chapter 10 baseline vital signs and sample history
TRANSCRIPT
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Chapter 10Baseline Vital Signs and SAMPLE History
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Overview
Baseline Vital Signs Reassessment of Vital Signs History Taking SAMPLE History
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Baseline Vital Signs
The first measurement of vital signs is sometimes referred to as the baseline vital signs.
Subsequent readings, or values, are compared against the baseline vital signs.
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Baseline Vital Signs
Respiration: Quantity– Does the patient seem to be breathing
very fast or slow?– For exact respiratory rate, count number
of breaths taken in 1 minute
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Baseline Vital Signs
Respiration: Quantity– Acceptable to count breaths taken in
30 seconds and multiply by 2– If patient’s breathing is irregular, count
respirations for 1 full minute
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Baseline Vital Signs
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Baseline Vital Signs
Respiration: Quality– In addition to the respiratory rate, note quality of
the respiration– Observe respiration: depth, regularity, and any
unusual noise or effort– Normal breathing quality: moderate depth,
regular, and quiet
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Baseline Vital Signs
Respiration: Quality– Labored breathing
• Discomfort• Increased use of chest and neck
muscles (accessory muscle use)• Nasal flaring
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Baseline Vital Signs
Respiration: Quality– Labored breathing
• Abnormal noises– Stridor– Snoring– Gurgling– Wheezing– Grunting
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Baseline Vital Signs
Pulse– The rate, strength, and regularity of a
patient’s pulse can indicate the severity of an illness or injury.
– Following these values over time will indicate any change in the patient’s condition or health.
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Baseline Vital Signs
Pulse– Common sites for a pulse check
• Adults: over the radial, femoral, and carotid arteries• Infants: brachial pulse (because it is usually easier to
find)
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Baseline Vital Signs
A. Radial
B. Femoral
C. Carotid
D. Brachial
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Baseline Vital Signs
Pulse: Quantity– Place the pads of two fingers on the
wrist, just below the base of the thumb– Count the number of pulse beats felt in
30 seconds, then multiply by 2
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Baseline Vital Signs
Pulse: Quality– Strength of pulse can be strong,
bounding, weak, or thready– Regularity of pulse can be regular
or irregular
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Baseline Vital Signs
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Baseline Vital Signs
Blood pressure– Measured by two methods:
• Auscultation, using a sphygmomanometer and a stethoscope
• Palpation
– Measured at both the contraction and relaxation phases
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– Reported in two numbers:• First (top) number is the systolic pressure• Second (lower) number is the diastolic pressure.
Baseline Vital Signs
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Baseline Vital Signs
Blood pressure– Cuff application
• Select a proper-sized cuff • Fit properly to the patient’s bare upper arm
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Baseline Vital Signs
Blood pressure measurement– Auscultation
• Apply cuff; then find brachial pulse
• Inflate cuff 20 mm Hg beyond where pulse disappears
• Place stethoscope on brachial pulse, then slowly release pressure in cuff
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Baseline Vital Signs
Blood pressure measurement– Auscultation
• Read number on dial upon return of the pulse (systolic)
• Read number on dial when the pulse disappears (diastolic)
• Report blood pressure as systolic over diastolic
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Baseline Vital Signs
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Baseline Vital Signs
Blood pressure measurement– Palpation
• When blood pressure cannot be heard due to noise interference, estimate it by the palpation method
• Confirm blood pressure by auscultation as soon as possible since palpation gives only an estimate
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Baseline Vital Signs
Blood pressure measurement– Palpation
• Palpate the return of the radial pulse during deflation of cuff and note number on gauge as the systolic pressure
• Diastolic pressure is not available with this method
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Stop and Review
Where do you assess for pulse in an infant? Define systolic pressure. Define diastolic pressure.
