Baseline Vital Signs and SAMPLE History
Getting Started… <ul><li>It all starts with a complaint… </li></ul><ul><ul><li>Chief Complaint (C/C) </li></ul></ul><ul><u...
Baseline Vital Signs <ul><li>Measurement of vital body functions </li></ul><ul><ul><li>Gives a basis for initiating care  ...
Respiratory Evaluation <ul><li>Areas of assessment </li></ul><ul><ul><li>Rate. Rhythm. Depth. Quality. </li></ul></ul><ul>...
Respiratory Evaluation cont’d. <ul><li>Quality </li></ul><ul><ul><li>Breath sounds </li></ul></ul><ul><ul><ul><li>Present ...
Accessory Muscle Use Nasal Flaring Retractions
Respiratory Evaluation Cont’d <ul><li>Noisy </li></ul><ul><ul><li>Increase in audible sound of breathing </li></ul></ul><u...
Respiratory Evaluation cont’d. <ul><li>Cyanosis </li></ul><ul><ul><li>Blue/pale coloring of skin </li></ul></ul><ul><ul><u...
Pediatric Considerations <ul><li>Mouth/Nose </li></ul><ul><ul><li>Smaller and easily obstructed </li></ul></ul><ul><li>Pha...
Respiratory Rate <ul><li>Count the # of respirations in 30 seconds and X by 2.  </li></ul><ul><ul><li>Try not to inform pt...
Pulse Rate <ul><li>Pulse </li></ul><ul><ul><li>Palpable wave of blood sent though arteries after contraction of L ventricl...
Pulse Rate <ul><li>Evaluation </li></ul><ul><ul><li>Radial pulse </li></ul></ul><ul><ul><ul><li>ALL pt 1 y/o + </li></ul><...
Pulse Rate <ul><li>Evaluation </li></ul><ul><ul><li>Depress artery and count rate for 30 seconds and X by 2 </li></ul></ul...
  Perfusion/Skin <ul><li>Clues to perfusion and oxygenation </li></ul><ul><li>Components </li></ul><ul><ul><li>Color </li>...
Skin Color <ul><li>Locations of assessment </li></ul><ul><ul><li>Nail beds, oral mucosa, conjunctiva </li></ul></ul><ul><u...
Baseline Vital Signs   Perfusion
Temperature  <ul><li>Place back of gloved hand on pt skin </li></ul><ul><li>Normal = Warm </li></ul><ul><li>Abnormal </li>...
Capillary Refill <ul><li>Evaluation </li></ul><ul><ul><li>Press on pt nail bed until it is blanched/white </li></ul></ul><...
The Circulatory System  Physiology Blood Pressure <ul><li>Blood pressure </li></ul><ul><ul><li>Force exerted from blood on...
Auscultating Blood Pressure <ul><li>Auscultation </li></ul><ul><ul><li>Listens to systolic/diastolic sounds as artery goes...
Blood Pressure Ranges <ul><li>Normal ranges </li></ul><ul><ul><li>Systolic = 100 + pt age (140-150mmHg) </li></ul></ul><ul...
Palpating Blood Pressure <ul><li>How to… </li></ul><ul><ul><li>Place B/P cuff as before </li></ul></ul><ul><ul><li>Palpate...
Pupils <ul><li>Why? </li></ul><ul><ul><li>Easy way to assess neural status </li></ul></ul><ul><li>How? </li></ul><ul><ul><...
Pupils PERRL <ul><li>Normal </li></ul><ul><ul><li>PERRL </li></ul></ul><ul><ul><li>“ Pupils Equal, Round & Reactive to lig...
Dilated Constricted Unequal
How often to assess <ul><li>Stable Pt </li></ul><ul><ul><li>Every 15 min </li></ul></ul><ul><li>Unstable Pt </li></ul><ul>...
SAMPLE History <ul><li>Sings/Symptoms </li></ul><ul><ul><li>Sign </li></ul></ul><ul><ul><ul><li>Any condition the EMT sees...
SAMPLE History <ul><li>Allergies </li></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Food </li></ul></ul><ul><ul>...
SAMPLE History <ul><li>Medications </li></ul><ul><ul><li>Prescription </li></ul></ul><ul><ul><ul><li>Current </li></ul></u...
SAMPLE History <ul><li>Past Pertinent Medical History </li></ul><ul><ul><li>Medical </li></ul></ul><ul><ul><li>Surgical </...
