DMACC EMT Chapter 11

PREHOSPITALPREHOSPITAL
EMERGENCY CAREEMERGENCY CARE
CHAPTER
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
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Prehospital Emergency Care, 10th
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Baseline Vital Signs,
Monitoring Devices,
and History Taking
11

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Learning ReadinessLearning Readiness
• EMS Education Standards, text p. 266.

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ObjectivesObjectives
• Please refer to pages 266 of your text
to view the objectives for this chapter.

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Key TermsKey Terms
• Please refer to page 267 of your text to
view the key terms for this chapter.

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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Gathering Patient Information
 Baseline Vital Signs
 Monitoring Equipment
 Preparing to Take the History
 Taking the History

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Case Study IntroductionCase Study Introduction
Chuck Mahon rubs his chest, trying to
relieve the discomfort he feels there as
two EMTs walk toward him. "Hi, I'm Bill,"
says the taller of the two, "and this is
Yolanda. We are EMTs, and we are here
to help. What seems to be the problem
today?"

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Case StudyCase Study
• What information will be important to
Bill and Yolanda in deciding what is
wrong with Mr. Mahon?
• What procedures and equipment will
the EMTs use to obtain this
information?

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IntroductionIntroduction
• Patient assessment helps you find out
what is wrong with the patient and
decide what care should be provided.
• Measuring vital signs over time reveals
trends in the patient's condition.
• The patient's history helps you
understand his underlying problems.

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Gathering Patient InformationGathering Patient Information
• When you arrive at the scene of an
emergency call, you must gather
information about the patient's
condition.
• Some information is readily available;
other information takes "detective
work."
• Always respect the patient's dignity.

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Baseline Vital SignsBaseline Vital Signs
• Vital signs are outward clues about
what is happening in the body. They
include:
 Respiration
 Pulse
 Skin
 Pupils
 Blood pressure
 Pulse oximetry
continued on next slide

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• Baseline vital signs are the first set of
measurements taken.
• Later findings are compared to the
baseline to detect trends.

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• Some vitals signs are detected by
looking, listening, and feeling.
• Other vital signs are measured using
special equipment.

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• Respiratory rate
 For adults, the range is 12 to 20 breaths
per minute.
 Respiratory rates that are less than 8 or
greater than 24 are of concern.
 Interpret findings based on the patient's
overall presentation.

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Assess the breathing (respiratory) rate, quality, and rhythm.

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• Count the breaths in 30 seconds and
multiply by 2.
• A breath is one inhalation + one
exhalation.

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Table 11-1 Normal Respiratory Rates

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• Ventilate an adult patient breathing at
a rate greater than 40 per minute or an
infant or young child breathing at a
rate greater than 60 per minute.
 Fatigue occurs and the rate cannot be
maintained.
 The rate is too fast to allow adequate
tidal volume.

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• Respiratory quality
 Normal
 Shallow
 Labored
 Noisy

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Table 11-2 Noisy Respiration

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• Respiratory rhythm is the regularity or
irregularity of respirations.
• An abnormal pattern in a patient with
an altered mental status is a serious
concern.

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• Pulse
 Pressure wave generated by the
contraction of the left ventricle
 Directly reflects heart function

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• Pulse locations
 Carotid
 Femoral
 Brachial
 Popliteal
 Posterior tibial
 Dorsalis pedis

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• If a patient is:
 1 year or older, check the radial pulse
 1 year or older without a peripheral
pulse, check the carotid pulse
 Less than 1 year, check the brachial
pulse

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Assess the pulse rate, quality, and rhythm. The radial pulse is assessed in patients older than 1 year of age.

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Assess the brachial pulse in patients who are less than 1 year of age.

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Assess the carotid pulse.

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• Pulse rate
 For adults, the average range is 60 to
80 beats per minute (resting).
 Infants' and children's heart rates are
faster.

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• Pulse rate
 Tachycardia is a heart rate >100 bpm.
 Bradycardia is a heart rate <60 bpm.
 Interpret findings based on the patient's
overall presentation.

