Vitals and History Taking
Hillcrest Fire TrainingDecember, 2000
Where are we going?
What are vital signs?How do you take them?So, what’s normal?SAMPLE History
What are the vitals
They provide information about the status of a patientBreating (Respirations)PulseSkinPupilsBlood Pressure
Counting Respirations
Respiration is one inhalation and exhalation.Determined by counting for 30 sec, and multiplying by 2.A hand on the stomach/chest may help
Normal Respirations
Adult 12-20/minChild 15-30/minInfant 25-50/min
Respiration Quality
NormalShallow (low tidal volume)Labored Use of accessory musclesFlaringTripod Breating
Noisy breathing
Pulse
Determined by counting for 30 sec and multiplying by 2.Irregular pulse counted for 60 sec.Provides information about heart, blood volume and perfusion.Taken at a pulse pointDon’t use your thumb
Common Pulse Points
Central Pulses Carotid Femoral
Peripheral Pulses Radial Brachial (children
under 1) Posterior Tibial,
Dorsalis Pedis
Pulse Quality
NormalBoundingWeakThreadyRegular/Irregular
Normal Pulse Rate
Adult 60-80/minChild 80-120Infant 120-150
Skin
Color Pink (Normal) Pale Cyanotic (Oxygen
problems) Red (CO or heat
problems) Yellow (Jaundice)
Temperature Warm (Normal) Hot Cool Cold
Condition Dry (Normal) Moist
Practice
Get pulse and respirations from at least two peopleTry to get pulse from carotid, radial, and brachial pulse points
Assessing Skin
Color assessed using lips, nail beds, inside of mouth, membranes of the eyePull back glove to determine temp and conditionIn children under 6 capillary refill is useful for determining perfusionRefill should take less than 2 seconds
Pupils
SizeConstrictedDilatedEqual/Unequal
Reactivity to lightCan check with pen light or by shielding eyes from light
Blood Pressure
Taken with manual or automatic BP cuffCan be taken by auscultation or palpation
Key Terms
Systolic Pressure when heart
is pumping
Diastolic Pressure when heart
is at rest
BP by Auscultation
Size using guides on cuffPosition on upper arm hoses pointing downInflate 30mmHg past pulsePosition stethoscope over brachial arteryDeflate Note first sound and last soundRecord as systolic/diastolic (140/80)
One last note on Vitals
First set of vitals is the baseline, you are interested in changesOn not sick patients, repeat every 15 minutesOn sick patients, repeat every 5 minutesTreat patient, not the vital signs or the equipment
BP by Auscultation
Size using guides on cuffPosition on upper arm hoses pointing downInflate 30mmHg past pulsePosition stethoscope over brachial arteryDeflate Note first sound and last soundRecord as systolic/diastolic (140/80)
BP by Palpation
Size using guides on cuffPosition on upper arm centered over brachial arteryInflate 30mmHg past pulseDeflate Record point at which pulse returnsRecord as Systolic/P (135/p)
Normal Blood Pressure
Male Systolic = 100+age
until 50 Diastolic =60-90
Female Systolic=90+age
until 50 Diastolic = 50-80
Practice
Get BP from two peopleTry at least two techniques for obtaining BP Auscultation,
Palpation, or Automatic Cuff
History Taking
SAMPLE
Organized technique to obtain pertinent medical informaitonCan obtain information from patient, family or bystandersSAMPLE is an acronym
SAMPLE
Signs/SymptomsAllergiesMedicationsPast Pertinent Medical ConditionsLast Oral IntakeEvents Leading to Injury or Illness
Signs/Symptoms
Signs – things you can see or hearSymptoms – things the patient reports
Allergies
Environmental and Medical allergies are importantMedic Alert tags are also useful
Medications
Prescription and OTC Including vitamins, herbal remedies
Birth Control PillsIllicit DrugsAlways get a list of meds, or take them withHome O2 rate is also importantWhat did you take, when, how much?
Past Pertinent Medical History
Underlying medical problemsRecent visits to hospitals/doctorsRecent medical proceduresRecent accidents/falls/traumaMedic Alert tags may be usefulLook for signs of medical equipment in the house
Last Oral Intake
What, how much, whenImportant for trauma patients, diabetics
Events Leading to Call
Get as much information as you canWhat happened, what were you doingHas anything unusual happened?If this is a chronic problem, what’s different this time?
Final SAMPLE notes
Try to ask open ended questions (avoid yes/no questions)Wait for the patient to respond5-10 seconds is not out of line
Note pertinent negativesWrite everything down
Practice
Let’s go through a couple of scenarios