (up to 1 yr)
50 to 90 mmHg (s)
*Varies with age and gender.
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Blood Pressure
 Hypotension:
– BP significantly lower than the normal range
– Critical hypotension: BP is no longer able to
compensate sufficiently to maintain adequate
perfusion
 Hypertension:
– BP significantly higher than the normal range
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Level of Consciousness
A - Alert
V - Responsive to
Verbal stimulus
P - Responsive to
Pain
U - Unresponsive
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Pupil Assessment
 P - Pupils
 E - Equal
 A - And
 R - Round
 R - Regular in size
 L - React to Light
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Abnormal Pupil Reactions
 Fixed with no reaction




to light.
Dilate with light and
constrict without light.
React sluggishly.
Unequal in size.
Unequal with light or
when light is removed.
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Reassessment of Vital Signs
 The vital signs you obtain serve two
important functions:
– First set establishes a baseline of respiratory
and cardiovascular system status
– Serves as a key baseline
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Reassessment of Vital Signs
 Reassess stable patients every 15 minutes.
 Reassess unstable
patients every
5 minutes.
 Reassess/record
VS after all medical
interventions.
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Questions?
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