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7)Baseline Vital Signs And Sample History
 

7)Baseline Vital Signs And Sample History

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    7)Baseline Vital Signs And Sample History 7)Baseline Vital Signs And Sample History Presentation Transcript

    • 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!