SAMPLE History <ul><li>Last oral intake </li></ul><ul><ul><li>Time </li></ul></ul><ul><ul><li>Quantity </li></ul></ul>
SAMPLE History <ul><li>Events leading to injury/illness </li></ul><ul><ul><li>Example </li></ul></ul><ul><ul><ul><li>Pt wa...
That does it… Have a GREAT night!
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7)Baseline Vital Signs And Sample History

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7)Baseline Vital Signs And Sample History

  1. 1. Baseline Vital Signs and SAMPLE History
  2. 2. Getting Started… <ul><li>It all starts with a complaint… </li></ul><ul><ul><li>Chief Complaint (C/C) </li></ul></ul><ul><ul><ul><li>Why was EMS called? </li></ul></ul></ul><ul><ul><li>Other useful information </li></ul></ul><ul><ul><ul><li>Pt. Age </li></ul></ul></ul><ul><ul><ul><li>Pt. Sex </li></ul></ul></ul><ul><ul><ul><li>Pt. Race </li></ul></ul></ul>
  3. 3. Baseline Vital Signs <ul><li>Measurement of vital body functions </li></ul><ul><ul><li>Gives a basis for initiating care </li></ul></ul><ul><ul><li>Allows reevaluation of interventions </li></ul></ul><ul><li>Includes: </li></ul><ul><ul><li>Respirations </li></ul></ul><ul><ul><li>Pulse </li></ul></ul><ul><ul><li>Blood pressure </li></ul></ul><ul><ul><li>Temperature </li></ul></ul><ul><ul><li>Pupils </li></ul></ul>
  4. 4. Respiratory Evaluation <ul><li>Areas of assessment </li></ul><ul><ul><li>Rate. Rhythm. Depth. Quality. </li></ul></ul><ul><li>Rate </li></ul><ul><ul><li>Adult = 12-20 per minute </li></ul></ul><ul><ul><li>Child = 15-30 per minute </li></ul></ul><ul><ul><li>Infant -= 30-60 per minute </li></ul></ul><ul><li>Rhythm </li></ul><ul><ul><li>Regular or irregular </li></ul></ul><ul><li>Depth </li></ul><ul><ul><li>Tidal volume adequate or inadequate </li></ul></ul><ul><ul><ul><li>Amount of air breathed in/out in one ventilation </li></ul></ul></ul><ul><ul><ul><li>Approx 500 mL </li></ul></ul></ul>
  5. 5. Respiratory Evaluation cont’d. <ul><li>Quality </li></ul><ul><ul><li>Breath sounds </li></ul></ul><ul><ul><ul><li>Present or diminished or absent </li></ul></ul></ul><ul><ul><li>Chest expansion </li></ul></ul><ul><ul><ul><li>Unequal or symmetrical </li></ul></ul></ul><ul><ul><li>Increased effort </li></ul></ul><ul><ul><ul><li>Accessory muscles </li></ul></ul></ul><ul><ul><ul><li>“ Seesaw” breathing </li></ul></ul></ul><ul><ul><ul><ul><li>Infants </li></ul></ul></ul></ul><ul><ul><ul><li>Nasal flaring </li></ul></ul></ul><ul><ul><ul><li>Retractions </li></ul></ul></ul><ul><ul><ul><ul><li>Above clavicles, between ribs </li></ul></ul></ul></ul><ul><ul><ul><li>Cyanosis </li></ul></ul></ul><ul><ul><ul><li>Shortness of breath </li></ul></ul></ul><ul><ul><ul><li>Altered mental status </li></ul></ul></ul>
  6. 6. Accessory Muscle Use Nasal Flaring Retractions
  7. 7. Respiratory Evaluation Cont’d <ul><li>Noisy </li></ul><ul><ul><li>Increase in audible sound of breathing </li></ul></ul><ul><li>Grunting </li></ul><ul><ul><li>Rhythmic, deep, short and hoarse </li></ul></ul><ul><ul><li>During exhalation </li></ul></ul><ul><li>Gurgling </li></ul><ul><ul><li>Air moving through water </li></ul></ul><ul><ul><li>=Fluid in upper airway </li></ul></ul><ul><li>Wheezing </li></ul><ul><ul><li>High pitched “whistling” </li></ul></ul><ul><ul><li>=Narrow bronchioles (Asthma) </li></ul></ul><ul><li>Crowing/Stridor </li></ul><ul><ul><li>High pitch on inspiration </li></ul></ul><ul><ul><li>= Obstruction at vocal cords/epiglottis </li></ul></ul><ul><li>Snoring </li></ul><ul><ul><li>Tongue blocking airway </li></ul></ul><ul><li>Gasping </li></ul><ul><ul><li>Short, rapid inspiratory phase </li></ul></ul><ul><ul><li>Assoc. with Resp. distress/failure </li></ul></ul>