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Table 11-3 Normal and Abnormal Pulse Rates

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• To obtain the rate
 Palpate the pulse with the tips of two or
three fingers.
 Count the beats in 30 seconds and
multiply by 2.

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• Pulse quality and rhythm
 Strong
 Weak
 Regular
 Irregular

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Table 11-4 Pulse Rate, Quality, Rhythm, and Related
Problems

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Click on any heart rate that would be outside theClick on any heart rate that would be outside the
normal range for an eight-year-old child.normal range for an eight-year-old child.
56
116
130
76
Click here after you have checked your answers.

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• Assess the appearance and condition of
the skin, looking for:
 Color
 Temperature
 Condition
 Capillary refill

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Assess relative skin temperature.

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Assess capillary refill in infants and children. Press on the nail or skin.

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• Normal skin characteristics
 Pink
 Warm
 Dry
 Capillary refill time
• <2 seconds in infants, children, and adult
males
• <3 seconds in females
• <4 seconds in the elderly

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Table 11-5 Skin Color, Temperature, and Condition

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• Check the pupils for:
 Size
 Equality
 Reactivity to light

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Assess pupils for size, equality, and reactivity.

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Table 11-6 Pupil Size, Equality, and Reactivity

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• Blood pressure
 Blood pressure is the force of blood
against arterial walls.
 Systolic blood pressure is the higher
pressure present during contraction of
the left ventricle.
 Diastolic blood pressure is the pressure
present during relaxation of the left
ventricle.

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• Blood pressure
 Systolic pressure reflects ejection of
blood from the left ventricle.
 Diastolic pressure reflects vascular
resistance and blood volume.

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Table 11-7 Normal Blood Pressures in Adults,
Children, and Infants

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• The difference between systolic blood
pressure and diastolic blood pressure is
the pulse pressure.
• Pulse pressure should be between 25%
and 50% of the systolic blood pressure.

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• Take a blood pressure in all patients 3
years and older.
• Low blood pressure is an indicator of
hypoperfusion.
• High blood pressure can damage the
heart and vessels.

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EMT SKILLS 11-1
Taking Blood Pressure by Auscultation

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Apply the cuff.

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Palpate the brachial artery.

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Close the valve and pump until the radial pulse is no longer felt. Note the number and deflate the cuff. Position
the stethoscope over the brachial artery and inflate the cuff to 30 mmHg above the level where you previously
stopped feeling the radial pulse.

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Deflate the cuff at about 2 mmHg per second. When you hear the first sound, record the pressure (systolic).
Continue releasing air. When you hear the last sound, record the pressure (diastolic).

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EMT SKILLS 11-2
Taking Blood Pressure by Palpation

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Apply the cuff and inflate rapidly to 30 mmHg above the level where you can no longer feel the radial pulse.

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Slowly deflate the cuff. Note the pressure at which the radial pulse returns (systolic). You will not be able to
measure the diastolic pressure by palpation.

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• Orthostatic vital signs are assessed in
patients with suspected volume loss.
• Obtain the blood pressure first with the
patient supine, and then 2 minutes
after he stands up.

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• Positive orthostatic changes are:
 A drop in systolic BP of 10 to 20 mmHg
 An increase in heart rate greater than
10 to 20 bpm
• Consider the patient's age and
medication when interpreting the
results.

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EMT SKILLS 11-3
Taking Orthostatic Vital Signs

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Place the patient supine and measure heart rate and blood pressure.

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Help the patient to a standing position, wait 2 minutes, then measure heart rate and blood pressure. Compare
the readings to those taken while the patient was supine. An increase in heart rate more than 10–20 bpm and a
decrease in blood pressure by 10–20 mmHg is considered a positive orthostatic test, indicating inadequate blood
volume.

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• Reassessing vital signs
 Every 15 minutes for stable patients
 Every 5 minutes for unstable patients
 Reassess after every intervention.

