Baseline Vital Signs and SAMPLE History

Getting Started…

• It all starts with a complaint…

• Chief Complaint (C/C)• Why was EMS called?

• Other useful information• Pt. Age• Pt. Sex• Pt. Race

Baseline Vital Signs

• Measurement of vital body functions• Gives a basis for initiating care • Allows reevaluation of interventions

• Includes:• Respirations• Pulse• Blood pressure• Temperature• Pupils

Respiratory Evaluation

• Areas of assessment• Rate. Rhythm. Depth. Quality.

• Rate• Adult = 12-20 per minute• Child = 15-30 per minute• Infant -= 30-60 per minute

• Rhythm• Regular or irregular

• Depth• Tidal volume adequate or inadequate

• Amount of air breathed in/out in one ventilation• Approx 500 mL

Respiratory Evaluation cont’d.

• Quality• Breath sounds

• Present or diminished or absent• Chest expansion

• Unequal or symmetrical• Increased effort

• Accessory muscles • “Seesaw” breathing

• Infants• Nasal flaring • Retractions

• Above clavicles, between ribs• Cyanosis• Shortness of breath• Altered mental status

Accessory Muscle Use

Nasal Flaring

Retractions

Respiratory Evaluation Cont’d

• Noisy• Increase in audible sound of breathing

• Grunting• Rhythmic, deep, short and hoarse • During exhalation

• Gurgling• Air moving through water• =Fluid in upper airway

• Wheezing• High pitched “whistling” • =Narrow bronchioles (Asthma)

• Crowing/Stridor• High pitch on inspiration • = Obstruction at vocal cords/epiglottis

• Snoring• Tongue blocking airway

• Gasping• Short, rapid inspiratory phase • Assoc. with Resp. distress/failure

Respiratory Evaluation cont’d.

• Cyanosis• Blue/pale coloring of skin

• Nail beds• Lips• Eyelids

• Why is this seen in these areas first???

• Indicates poor perfusion

Pediatric Considerations

• Mouth/Nose• Smaller and easily obstructed

• Pharynx• Tongue is BIG

• Trachea• Narrower• Softer and more flexible

• Cricoid Cartilage• Less developed/Less rigid = easily kinked

• Diaphragm • Chest is soft• Depend on diaphragm to do most of the work of breathing

• Seesaw Breathing….

Respiratory Rate

• Count the # of respirations in 30 seconds and X by 2. • Try not to inform pt • They could adjust rate

Pulse Rate

• Pulse• Palpable wave of blood sent though arteries after contraction of L

ventricle • Peripheral

• Radial• Brachial• Posterior tibial• Dorsalis pedis

• Central• Carotid • Femoral

Pulse Rate

• Evaluation• Radial pulse

• ALL pt 1 y/o +

• Brachial pulse• pt less than 1 y/o

• If unresponsive OR peripheral pulse isn't palpable • Carotid pulse• NEVER on both sides

• Use index and middle finger• NO THUMBS

Pulse Rate

• Evaluation• Depress artery and count

rate for 30 seconds and X by 2

• OR 15 seconds and X by 4

• Less accurate

• Range• Infant (Birth - 1 year)

• 100-160• Child (2-10 y/o)

• 70-150• Child (12 y/o+) Adult

• 60-100

Perfusion/Skin

• Clues to perfusion and oxygenation• Components

• Color• Temp• Moisture• Capillary Refill

Skin Color

• Locations of assessment• Nail beds, oral mucosa, conjunctiva• Pediatric

• Palms of hand/Sole of feet• Normal = Pink• Abnormal

• Pale• Poor Perfusion

• Cyanotic• Blue/grey= Poor oxygenation/perfusion

• Flushed• Heat or CO exposure

• Jaundiced • Liver/Gallbladder problems

Baseline Vital Signs Perfusion

Temperature

• Place back of gloved hand on pt skin• Normal = Warm• Abnormal

• Hot• Fever/Heat exposure

• Cool• Poor perfusion/Cold exposure

• Cold• Extreme cold exposure• Excessively dead…

• Also check for moisture• Diaphoresis or extremely dry

Capillary Refill

• Evaluation• Press on pt nail bed until it

is blanched/white• Release and count time

until pink returns

• Normal• 2 seconds or less

• Abnormal• More than 2 seconds

The Circulatory System Physiology

Blood Pressure

• Blood pressure• Force exerted from blood on walls of

vessels • Phases of Cardiac Cycle

• Systolic• Pressure against the walls when the L

ventricle contracts• HIGH PRESSURE

• Diastolic • Pressure against the walls when the L

ventricle relaxes• Low pressure

Auscultating Blood Pressure

• Auscultation• Listens to systolic/diastolic sounds as artery goes from

collapsed to open • How to…

• Place cuff just above elbow• Use marking, line up with brachial artery• Locate brachial pulse and place your stethoscope• Close valve • Inflate until needle stops undulating as pressure increases

(150-220 mmHg)• Release pressure until you hear a heartbeat =Systolic• Continue until you hear no sound = Diastolic

Blood Pressure Ranges

• Normal ranges• Systolic = 100 + pt age (140-150mmHg)• Diastolic= 65-90 mmHg• Textbook perfect = 120/80

• Expressed as:• Systolic/Diastolic

• Asses in ALL pt 3 y/o +

Palpating Blood Pressure

• How to…• Place B/P cuff as before• Palpate radial pulse• Inflate cuff as normal• Deflate cuff until you feel the radial artery• Gives you ONLY the systolic pressure

• Why do it?• Unable to obtain brachial b/p

• Expressed as • 120/palp or 120/p

Pupils

• Why?• Easy way to assess

neural status

• How?• Briefly shine a light in the

pt eyes

• Evaluation:• Diameter• Reactivity to light• Equal size

Pupils PERRL

• Normal• PERRL• “Pupils Equal, Round & Reactive to light”

• Abnormal• Constricted/pinpoint

• Overdose (opiate i.e. Heroine)• Dilated

• Severe lack of O2 = Hypoxia• Brain Death• Toxic substances

• Unequal• Brain Injury

Dilated

Constricted

Unequal

How often to assess

• Stable Pt• Every 15 min

• Unstable Pt• Every 5 min

• Following ANY medical intervention

SAMPLE History

• Sings/Symptoms• Sign

• Any condition the EMT sees

• Symptom• Any condition described

by the pt

SAMPLE History

• Allergies• Medications• Food• Environmental

SAMPLE History

• Medications• Prescription

• Current• Recent• Birth control?

• Non-Prescription• Current• Recent

SAMPLE History

• Past Pertinent Medical History• Medical• Surgical• Trauma

SAMPLE History

• Last oral intake• Time• Quantity

SAMPLE History

• Events leading to injury/illness• Example

• Pt was dizzy then fell• Medical – Trauma

• Pt fell and then was dizzy• Trauma- Medical

That does it… Have a GREAT night!