Overview - Jones & Bartlett Learningems.jbpub.com/stoy/emt/lecturenotes/Chapter_05.pdf · Overview Baseline Vital ... Average chest wall motion, not using accessory muscles ... deformities

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Slide 1

Chapter 5

Baseline Vital Signs andSAMPLE History

Slide 2

Overview

Baseline Vital Signs Breathing

Skin

Pupils

Blood Pressure

Vital Sign Reassessment

SAMPLE History

Slide 3

Baseline Vital Signs

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

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Trending

The process of comparing sets of vital signs or other assessment information over time

A single set of vital signs does not provide as much information as does

a trend in the patient’s vital signs.

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Vital Signs

Breathing

Skin

Pupils

Blood pressure

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Breathing

Assess both rate and quality


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Breathing

Rate Determined by counting the number of breaths in

a 30-second period and multiplying by 2

Care should be taken not to inform the patient—this may cause them to

influence the rate

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Breathing Quality

Can be determined while assessing the rate• Normal

Average chest wall motion, not using accessory muscles

• Shallow Slight chest or abdominal wall motion

• Labored An increase in the effort of breathing Often characterized by the use of accessory muscles

• Noisy An increase in the audible sound of breathing

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Labored Breathing Accessory muscles may be used during

labored breathing

Neckmuscles

Chestmuscles

Intercostalmuscles

Abdominalmuscles


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Labored Breathing Retractions may indicate labored breathing

Sternal

Supraclavicular

Intercostal

Substernal

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Breathing

Abnormal respiratory sounds Grunting

Stridor

Snoring

Wheezing

Gurgling

Crowing

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Pulse

Pulse points


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Pulse

Assess for rate and quality

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Pulse

Rate Rate is the number of beats felt in 30 seconds

multiplied by 2 Quality

• Strong• Weak• Regular• Irregular

If peripheral pulse is not palpable, assess carotid pulse

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Pulse

Assess the brachial pulse in infants


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Skin

Assess color, temperature, and condition

In patients younger than 6 years of age, capillary refill should be evaluated

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Skin

Color Assessed in the nail beds, oral mucosa, and

conjunctiva

In infants and children, use the palms of hands and soles of feet

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Skin Color findings

Normal• Pink

Normal perfusion

Abnormal • Pale

Poor perfusion (impaired blood flow)

• Cyanotic (blue-gray) Inadequate oxygenation or poor perfusion

• Flushed (red) Exposure to heat or carbon monoxide poisoning

• Jaundice (yellow) Liver abnormalities


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Skin

Temperature Assessed by placing

the back of your hand on the patient’s skin

When the EMT wears gloves, it may be necessary to pull the back of the glove down to assess skin temperature and condition.

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Skin

Temperature findings Normal skin

• Warm

Abnormal skin temperatures• Hot

Fever or an exposure to heat

• Cool Poor perfusion or exposure to cold

• Cold Extreme exposure to cold

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Skin

Condition Normal

• Dry

Abnormal• Wet

• Moist

• Dry


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Capillary Refill

Assess capillary refill in infants and children younger than 6 years of age

Press on the patient’s skin or nail beds and determine time for return to initial color

Normal capillary refill in infants and children is < 2 seconds Abnormal capillary refill in infants and children is > 2

seconds

Capillary refill cannot be accurately assessed under extreme temperature conditions.

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Pupils

Pupils are assessed by briefly shining a light into the patient’s eyes and determining size and reactivity

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Pupils

Assessment findings Size

• Dilated (very big)

• Normal

• Constricted (small)

• Equal or unequal

Reactivity • Reactive—change when exposed to light

• Nonreactive—do not change when exposed to light

• Equally or unequally reactive


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Pupils

Constricted pupils

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Pupils

Dilated pupils

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Pupils

Unequal pupils


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Blood Pressure

Assess systolic and diastolic pressures Systolic blood pressure is the first distinct sound of

blood flowing through the artery as the pressure in the blood pressure cuff is released

Diastolic blood pressure is the point during deflation of the blood pressure cuff at which sounds of the pulse beat disappear

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You might not have time to measure the blood pressure until

the patient is en route to the hospital.

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Blood Pressure

Two methods of obtaining blood pressure Auscultation

• Listen for the systolic and diastolic sounds

Palpation• Measured by feeling for return of pulse with deflation of

the cuff


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Blood pressure should be measured in all patients older than 3 years of

age.

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Video Clip: Measuring Blood Pressure by Ausculatation

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Video Clip: Palpation of Blood Pressure


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The general assessment of the infant or child patient, such as sick-

appearing, in respiratory distress, or unresponsive, is more valuable

than vital sign numbers.

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Vital Sign Reassessment

Vital signs should be assessed and recorded every 15 minutes (at a minimum) in a stable patient

Vital signs should be assessed and recorded every 5 minutes in the unstable patient

Vital signs should be assessed following all medical interventions

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SAMPLE History

S Signs and Symptoms

A Allergies

M Medications

P Past medical history

L Last oral intake

E Events leading to injury or illness


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Signs/Symptoms

Sign Any condition, medical or trauma, that can been seen

and identified by the EMT

Bleeding, noisy breathing, and deformities are examples of signs.

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Signs/Symptoms

Symptom Any condition described by the patient that cannot

be seen by the EMT

Chest pain, nausea, and shortness of breath are examples of symptoms.

Slide 39

Allergies

Medications

Food

Environmental allergies

Consider medical identification tag


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Medications Prescription

Current

Recent

Birth control pills

Nonprescription Current

Recent


Be careful not to phrase this as “Do you take any drugs?” or “What drugs do you currently take?” The word “drug” has

different meanings for different patients.

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Pertinent Past History

Medical

Surgical

Trauma


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Last Oral Intake

Solid or liquid

Time

Quantity


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Events Leading to Injury or Illness

Chest pain with exertion

Chest pain while at rest

Slide 44

Summary

Baseline Vital Signs Breathing Skin Pupils Blood Pressure Vital Sign Reassessment

SAMPLE History


Documents

Overview - Jones & Bartlett Learningems.jbpub.com/stoy/emt/lecturenotes/Chapter_05.pdf · Overview Baseline Vital ... Average chest wall motion, not using accessory muscles ... deformities