1. Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 5-1 Chapter 5 Baseline Vital Signs and SAMPLE History

2. 5-2 Objectives

3. 5-3 Signs and Symptoms (S/S) Sign –A medical or trauma condition displayed by the patient –Can be seen, heard, smelled, measured, or felt

4. 5-4 Signs and Symptoms (S/S) Symptom –A condition described by the patient

5. 5-5 Vital Signs

6. 5-6 Vital Signs Breathing Pulse Temperature Pupils Blood pressure Vital signs are measured to –Detect changes in normal body function –Recognize life-threatening situations –Determine a patient’s response to treatment

7. 5-7 Baseline Vital Signs An initial set of vital sign measurements against which later measurements can be compared Allow you to note changes (trends) in the patient’s condition and response to treatment

8. 5-8 Vital Signs—Equipment Watch with a second hand or digital watch that shows seconds –Used to count respirations and pulse Penlight or flashlight –Used to look at your patient’s pupils Stethoscope –Used to hear sounds within the body –Also used to measure blood pressure Blood pressure cuff Pen and paper

9. 5-9 Pulse

10. 5-10 Pulse Arteries –Large blood vessels that carry blood away from the heart to the rest of the body Pulse –Rhythmic contraction and expansion of the arteries with each beat of the heart

11. 5-11 Circulation—Central Pulses A central pulse is found close to the body trunk

12. 5-12 Circulation—Peripheral Pulses A peripheral pulse is located farther from the body trunk than a central pulse

13. 5-13 Taking a Pulse Use the pads of your index and middle fingers Apply gentle pressure to the artery Count the number of beats for 30 seconds Multiply the number by 2 to determine the number of beats per minute –If the pulse is irregular, count for 1 full minute

14. 5-14 Normal Pulse Rates at Rest AgeBeats per Minute NewbornBirth to 1 month120 to 160 Infant1 to 12 months80 to 140 Toddler1 to 3 years80 to 130 Preschooler4 to 5 years80 to 120 School-age child 6 to 12 years70 to 110 Adolescent13 to 18 years60 to 100 Adult18 years and older60 to 100

15. 5-15 Possible Causes of a Slow Heart Rate Coughing Vomiting Straining to have a bowel movement Heart attack Head injury Very low body temperature (hypothermia) Sleep apnea Some medications

16. 5-16 Possible Causes of a Rapid Heart Rate Fever Fear Pain Anxiety Infection Shock Exercise Heart failure Substances such as caffeine and nicotine Cocaine, amphetamines, “Ecstasy,” cannabis Some medications

17. 5-17 Pulse Quality Refers to the strength of the heartbeat felt when taking a pulse Normal –Pulse is easily felt –Pressure is equal for each beat –“Strong” pulse “Weak” = hard to feel Weak and fast = “thready”

18. 5-18 Respirations

19. 5-19 Respiration Respiration is the process of breathing air into the lungs (inhalation) and out of the lungs (exhalation). A single respiration consists of one inhalation and one exhalation.

20. 5-20 Counting Respirations Place the patient’s arm across his chest or abdomen. Hold the patient’s wrist. Count each rise and fall of the chest or abdomen as one respiration.

21. 5-21 Respiratory Rates at Rest AgeBreaths per Minute NewbornBirth to 1 month30 to 50 Infant1 to 12 months20 to 40 Toddler1 to 3 years20 to 30 Preschooler4 to 5 years20 to 30 School-age child 6 to 12 years16 to 30 Adolescent13 to 18 years12 to 20 Adult18 years and older12 to 20

22. 5-22 Respirations—Shallow Breathing Difficult to see movement of the chest or abdomen during breathing –Only a small volume of air is exchanged.