  8. 8. Respiratory Evaluation cont’d. <ul><li>Cyanosis </li></ul><ul><ul><li>Blue/pale coloring of skin </li></ul></ul><ul><ul><ul><li>Nail beds </li></ul></ul></ul><ul><ul><ul><li>Lips </li></ul></ul></ul><ul><ul><ul><li>Eyelids </li></ul></ul></ul><ul><ul><li>Why is this seen in these areas first??? </li></ul></ul><ul><ul><li>Indicates poor perfusion </li></ul></ul>
  9. 9. Pediatric Considerations <ul><li>Mouth/Nose </li></ul><ul><ul><li>Smaller and easily obstructed </li></ul></ul><ul><li>Pharynx </li></ul><ul><ul><li>Tongue is BIG </li></ul></ul><ul><li>Trachea </li></ul><ul><ul><li>Narrower </li></ul></ul><ul><ul><li>Softer and more flexible </li></ul></ul><ul><li>Cricoid Cartilage </li></ul><ul><ul><li>Less developed/Less rigid = easily kinked </li></ul></ul><ul><li>Diaphragm </li></ul><ul><ul><li>Chest is soft </li></ul></ul><ul><ul><li>Depend on diaphragm to do most of the work of breathing </li></ul></ul><ul><ul><ul><li>Seesaw Breathing…. </li></ul></ul></ul>
  10. 10. Respiratory Rate <ul><li>Count the # of respirations in 30 seconds and X by 2. </li></ul><ul><ul><li>Try not to inform pt </li></ul></ul><ul><ul><li>They could adjust rate </li></ul></ul>
  11. 11. Pulse Rate <ul><li>Pulse </li></ul><ul><ul><li>Palpable wave of blood sent though arteries after contraction of L ventricle </li></ul></ul><ul><li>Peripheral </li></ul><ul><ul><li>Radial </li></ul></ul><ul><ul><li>Brachial </li></ul></ul><ul><ul><li>Posterior tibial </li></ul></ul><ul><ul><li>Dorsalis pedis </li></ul></ul><ul><li>Central </li></ul><ul><ul><li>Carotid </li></ul></ul><ul><ul><li>Femoral </li></ul></ul>
  12. 12. Pulse Rate <ul><li>Evaluation </li></ul><ul><ul><li>Radial pulse </li></ul></ul><ul><ul><ul><li>ALL pt 1 y/o + </li></ul></ul></ul><ul><ul><li>Brachial pulse </li></ul></ul><ul><ul><ul><li>pt less than 1 y/o </li></ul></ul></ul><ul><ul><li>If unresponsive OR peripheral pulse isn't palpable </li></ul></ul><ul><ul><ul><li>Carotid pulse </li></ul></ul></ul><ul><ul><ul><li>NEVER on both sides </li></ul></ul></ul><ul><ul><li>Use index and middle finger </li></ul></ul><ul><ul><ul><li>NO THUMBS </li></ul></ul></ul>
  13. 13. Pulse Rate <ul><li>Evaluation </li></ul><ul><ul><li>Depress artery and count rate for 30 seconds and X by 2 </li></ul></ul><ul><ul><ul><li>OR 15 seconds and X by 4 </li></ul></ul></ul><ul><ul><ul><li>Less accurate </li></ul></ul></ul><ul><li>Range </li></ul><ul><ul><li>Infant (Birth - 1 year) </li></ul></ul><ul><ul><ul><li>100-160 </li></ul></ul></ul><ul><ul><li>Child (2-10 y/o) </li></ul></ul><ul><ul><ul><li>70-150 </li></ul></ul></ul><ul><ul><li>Child (12 y/o+) Adult </li></ul></ul><ul><ul><ul><li>60-100 </li></ul></ul></ul>
  14. 14. Perfusion/Skin <ul><li>Clues to perfusion and oxygenation </li></ul><ul><li>Components </li></ul><ul><ul><li>Color </li></ul></ul><ul><ul><li>Temp </li></ul></ul><ul><ul><li>Moisture </li></ul></ul><ul><ul><li>Capillary Refill </li></ul></ul>