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Monitoring EquipmentMonitoring Equipment
• Pulse oximetry detects hypoxia by
measuring oxygen saturation levels in
the blood.
• A pulse oximeter measures the level of
hemoglobin saturated with oxygen.

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EMT SKILLS 11-4
Pulse Oximetry

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A pulse oximeter.

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A pulse oximeter placed on the patient's finger.

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A mini "finger-size" pulse oximeter.

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• Normal SpO2 is 97% to 100%
• An SpO2 <94% indicates hypoxia
• An SpO2 <90% indicates severe
hypoxia

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• Use pulse oximetry in conjunction with
other assessments to determine what
interventions are needed.
• Pulse oximetry helps assess the
effectiveness of interventions.

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• Pulse oximetry may be inaccurate in
these instances:
 Shock
 Hypothermia
 Excessive patient movement
 Nail polish
 Carbon monoxide exposure, including
from cigarette smoking
 Anemia

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• Noninvasive blood pressure monitor
 Can be set to reassess the blood
pressure at selected intervals, or can be
activated manually
 Alarms can be set to signal pressures
that exceed or fall below set upper and
lower limits.

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A noninvasive blood pressure device.

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Mr. Mahon reports that he began feeling
some pressure in his chest about 15
minutes ago. Bill organizes several
questions in his mind, as Yolanda obtains
respiratory and pulse rates, a blood
pressure, and a pulse oximetry reading.
Meanwhile, Bill can see that Mr. Mahon's
skin is slightly pale, and cool and moist
to the touch.

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• Reduce the patient's anxiety by doing
the following:
 Bring order to the environment.
 Introduce yourself.
 Gain patient consent.
 Position yourself.

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Taking the HistoryTaking the History
• The history begins with the reason why
EMS was called, which is the chief
complaint.
• The history helps guide the physical
examination.
• The process must be dynamic to
accommodate the situation.

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• S – Signs and symptoms
• A – Allergies
• M – Medications
• P – Pertinent past medical history
• L – Last oral intake
• E – Events leading to the problem

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• Signs are observable physical signs of
illness or injury.
• Symptoms cannot be observed and
must be described by the patient.
• The mnemonic OPQRST helps you
evaluate the signs and symptoms.

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• Ask about the following medications:
 Prescription
 Over-the-counter
 Birth control pills
 Illicit drugs
 Herbal medications
 Erectile dysfunction drugs
 Use of another person's medications
 Vitamins continued on next slide

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• Sensitive topics
 You may need to ask about alcohol or
drug use, physical or sexual abuse, or
sexual history.
 Ask only pertinent, necessary questions.
 Be sensitive and nonjudgmental.
 Respect the patient's privacy.

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Case Study Wrap-UpCase Study Wrap-Up
Bill learns that Mr. Mahon's chest discomfort
started 15 minutes ago while he was
working on his computer. Nothing has made
the discomfort better or worse. Mr. Mahon
describes the sensation as a heavy pressure,
and says he can feel the sensation in his left
shoulder and arm. When Bill asks, Mr.
Mahon says the severity of the discomfort is
a 7 on a scale from 1 to 10.

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Mr. Mahon's vital signs are as follows:
respirations 16 per minute, and of
normal depth; pulse strong, but
occasionally irregular at 84 beats per
minute; blood pressure is 132/90, and
SpO2 is 99% on room air.

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Based on the history, Bill suspects acute
coronary syndrome. He administers
aspirin and nitroglycerin to Mr. Mahon,
according to protocol, as they prepare to
transport him to the hospital.

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Lesson SummaryLesson Summary
• You will take vital signs on every
patient you encounter.
• Baseline vital signs allow comparison
with later vital signs to detect trends.
• Vital signs include respirations, pulse,
blood pressure, skin, pupils, and pulse
oximetry.

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Lesson SummaryLesson Summary
• A medical history is important in
determining the patient's condition and
the care needed.
• You must be prepared to overcome
many challenges in history-taking.

DMACC EMT Chapter 11

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