23. 5-23 Respirations—Labored Breathing Increased work (effort) of breathing –Gasping for air –Nasal flaring –Use of neck, abdominal, rib muscles –Retractions –Skin color changes

24. 5-24 Abnormal Respiratory Sounds Stridor Snoring Wheezing Gurgling Crowing

25. 5-25 Skin Color, Temperature, and Condition

26. 5-26 Perfusion Assess perfusion by evaluating –Skin color –Skin temperature –Skin condition (moist, dry) –Capillary refill In infants and children younger than 6 years of age

27. 5-27 Skin Color Pale Blue (cyanotic) Mottled Flushed (red) Jaundiced (yellow)

28. 5-28 Skin Temperature and Condition Skin temperature –Warm (normal) –Hot –Cool –Cold –Clammy (cool and moist) Skin condition (moisture) –Dry (normal) –Moist –Excessively dry

29. 5-29 Capillary Refill

30. 5-30 Capillary Refill Normal: < 2 sec Delayed: 3-5 sec –Poor perfusion –Exposure to cool temperatures Markedly delayed: > 5 sec –Suggests shock

31. 5-31 Pupils

32. 5-32 Pupils Examine the patient’s pupils for: –Size –Equality –Reactivity

33. 5-33 Blood Pressure

34. 5-34 Blood Pressure Blood pressure –Force exerted by the blood on the walls of the arteries –Blood pressure by auscultation involves the use of a stethoscope Systolic pressure –The pressure in an artery when the heart is pumping blood Diastolic pressure –The pressure in an artery when the heart is at rest

35. 5-35 Using a Stethoscope

36. 5-36 Blood Pressure by Auscultation

37. 5-37 Blood Pressure by Auscultation

38. 5-38 Blood Pressure by Auscultation

39. 5-39 Blood Pressure by Auscultation

40. 5-40 Blood Pressure by Auscultation

41. 5-41 Blood Pressure by Auscultation

42. 5-42 Blood Pressure by Palpation

43. 5-43 Blood Pressure by Palpation

44. 5-44 Blood Pressure by Palpation

45. 5-45 Blood Pressure by Palpation

46. 5-46 Normal BP at Rest Life StageAgeSystolic Pressure Diastolic Pressure NewbornBirth to 1 month74 to 10050 to 68 Infant1 to 12 months84 to 10656 to 70 Toddler1 to 3 years98 to 10650 to 70 Preschooler4 to 5 years98 to 11264 to 70 School-age child6 to 12 years104 to 12464 to 80 Adolescent13 to 18 years118 to 13270 to 82 Adult18 years and older100 to 11960 to 79

47. 5-47 Key Point! Unstable patient –Assess and record vital signs every 5 minutes. Stable patient –Assess and record vital signs (at a minimum) every 15 minutes. Remember: A stable patient can become unstable very quickly. Reassess frequently!

48. 5-48 Additional Vital Signs

49. 5-49 Pulse Oximetry

50. 5-50 Pulse Oximetry

51. 5-51 Pulse Oximetry – Indications Altered mental status Respiratory rate outside the normal range for age Increased work of breathing Respiratory or cardiac chief complaints History of respiratory difficulty or respiratory disease During delivery of supplemental oxygen During and after endotracheal intubation During transport of a sick or injured child

52. 5-52 Pulse Oximetry Examples of conditions that may cause inaccurate pulse oximetry readings: –Cardiac arrest –Shock –Hypothermia –Carbon monoxide poisoning –Sickle-cell disease –Patient movement, shivering –Patient use of nail polish

53. 5-53 End-Tidal Carbon Dioxide (ETCO 2 )

54. 5-54 End-Tidal Carbon Dioxide (ETCO 2 )

55. 5-55 Pain Assessment

56. 5-56 Pain Assessment

57. 5-57 SAMPLE History

58. 5-58 SAMPLE History Find out pertinent facts about the patient’s medical history. –Avoid questions that the patient can answer with a “yes” or “no.” –Ask questions that will give you as much information as possible. –Allow the patient time to answer.

59. 5-59 SAMPLE History If the patient is unresponsive: –Look at the scene –Look for medical identification tags –Question family members, coworkers, others

60. 5-60 SAMPLE History Signs and symptoms Allergies Medications (Pertinent) Past medical history Last oral intake Events leading to the injury or illness

61. 5-61 OPQRST Onset Provocation/Palliation Quality Region/Radiation Severity Time

62. 5-62 Questions?