  15. 15. Skin Color <ul><li>Locations of assessment </li></ul><ul><ul><li>Nail beds, oral mucosa, conjunctiva </li></ul></ul><ul><ul><li>Pediatric </li></ul></ul><ul><ul><ul><li>Palms of hand/Sole of feet </li></ul></ul></ul><ul><ul><li>Normal = Pink </li></ul></ul><ul><ul><li>Abnormal </li></ul></ul><ul><ul><ul><li>Pale </li></ul></ul></ul><ul><ul><ul><ul><li>Poor Perfusion </li></ul></ul></ul></ul><ul><ul><ul><li>Cyanotic </li></ul></ul></ul><ul><ul><ul><ul><li>Blue/grey= Poor oxygenation/perfusion </li></ul></ul></ul></ul><ul><ul><ul><li>Flushed </li></ul></ul></ul><ul><ul><ul><ul><li>Heat or CO exposure </li></ul></ul></ul></ul><ul><ul><ul><li>Jaundiced </li></ul></ul></ul><ul><ul><ul><ul><li>Liver/Gallbladder problems </li></ul></ul></ul></ul>
  16. 16. Baseline Vital Signs Perfusion
  17. 17. Temperature <ul><li>Place back of gloved hand on pt skin </li></ul><ul><li>Normal = Warm </li></ul><ul><li>Abnormal </li></ul><ul><ul><li>Hot </li></ul></ul><ul><ul><ul><li>Fever/Heat exposure </li></ul></ul></ul><ul><ul><li>Cool </li></ul></ul><ul><ul><ul><li>Poor perfusion/Cold exposure </li></ul></ul></ul><ul><ul><li>Cold </li></ul></ul><ul><ul><ul><li>Extreme cold exposure </li></ul></ul></ul><ul><ul><ul><li>Excessively dead… </li></ul></ul></ul><ul><li>Also check for moisture </li></ul><ul><ul><li>Diaphoresis or extremely dry </li></ul></ul>
  18. 18. Capillary Refill <ul><li>Evaluation </li></ul><ul><ul><li>Press on pt nail bed until it is blanched/white </li></ul></ul><ul><ul><li>Release and count time until pink returns </li></ul></ul><ul><li>Normal </li></ul><ul><ul><li>2 seconds or less </li></ul></ul><ul><li>Abnormal </li></ul><ul><ul><li>More than 2 seconds </li></ul></ul>
  19. 19. The Circulatory System Physiology Blood Pressure <ul><li>Blood pressure </li></ul><ul><ul><li>Force exerted from blood on walls of vessels </li></ul></ul><ul><li>Phases of Cardiac Cycle </li></ul><ul><ul><li>Systolic </li></ul></ul><ul><ul><ul><li>Pressure against the walls when the L ventricle contracts </li></ul></ul></ul><ul><ul><ul><li>HIGH PRESSURE </li></ul></ul></ul><ul><ul><li>Diastolic </li></ul></ul><ul><ul><ul><li>Pressure against the walls when the L ventricle relaxes </li></ul></ul></ul><ul><ul><ul><li>Low pressure </li></ul></ul></ul>
  20. 20. Auscultating Blood Pressure <ul><li>Auscultation </li></ul><ul><ul><li>Listens to systolic/diastolic sounds as artery goes from collapsed to open </li></ul></ul><ul><li>How to… </li></ul><ul><ul><li>Place cuff just above elbow </li></ul></ul><ul><ul><li>Use marking, line up with brachial artery </li></ul></ul><ul><ul><li>Locate brachial pulse and place your stethoscope </li></ul></ul><ul><ul><li>Close valve </li></ul></ul><ul><ul><li>Inflate until needle stops undulating as pressure increases (150-220 mmHg) </li></ul></ul><ul><ul><li>Release pressure until you hear a heartbeat =Systolic </li></ul></ul><ul><ul><li>Continue until you hear no sound = Diastolic </li></ul></ul>
  21. 21. Blood Pressure Ranges <ul><li>Normal ranges </li></ul><ul><ul><li>Systolic = 100 + pt age (140-150mmHg) </li></ul></ul><ul><ul><li>Diastolic= 65-90 mmHg </li></ul></ul><ul><ul><li>Textbook perfect = 120/80 </li></ul></ul><ul><li>Expressed as: </li></ul><ul><ul><li>Systolic/Diastolic </li></ul></ul><ul><li>Asses in ALL pt 3 y/o + </li></ul>
