Transcript 451_Chap
CHAPTER 5 Baseline Vital Signs & SAMPLE History Baseline Vital Signs Sign: Any medical or trauma condition displayed by the patient and identified by the EMT. Examples of signs are hemorrhage, noisy breathing, bone deformities. Symptom: Any condition described by the patient that cannot be observed. Examples of symptoms are chest pain, shortness of breath, nausea. Vital Signs Breathing: Rate, quality Pulse: Rate, character, rhythm Skin: Color, temperature, condition Pupils: Blood pressure Reactivity, equality Average Vital Sign Ranges by Age AGE P R Newborn 120-160 40-60 BP 80/40 1 year 80-140 30-40 82/44 3 years 80-120 25-30 86/50 5 years 70-115 20-25 90/52 7 years 70-115 20-25 94/54 10 years 70-115 15-20 100/60 15 years 70-90 15-20 110/64 Adult 60-80 12-20 120/80 Trending: The process of comparing sets of vital signs or other assessment information over time. Level of Consciousness To assess level of consciousness: A- Alert and awake; aware of time, place, date and person V- Responds to verbal stimuli P- Responds to painful stimuli, does not respond to verbal stimuli U- Unconscious, does not respond to any stimuli Breathing Respirations: One breath in a single cycle of breathing in and out. Can be determined by counting the number of breaths in 30 seconds and multiplying by two. Breathing Assessment Rate Averages 12-20 breaths per minute in adults Quality Normal respirations? Shallow respirations? Labored respirations? Noisy respirations? Patients often breathe FASTE when they are ill or injured. Abnormal Respiratory Sounds Grunting Stridor Snoring Wheezing Gurgling Crowing Accessory muscles may be used during labored breathing. Neck Muscles Chest Muscles Intercostal Muscles Abdominal Muscles Retractions may indicate labored breathing. Sternal Intercostal Substernal Supraclavicular Pulse Key Pulse Points Carotid Brachial Radial Femoral Posterior Tibial Dorsalis Pedis Assessing the Pulse Rate Quality Averages 60-80 beats per minute in adults Strength (strong or weak) Rhythm Regular or irregular Locating the Radial Pulse Locating the Carotid Pulse Palpate the brachial pulse in an infant. Skin Perfusion: The process of distributing blood to the organs, delivering oxygen, and removing wastes. The skin condition is a good indicator of perfusion. Assessment of the Skin Color (nail beds, oral mucosa, conjunctiva) Pink? Pale? Cyanotic? Flushed? Jaundiced? Temperature Warm? Hot? Cool or cold? Assessment of the Skin Condition continued Dry? Wet or moist? Abnormally dry? Clammy (cool & moist)? Capillary refill (considered an inaccurate indicator of perfusion in patients over the age of 6 years) Assess skin temperature with the back of your hand. Slow CRT may indicate poor perfusion. Pupils Pupils are normally equal, reactive to light and midsize. Constricted Pupils Unequal Pupils Dilated Pupils To assess the pupils: First evaluate in ambient light for constriction or dilation. Next, pass a light source across each pupil and note the response. Each pupil should constrict in the same manner. Blood Pressure Blood pressure: Measurement of the force the blood exerts against the walls of blood vessels during the heart’s contraction and relaxation phases. Systolic: pressure during contraction Diastolic: pressure during relaxation Systolic Diastolic Changes in successive blood pressure readings may provide valuable clues about the patient’s condition. Measuring BP by auscultation. Measuring BP by palpation. Vital Sign Reassessment Reassess vital signs every 5 minutes for unstable patients. Reassess vital signs every 15 minutes for stable patients. SAMPLE History Patient history: A concise and inclusive set of information gathered about patients and their medical problems. Signs and symptoms A llergies Medications Pertinent past medical history Last oral intake (solid or liquid) Events leading to injury or illness Onset Provocation Quality Radiation Severity Time SUMMARY Baseline Vital Signs SAMPLE History