1. Baseline Vital Signs & SAMPLE History CHAPTER 5

2. Baseline Vital Signs

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

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

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

6. Average Vital Sign Ranges by Age P 120-160 80-140 80-120 70-115 70-90 60-80 AGE Newborn 1 year 3 years 5 years 7 years 10 years 15 years Adult R 40-60 30-40 25-30 20-25 15-20 12-20 BP 80/40 82/44 86/50 90/52 94/54 100/60 110/64 120/80

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

8. Level of Consciousness

9. 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

10. BreathingBreathing

11. 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.

12. Breathing Assessment  Rate  Averages 12-20 breaths per minute in adults  Quality  Normal respirations?  Shallow respirations?  Labored respirations?  Noisy respirations?

13. Patients often breathe FASTER when they are ill or injured.

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

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

16. Retractions may indicate labored breathing. Sternal Supraclavicular Intercostal Substernal

17. PulsePulse

18. Key Pulse Points Carotid Radial Brachial Femoral Posterior Tibial Dorsalis Pedis

19. Assessing the Pulse  Rate  Averages 60-80 beats per minute in adults  Quality  Strength (strong or weak)  Rhythm  Regular or irregular

20. Locating the Radial Pulse

21. Locating the Carotid Pulse

22. Palpate the brachial pulse in an infant.

23. SkinSkin

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

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

26. 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)

27. Assess skin temperature with the back of your hand.

28. Slow CRT may indicate poor perfusion.

29. PupilsPupils

30. Pupils are normally equal, reactive to light and midsize.

31. Constricted Pupils

32. Unequal Pupils

33. Dilated Pupils

34. 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.

35. Blood Pressure

36. 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

37. Systolic Diastolic

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

39. Measuring BP by auscultation.

40. Measuring BP by palpation.

41. Vital Sign Reassessment

42. Reassess vital signs every 5 minutes for unstable patients.

43. Reassess vital signs every 15 minutes for stable patients.

44. SAMPLE History

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

46. 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

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

48. SUMMARY Baseline Vital Signs Baseline Vital Signs SAMPLE History SAMPLE History