Baseline Vital Signs & SAMPLE History CHAPTER 5

Baseline Vital Signs

Sign: Any medical or trauma condition displayed by the patient and identified by the EMT. Examples of signs are hemorrhage, noisy breathing, bone deformities.

Symptom: Any condition described by the patient that cannot be observed. Examples of symptoms are chest pain, shortness of breath, nausea.

Vital Signs  Breathing: Rate, quality  Pulse: Rate, character, rhythm  Skin: Color, temperature, condition  Pupils: Reactivity, equality  Blood pressure

Average Vital Sign Ranges by Age P AGE Newborn 1 year 3 years 5 years 7 years 10 years 15 years Adult R BP 80/40 82/44 86/50 90/52 94/54 100/60 110/64 120/80

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

Level of Consciousness

To assess level of consciousness: A -Alert and awake; aware of time, place, date and person V - Responds to verbal stimuli P -Responds to painful stimuli, does not respond to verbal stimuli U -Unconscious, does not respond to any stimuli

BreathingBreathing

Respirations: One breath in a single cycle of breathing in and out. Can be determined by counting the number of breaths in 30 seconds and multiplying by two.

Breathing Assessment  Rate  Averages breaths per minute in adults  Quality  Normal respirations?  Shallow respirations?  Labored respirations?  Noisy respirations?

Patients often breathe FASTER when they are ill or injured.

Abnormal Respiratory Sounds  Grunting  Stridor  Snoring  Wheezing  Gurgling  Crowing

Accessory muscles may be used during labored breathing. Neck Muscles Chest Muscles Intercostal Muscles Abdominal Muscles

Retractions may indicate labored breathing. Sternal Supraclavicular Intercostal Substernal

PulsePulse

Key Pulse Points Carotid Radial Brachial Femoral Posterior Tibial Dorsalis Pedis

Assessing the Pulse  Rate  Averages beats per minute in adults  Quality  Strength (strong or weak)  Rhythm  Regular or irregular

Locating the Radial Pulse

Locating the Carotid Pulse

Palpate the brachial pulse in an infant.

SkinSkin

Perfusion: The process of distributing blood to the organs, delivering oxygen, and removing wastes. The skin condition is a good indicator of perfusion.

Assessment of the Skin  Color (nail beds, oral mucosa, conjunctiva)  Pink?  Pale?  Cyanotic?  Flushed?  Jaundiced?  Temperature  Warm?  Hot?  Cool or cold?

Assessment of the Skin continued  Condition  Dry?  Wet or moist?  Abnormally dry?  Clammy (cool & moist)?  Capillary refill (considered an inaccurate indicator of perfusion in patients over the age of 6 years)

Assess skin temperature with the back of your hand.

Slow CRT may indicate poor perfusion.

PupilsPupils

Pupils are normally equal, reactive to light and midsize.

Constricted Pupils

Unequal Pupils

Dilated Pupils

To assess the pupils:  First evaluate in ambient light for constriction or dilation.  Next, pass a light source across each pupil and note the response.  Each pupil should constrict in the same manner.

Blood Pressure

Blood pressure: Measurement of the force the blood exerts against the walls of blood vessels during the heart’s contraction and relaxation phases.  Systolic: pressure during contraction  Diastolic: pressure during relaxation

Systolic Diastolic

Changes in successive blood pressure readings may provide valuable clues about the patient’s condition.

Measuring BP by auscultation.

Measuring BP by palpation.

Vital Sign Reassessment

Reassess vital signs every 5 minutes for unstable patients.

Reassess vital signs every 15 minutes for stable patients.

SAMPLE History

Patient history: A concise and inclusive set of information gathered about patients and their medical problems.

S igns and symptoms A llergies M edications P ertinent past medical history L ast oral intake (solid or liquid) E vents leading to injury or illness

O nset P rovocation Q uality R adiation S everity T ime

SUMMARY Baseline Vital Signs Baseline Vital Signs SAMPLE History SAMPLE History