Transcript Chapter 10 - Wando High School

Chapter 10
Baseline Vital Signs and SAMPLE History
Chapter 11
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Objectives
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Identify vital signs.
Describe how to assess the quality and
quantity of respirations.
Recognize a normal respiratory rate and
quality.
Describe how to assess the quality and
quantity of the pulse.
Recognize a normal pulse rate and quality.
Describe the methods to assess blood
pressure.
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Objectives
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Define systolic pressure.
Define diastolic pressure.
Describe the methods to assess the pupils.
Identify normal and abnormal pupil size,
shape, and reaction.
Describe the methods to assess the skin
color, temperature, and condition.
Describe how to assess capillary refill in
infants and children.
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Objectives
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Identify normal and abnormal skin color,
temperatures, and conditions.
Identify normal and abnormal capillary
refill in infants and children.
Identify the components of the SAMPLE
history.
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Objectives
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Differentiate between a sign and symptom.
State the importance of accurately
reporting and recording the baseline vital
signs.
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Baseline Vital Signs and SAMPLE
History
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Overview
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Baseline Vital Signs
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Reassessment of Vital Signs
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History Taking
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Conclusion
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Introduction to Patient
Assessment
Chapter 11
Introduction to Patient Assessment
 Patient assessment
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Chapter 11
Process performed to determine proper
emergency medical care
Use your senses to obtain clues about your
patient
Medical vs. trauma patients
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Introduction to Patient Assessment
 Patient assessment plan
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Chapter 11
Systematic evaluation of the patient
a) Scene size-up
b) Initial assessment
c) Physical examination
d) Patient history
e) Ongoing assessment
f) Hand-off report
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Introduction to Patient Assessment
 Medical vs. trauma
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Trauma
a) Most pertinent information from
physical examination
– Medical
a) Most pertinent information from
patient history
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Limmer, First Responder: A Skills Approach, 7th ed.
Vital Signs
 Measurement of a
patient’s
respiration, pulse,
skin, pupils, and
blood pressure
 Frequent
reassessment
identifies trends
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Overview
 Vital signs
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Respiratory rate*
Heart rate*
Blood pressure*
Skin temperature*
Pupillary response*
Pulse oximetry
 Provide information about patient’s
physical condition and present state of
health
Chapter 10
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Baseline Vital Signs
 Baseline vital signs are the first set of
vital signs obtained
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used as a baseline to compare subsequent
sets
a) Completed after initial assessment
b) Lifesaving measures first
c) Gives a basis for comparison
d) Proficiency important
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practice makes perfect
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Baseline Vital Signs
Respiration: breathing assessment
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Quantity
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How quickly the patient breaths per minute
a) Fast vs. slow
b) Inhalation & exhalation
c) Count for 30 seconds X 2 = breaths per
minute
Quality
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Depth
Regularity
Unusual noise or effort
Labored Breathing  use additional muscles
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Respiratory Rates
10 - 1
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Accessory Muscles
When breathing
becomes more
difficult, muscles of
the chest and neck
work harder
–Nasal flaring
–Cyanosis
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Accessory Muscles
Abnormal breathing sounds
–Stridor: harsh sound heard on inhalation
–Snoring: tongue falls back into throat
a) common in unconscious patients
b) can occlude airway
–Gurgling: liquid material in upper airway
a) may need to suction airway
–Wheezing: high-pitched sound from lower airway
obstruction
a) common in inhalation and exhalation
–Grunting: labored-breathing sound  extreme effort
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Respiration
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Measure by observing chest rise and fall
> than 24: tachypnea
< than 12: bradypnea
difficulty breathing is called dyspnea
“-tachy” ~ fast
“-brady” ~ slow
“-pnea” breathing
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Respiration
Respiration: Skill 10-1
–1. EMT places had on top of patients hand then
places patient’s hand on top of the abdomen
a)Note movement, irregular patterns, noise & effort of
chest/abdomen
–2. Count number of complete breaths taken for 30
seconds
a)one inhalation plus one exhalation = 1 breath
–3. Multiply this number by 2 = Breaths per minute
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Respiration
1. EMT places hand on patient’s
hand
2. Place patient’s had on abdomen
Counting
Respiration
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3. Count respirations for 30 seconds
Respiration Recording