  22. 22. Palpating Blood Pressure <ul><li>How to… </li></ul><ul><ul><li>Place B/P cuff as before </li></ul></ul><ul><ul><li>Palpate radial pulse </li></ul></ul><ul><ul><li>Inflate cuff as normal </li></ul></ul><ul><ul><li>Deflate cuff until you feel the radial artery </li></ul></ul><ul><ul><li>Gives you ONLY the systolic pressure </li></ul></ul><ul><li>Why do it? </li></ul><ul><ul><li>Unable to obtain brachial b/p </li></ul></ul><ul><li>Expressed as </li></ul><ul><ul><li>120/palp or 120/p </li></ul></ul>
  23. 23. Pupils <ul><li>Why? </li></ul><ul><ul><li>Easy way to assess neural status </li></ul></ul><ul><li>How? </li></ul><ul><ul><li>Briefly shine a light in the pt eyes </li></ul></ul><ul><li>Evaluation: </li></ul><ul><ul><li>Diameter </li></ul></ul><ul><ul><li>Reactivity to light </li></ul></ul><ul><ul><li>Equal size </li></ul></ul>
  24. 24. Pupils PERRL <ul><li>Normal </li></ul><ul><ul><li>PERRL </li></ul></ul><ul><ul><li>“ Pupils Equal, Round & Reactive to light ” </li></ul></ul><ul><li>Abnormal </li></ul><ul><ul><li>Constricted/pinpoint </li></ul></ul><ul><ul><ul><li>Overdose (opiate i.e. Heroine) </li></ul></ul></ul><ul><ul><li>Dilated </li></ul></ul><ul><ul><ul><li>Severe lack of O2 = Hypoxia </li></ul></ul></ul><ul><ul><ul><li>Brain Death </li></ul></ul></ul><ul><ul><ul><li>Toxic substances </li></ul></ul></ul><ul><ul><li>Unequal </li></ul></ul><ul><ul><ul><li>Brain Injury </li></ul></ul></ul>
  25. 25. Dilated Constricted Unequal
  26. 26. How often to assess <ul><li>Stable Pt </li></ul><ul><ul><li>Every 15 min </li></ul></ul><ul><li>Unstable Pt </li></ul><ul><ul><li>Every 5 min </li></ul></ul><ul><li>Following ANY medical intervention </li></ul>
  27. 27. SAMPLE History <ul><li>Sings/Symptoms </li></ul><ul><ul><li>Sign </li></ul></ul><ul><ul><ul><li>Any condition the EMT sees </li></ul></ul></ul><ul><ul><li>Symptom </li></ul></ul><ul><ul><ul><li>Any condition described by the pt </li></ul></ul></ul>
  28. 28. SAMPLE History <ul><li>Allergies </li></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Food </li></ul></ul><ul><ul><li>Environmental </li></ul></ul>
  29. 29. SAMPLE History <ul><li>Medications </li></ul><ul><ul><li>Prescription </li></ul></ul><ul><ul><ul><li>Current </li></ul></ul></ul><ul><ul><ul><li>Recent </li></ul></ul></ul><ul><ul><ul><li>Birth control? </li></ul></ul></ul><ul><ul><li>Non-Prescription </li></ul></ul><ul><ul><ul><li>Current </li></ul></ul></ul><ul><ul><ul><li>Recent </li></ul></ul></ul>
  30. 30. SAMPLE History <ul><li>Past Pertinent Medical History </li></ul><ul><ul><li>Medical </li></ul></ul><ul><ul><li>Surgical </li></ul></ul><ul><ul><li>Trauma </li></ul></ul>
  31. 31. SAMPLE History <ul><li>Last oral intake </li></ul><ul><ul><li>Time </li></ul></ul><ul><ul><li>Quantity </li></ul></ul>
  32. 32. SAMPLE History <ul><li>Events leading to injury/illness </li></ul><ul><ul><li>Example </li></ul></ul><ul><ul><ul><li>Pt was dizzy then fell </li></ul></ul></ul><ul><ul><ul><ul><li>Medical – Trauma </li></ul></ul></ul></ul><ul><ul><ul><li>Pt fell and then was dizzy </li></ul></ul></ul><ul><ul><ul><ul><li>Trauma- Medical </li></ul></ul></ul></ul>
  33. 33. That does it… Have a GREAT night!
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