Baseline Vital Signs and SAMPLE History

Getting Started

It all starts with a complaint

Chief Complaint (C/C)

Why was EMS called? Pt. Age Pt. Sex Pt. Race

Other useful information

Baseline Vital Signs

Measurement of vital body functions

Gives a basis for initiating care Allows reevaluation of interventions Respirations Pulse Blood pressure Temperature Pupils

Includes:

Respiratory Evaluation

Areas of assessment

Rate. Rhythm. Depth. Quality. Adult = 12-20 per minute Child = 15-30 per minute Infant -= 30-60 per minute Regular or irregular Tidal volume adequate or inadequate

Rate

Rhythm

Depth

Amount of air breathed in/out in one ventilation Approx 500 mL

Respiratory Evaluation contd.

Quality

Breath sounds

Present or diminished or absent

Chest expansion

Unequal or symmetrical
Accessory muscles Seesaw breathing

Increased effort
Infants

Nasal flaring Retractions

Above clavicles, between ribs

Cyanosis Shortness of breath Altered mental status

Accessory Muscle Use

Retractions

Nasal Flaring

Respiratory Evaluation Contd

Noisy Increase in audible sound of breathing Grunting Rhythmic, deep, short and hoarse During exhalation Gurgling Air moving through water =Fluid in upper airway Wheezing High pitched whistling =Narrow bronchioles (Asthma) Crowing/Stridor High pitch on inspiration = Obstruction at vocal cords/epiglottis Snoring Tongue blocking airway Gasping Short, rapid inspiratory phase Assoc. with Resp. distress/failure

Respiratory Evaluation contd.

Cyanosis

Blue/pale coloring of skin

Nail beds Lips Eyelids

Why is this seen in these areas first??? Indicates poor perfusion

Pediatric Considerations

Mouth/Nose

Smaller and easily obstructed Tongue is BIG Narrower Softer and more flexible Less developed/Less rigid = easily kinked

Pharynx Trachea Cricoid Cartilage

Diaphragm

Chest is soft Depend on diaphragm to do most of the work of breathing

Seesaw Breathing.

Respiratory Rate

Count the # of respirations in 30 seconds and X by 2.

Try not to inform pt They could adjust rate

Pulse Rate

Pulse

Palpable wave of blood sent though arteries after contraction of L ventricle

Peripheral

Radial Brachial Posterior tibial Dorsalis pedis

Carotid Femoral

Central

Pulse Rate

Evaluation

Radial pulse

ALL pt 1 y/o + pt less than 1 y/o

Brachial pulse

If unresponsive OR peripheral pulse isn't palpable

Carotid pulse NEVER on both sides

NO THUMBS

Use index and middle finger

Pulse Rate

Evaluation

Depress artery and count rate for 30 seconds and X by 2

OR 15 seconds and X by 4 Less accurate

Range

Infant (Birth - 1 year)

100-160 70-150

Child (2-10 y/o)

Child (12 y/o+) Adult

60-100

Perfusion/Skin

Clues to perfusion and oxygenation Components

Color Temp Moisture Capillary Refill

Skin Color

Locations of assessment

Nail beds, oral mucosa, conjunctiva Pediatric

Palms of hand/Sole of feet

Normal = Pink Abnormal

Pale

Poor Perfusion

Cyanotic

Blue/grey= Poor oxygenation/perfusion

Heat or CO exposure Liver/Gallbladder problems

Flushed Jaundiced

Baseline Vital Signs Perfusion

Temperature

Place back of gloved hand on pt skin Normal = Warm Abnormal

Hot

Fever/Heat exposure
Poor perfusion/Cold exposure Extreme cold exposure Excessively dead

Cool Cold

Also check for moisture

Diaphoresis or extremely dry

Capillary Refill

Evaluation

Press on pt nail bed until it is blanched/white Release and count time until pink returns 2 seconds or less

Normal

Abnormal

More than 2 seconds

The Circulatory System Physiology

Blood Pressure

Blood pressure

Force exerted from blood on walls of vessels

Phases of Cardiac Cycle

Systolic

Pressure against the walls when the L ventricle contracts HIGH PRESSURE

Diastolic

Pressure against the walls when the L ventricle relaxes Low pressure

Auscultating Blood Pressure

Auscultation

Listens to systolic/diastolic sounds as artery goes from collapsed to open Place cuff just above elbow Use marking, line up with brachial artery Locate brachial pulse and place your stethoscope Close valve Inflate until needle stops undulating as pressure increases (150-220 mmHg) Release pressure until you hear a heartbeat =Systolic Continue until you hear no sound = Diastolic

How to

Blood Pressure Ranges

Normal ranges

Systolic = 100 + pt age (140-150mmHg) Diastolic= 65-90 mmHg Textbook perfect = 120/80 Systolic/Diastolic

Expressed as:

Asses in ALL pt 3 y/o +

Palpating Blood Pressure

How to

Place B/P cuff as before Palpate radial pulse Inflate cuff as normal Deflate cuff until you feel the radial artery Gives you ONLY the systolic pressure Unable to obtain brachial b/p 120/palp or 120/p

Why do it?

Expressed as

Pupils

Why?

Easy way to assess neural status Briefly shine a light in the pt eyes Diameter Reactivity to light Equal size

How?

Evaluation:

Pupils PERRL

Normal

PERRL Pupils Equal, Round & Reactive to light Constricted/pinpoint

Abnormal

Overdose (opiate i.e. Heroine) Severe lack of O2 = Hypoxia Brain Death Toxic substances Brain Injury

Dilated

Unequal

Dilated

Constricted

Unequal

How often to assess

Stable Pt

Every 15 min Every 5 min

Unstable Pt

Following ANY medical intervention

SAMPLE History

Sings/Symptoms

Sign

Any condition the EMT sees Any condition described by the pt

Symptom

SAMPLE History

Allergies

Medications Food Environmental

SAMPLE History

Medications

Prescription

Current Recent Birth control? Current Recent

Non-Prescription

SAMPLE History

Past Pertinent Medical History Medical Surgical Trauma

SAMPLE History

Last oral intake

Time Quantity

SAMPLE History

Events leading to injury/illness

Example

Pt was dizzy then fell

Medical Trauma Trauma- Medical

Pt fell and then was dizzy

That does it Have a GREAT night!