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Baseline Vital Signs
Pulse: measuring the number of heart beats
per minute
 Measured where an artery comes close to
the skin
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EMT feels pressure of blood pumped through
artery
Radial, femoral, and carotid
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Baseline Vital Signs
Pulse
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Quantity
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Quality
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Beating of the heart per minute
Count # of pulse beats felt in 30 seconds X 2
Regular
Irregular
Bounding
Strong
Weak
Thready
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Pulse Rates
10 - 2
> than 100:
tachycardia
< than 90:
brachycardia
- “-cardia”~ heart
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Baseline Vital Signs
Pulse
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Measured by index and
middle fingers over pulse
point
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Do not take with thumb 
has its own pulse
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Pulse Rates
 Radial Pulse: Skill 10-2
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1. EMT notes condition of the skin
a) Warm or cool; most or dry
– 2. Find radial pulse
a) Anterior surface of distal forearm
proximal to the thumb
b) Note quality and regularity of the pulse as
weak or strong
c) Regular or irregular
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Pulse Rates
 Radial Pulse: Skill 10-2
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3. EMT counts the number of pulse beats for
30 seconds
a) If irregular, count for 1 minute
– 4. Multiply the number by 2 to obtain beats
per minute
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1. Note condition of skin
Chapter 10
3. Count pulse beats for 30 seconds
2. Find radial pulse
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4. Multiply number by 2 = BPM
Pulse Rate Recording
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Pulse Points
R
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F
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C
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A
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Baseline Vital Signs
Temperature: Refers to temperture inside
the body or core body heat
 Measured in 4 ways
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Oral: 97.6 ˚ F – 99.6 ˚ F
Rectal: 98.6 ˚ F – 100.6 ˚ F
Axillary: 96.6 ˚ F – 98.6 ˚ F
Tympanic: 98.6 ˚ F – 100.6 ˚ F
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Baseline Vital Signs
Temperature
 Duration of taking temperature
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Tympanic: a few seconds
Oral & rectal: 3 minutes
Axillary mercury: 10 minutes
Electronic temperatures: when bee sounds,
temperature is obtained
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Baseline Vital Signs
Blood pressure:
measures pressure
exerted on arterial
walls  Systolic &
Diastolic
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Baseline Vital Signs
Blood pressure
 Measured with a
sphygmomanometer
aka blood pressure
cuff & stethoscope
 Reported:
Systolic = 120
Diastolic = 80
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Baseline Vital Signs
Blood pressure
 Cuff application
 Measurement by Auscultation
 Measurement by Palpation
Chapter
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Baseline Vital Signs
Blood pressure
 Cuff application
 Measurement by Auscultation
 Measurement by Palpation
Chapter
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Baseline Vital Signs
Blood pressure
 Cuff application
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Select proper size
a) Cover 2/3 of upper
arm from elbow to
shoulder
– Apply to bare upper
arm
a) Remove clothing or
roll up the sleeve to
expose upper arm
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Baseline Vital Signs
Blood pressure
 Measurement by Auscultation
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Use of BP cuff & stethoscope
Pulse found toward medial part of antecubital
fossa
a) Space on front of arm (opposite of elbow)
– Inflate BP cuff until pulse is absent + 20 mm
Hg
– Stethoscope placed on brachial pulse
– Pressure in cuff released slowly
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Baseline Vital Signs
Blood pressure
 Measurement by Auscultation
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Listen for sound of pulse returning  systolic
blood pressure…read dial!
Continue to listen until audible pulse disappears
 diastolic blood pressure…note number on dial
at last beat
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Blood Pressure
10 - 3
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Baseline Vital Signs
Blood pressure: Skill 10-3
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1. Place BP cuff around upper arm
2. Find brachial pulse
– Medial side of elbow
3. Close valve on cuff & inflate until brachial pulse is absent
~ 20 mm Hg past
4. EMT places head of stethoscope on brachial pulse and
insert ear tips
5. Slowly deflate BP cuff 10 mm Hg per second using valve
next to bulb
6. Note the systolic and diastolic pressures
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Systolic = first beat heard
Diastolic = last beat heard
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Blood Pressure
1. EMT places cuff around upper arm snugly
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Blood Pressure
2. Locate brachial pulse.
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Blood Pressure
3. Close valve on cuff and inflate cuff until brachial pulse
is absent, then continue inflating for 20 mm Hg or higher
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Blood Pressure
4. Place head of stethoscope on the brachial pulse
and ear tips in ears
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Blood Pressure
5. Slowly deflate cuff, about 10 mm Hg a second using
the relief valve next to bulb.