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Baseline Vital Signs
Skin: Temperature and moisture – Skin condition can indicate the patient’s
circulatory status– Use skin-to-skin contact to measure the
temperature on the patient’s forehead or abdomen
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Baseline Vital Signs
Skin: Temperature and moisture– A healthy person normally has warm, dry skin– Temperature: hot, warm, cool, or cold– Moisture: cool and clammy or moist or sweaty
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Baseline Vital Signs
Skin: Color– Determine skin color by assessing the nail beds,
oral mucosa, or conjunctiva – Normal skin is a healthy pink color from good
blood flow – Pallid skin indicates a decreased blood supply
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Baseline Vital Signs
Skin: Color– A bluish discoloration, or cyanosis, indicates
a state of poor oxygenation – Other skin colors may give clues about
underlying disease states
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Baseline Vital Signs
– A flush can occur from embarrassment or disease
– Jaundiced skin can be caused by liver disease.
– Note the pallor, a sign of shock
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Baseline Vital Signs
Skin: Capillary refill– Time it takes for the blood to return to the skin
when the skin is compressed
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Baseline Vital Signs
Skin: Capillary refill– In children
• Capillaries of a healthy child have a constant supply of oxygenated blood
• Refill time of less than 2 seconds • If more than 2 seconds, the child’s skin is
hypoperfused, indicating the child may be in shock
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Baseline Vital Signs
Pupil– Black part in the center of the eye – Usually round and changes size in reaction to
changing light conditions – Changes in pupillary reaction may mean
improvement or deterioration of the patient’s neurologic status, or brain function
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Baseline Vital Signs
Pupil – When checking pupil response, shield patient’s
eyes from the room light, and use a handheld penlight to assess size, shape, and reaction
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Baseline Vital Signs
Pupil: Size and shape– Describe pupil diameter by exact
measurement or general terms– Pupil of the eye is normally round
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Baseline Vital Signs
Pupil: Size and shape– Consensual response: both pupils are usually the
same size and tend to react together when one is exposed to light
– Anisocoria: pupils are not of equal size
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Baseline Vital Signs
– Constricted pupils
– Dilated pupils
– Anisocoria
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Baseline Vital Signs
Pupil: Reactivity– Normal and reactive pupil: constricts briskly when
exposed to light and dilates when light is removed– Nonreactive pupil: responds slowly to light or not
at all– PERRL: pupils, equal, round, and reactive to light
(normal response of the pupils)
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Baseline Vital Signs
Pulse oximetry– Normal, 96% to 100%: blood is well oxygenated
and respirations are effective– Less than 96%: blood is poorly oxygenated and
there may be problems with breathing or circulation
– Less than 90%: serious oxygenation problem
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Baseline Vital Signs
Pulse oximetry– Accuracy requires an adequate sample of
capillary blood– Device should have a lighted bar meter or a
green or yellow light indicator that visually confirms that the sample is adequate
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Baseline Vital Signs
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Reassessment of Vital Signs
Reassess vital signs to determine changes in the patient’s condition
Initial vital signs are normal and patient is stable: reassess every 10 to 15 minutes
Initial vital signs are abnormal or patient is unstable: reassess every 5 minutes
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Reassessment of Vital Signs
Medication is administered (including oxygen): reassess within 5 minutes
Carefully document all measurements of vital signs, including the times they were taken
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Stop and Review
Describe normal and abnormal pupil size, shape, and reaction.
Describe normal and abnormal skin color, temperature, and condition.
Why is reassessment of vital signs important?
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History Taking
Obtaining an accurate history is vitally important The history often describes the reason for the
patient’s present health crisis as well as past successful treatments
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History Taking
Patient rapport– Remember, the call may be very stressful for the
patient
– The EMT should provide: • Proper introduction of the crew• Proper etiquette• Comforting touch
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SAMPLE History
Obtain basic information as soon as possible after all life threats have been properly addressed
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SAMPLE History
SAMPLE questions:– Signs and symptoms– Allergies– Medications– Past medical and surgical history– Last oral intake– Events leading up to incident or illness
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SAMPLE History
Watch this video of an EMT asking SAMPLE questions of a patient
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Stop and Review
Identify the components of the SAMPLE history.