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

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  • 1. Baseline Vital Signs and SAMPLE History
  • 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. 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. 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. 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. Accessory Muscle Use Nasal Flaring Retractions
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. Baseline Vital Signs Perfusion
  • 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. 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. 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. 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. 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. 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. 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. 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. Dilated Constricted Unequal
  • 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. 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. 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. 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. 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. SAMPLE History <ul><li>Last oral intake </li></ul><ul><ul><li>Time </li></ul></ul><ul><ul><li>Quantity </li></ul></ul>
  • 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. That does it… Have a GREAT night!

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