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Blood Pressure
6. Note the systolic and diastolic pressure.
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Blood Pressure Recording
Systolic # / Diastolic #
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Baseline Vital Signs
Skin:tells EMT about patient’s circulatory
status~ HR + BP + Skin eval = clues to
circulatory problems
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Temperature and Moisture
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Healthy = warm, dry skin
Moisture = normal sweating or nervous system reaction
to stress
Cool + Clammy indicates circulatory issue
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Jaundice
Pallor
Chapter 10
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Flushed
Baseline Vital Signs
Skin
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Color
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Pallor: pale ~ decreased blood supply (hypoperfusion)
Jaundice: yellow ~ liver disease
Flushed: red ~ sunburn, heat exposure,
Cyanosis: blue
Capillary Refill in Children
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Normal refill time is less than 2 seconds
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Baseline Vital Signs
Pupils: tells EMT how brain is functioning
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Size and Shape
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2 mm-8 mm
Dialated (large) or Constricted (small)
Same size and react together to light & dark
a) Unequal = anisocoria
Reactivity
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Light = constrict
Light removed = return to normal
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No response = nonreactive
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Constricted Pupils
Chapter 10
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Dialated Pupils
Chapter 10
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Unequal Pupils (anisocoria)
Chapter 10
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Baseline Vital Signs
Pupils
 Assessing pupillary response
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Pen light
Observe size, shape &
reactivity
PERRL
a) Pupils equal, round, and
reactive to light
Injuries to brain can alter
normal reaction
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Baseline Vital Signs
Pulse Oximetry
 Determines the effectiveness of
respirations
 Oxygen is bound & carried by hemoglobin
 Measures % of hemoglobin bound with
Oxygen
 Normal = 96-100%
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99% = 99% of pt’s hemoglobin is saturated
with oxygen
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Baseline Vital Signs
Pulse Oximetry
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Less than 96%
poorly oxygenated
Below 90%
serious problems
 Hypoxia: insufficient
amount of oxygen in
tissues
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Reassessment of Vital Signs
 Repeat every 10-15 minutes with stable
patients
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Assess for changes
 Repeat at least every 5 minutes with
unstable patients
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History Taking
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Patient Rapport
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Proper introduction of the crew
a) “Hi, my name is Jessica Brown. I’m an EMT with
Mount Pleasant Fire Department, and my crew and I
have come to help you.”
The EMT and proper etiquette
a) “It is nice to meet you Mr. Jones.”
Comforting touch/talking
a) Calms & reassures patient
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“We are going to take care of you.”
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SAMPLE History
Signs and Symptoms
Allergies
Medications
Past Medical History/Surgical History
Last Oral Intake
Events Leading up to Incident/Illness
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Signs versus Symptoms
Symptom
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The patient’s perception of the illness or injury.
Examples: ankle pain, shortness of breath, and dizziness
Sign
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The objective condition that is observable to
the EMT.
Examples: swelling, labored breathing, rapid vitals, and
bleeding
Chapter
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Signs versus Symptoms:
Table 10-6
Signs
Chapter
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Symptoms
Ankle swelling
Ankle pain
Labored breathing
Shortness of breath
Abdominal tenderness
Abdominal pain
Unsteadiness
Dizziness
Rapid pulse rate
Heart palpitations
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Signs versus Symptoms
Allergies
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Allergies to medications or products
Medications
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Chapter
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Current medications taken by patient
Doctor ordered changes in medications recently
Taking regularly  compliant
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Signs versus Symptoms
Past Medical/Surgical History
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List of past medical conditions or procedures
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Stroke, seizures, heart attack, HBP, diabetes, caner
Last Oral Intake
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Chapter
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Last time seriously ill or injured
Last to eat/drink
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Signs versus Symptoms
Events Leading Up to Incident/Illness
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How incident occurred or what led up to it
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Event leading up to injury or illness is often the
cause or trigger for incident/illness
a) Ex: exercise can induce shortness of breath
from an asthma attack or chest pain from angina
b) Ex: driving motorcycle without helmet
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Conclusion
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The EMT is responsible for gathering
information on every patient encountered.
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This information includes vital signs and basic
patient history.
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Familiarity with the normal values of vital signs
must be understood in order to recognize
abnormal readings.
Chapter 10
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