2. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 1 Chapter 5 Baseline Vital Signs and SAMPLE History

3. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 2 Overview  Baseline Vital Signs  Breathing  Skin  Pupils  Blood Pressure  Vital Sign Reassessment  SAMPLE History

4. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 3 Baseline Vital Signs

5. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 4 Vital Signs  Breathing  Skin  Pupils  Blood pressure

6. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 5 Breathing  Assess both rate and quality

7. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 6 Breathing  Rate  Determined by counting the number of breaths in a 30-second period and multiplying by 2 Care should be taken not to inform the patient—this may cause them to influence the rate

8. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 7 Breathing  Quality  Can be determined while assessing the rate Normal Normal  Average chest wall motion, not using accessory muscles Shallow Shallow  Slight chest or abdominal wall motion Labored Labored  An increase in the effort of breathing  Often characterized by the use of accessory muscles Noisy Noisy  An increase in the audible sound of breathing

9. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 8 Breathing  Abnormal respiratory sounds  Snoring  Wheezing  Gurgling

10. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 9 Pulse  Pulse points

11. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 10 Pulse  Assess for rate and quality

12. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 11 Pulse  Rate  Rate is the number of beats felt in 30 seconds multiplied by 2  Quality Strong Strong Weak Weak Regular Regular Irregular Irregular If peripheral pulse is not palpable, assess carotid pulse

13. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 12 Pulse  Assess the brachial pulse in infants

14. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 13 Skin  Assess color, temperature, and condition  In patients younger than 6 years of age, capillary refill should be evaluated

15. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 14 Skin  Color  Assessed in the nail beds, oral mucosa, and conjunctiva  In infants and children, use the palms of hands and soles of feet

16. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 15 Skin  Color findings  Normal Pink Pink  Normal perfusion  Abnormal Pale Pale  Poor perfusion (impaired blood flow) Cyanotic (blue-gray) Cyanotic (blue-gray)  Inadequate oxygenation or poor perfusion Flushed (red) Flushed (red)  Exposure to heat or carbon monoxide poisoning Jaundice (yellow) Jaundice (yellow)  Liver abnormalities

17. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 16 Skin  Temperature  Assessed by placing the back of your hand on the patient’s skin   When the EMT wears gloves, it may be necessary to pull the back of the glove down to assess skin temperature and condition.

18. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 17 Skin  Temperature findings  Normal skin Warm Warm  Abnormal skin temperatures Hot Hot  Fever or an exposure to heat Cool Cool  Poor perfusion or exposure to cold Cold Cold  Extreme exposure to cold

19. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 18 Skin  Condition  Normal Dry Dry  Abnormal Wet Wet Moist Moist Dry Dry

20. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 19 Capillary Refill  Assess capillary refill in infants and children younger than 6 years of age  Press on the patient’s skin or nail beds and determine time for return to initial color  Normal capillary refill in infants and children is < 2 seconds  Abnormal capillary refill in infants and children is > 2 seconds Capillary refill cannot be accurately assessed under extreme temperature conditions.

21. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 20 Pupils  Pupils are assessed by briefly shining a light into the patient’s eyes and determining size and reactivity  PERRL Pupil Equal Round Reactive to Light

22. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 21 Pupils  Assessment findings  Size Dilated (very big) Dilated (very big) Normal Normal Constricted (small) Constricted (small) Equal or unequal Equal or unequal  Reactivity Reactive—change when exposed to light Reactive—change when exposed to light Nonreactive—do not change when exposed to light Nonreactive—do not change when exposed to light Equally or unequally reactive Equally or unequally reactive

23. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 22 Pupils  Constricted pupils

24. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 23 Pupils  Dilated pupils

25. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 24 Pupils  Unequal pupils

26. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 25 Blood Pressure  Assess systolic and diastolic pressures  Systolic blood pressure is the first distinct sound of blood flowing through the artery as the pressure in the blood pressure cuff is released  Diastolic blood pressure is the point during deflation of the blood pressure cuff at which sounds of the pulse beat disappear

27. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 26 You might not have time to measure the blood pressure until the patient is en route to the hospital.

28. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 27 Blood Pressure  Two methods of obtaining blood pressure  Auscultation Listen for the systolic and diastolic sounds Listen for the systolic and diastolic sounds  Palpation Measured by feeling for return of pulse with deflation of the cuff Measured by feeling for return of pulse with deflation of the cuff

29. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 28 Blood pressure should be measured in all patients older than 3 years of age.

30. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 29 The general assessment of the infant or child patient, such as sick- appearing, in respiratory distress, or unresponsive, is more valuable than vital sign numbers.

31. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 30 Vital Sign Reassessment  Vital signs should be assessed and recorded every 15 minutes (at a minimum) in a stable patient  Vital signs should be assessed and recorded every 5 minutes in the unstable patient  Vital signs should be assessed following all medical interventions

32. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 31 SAMPLE History  S Signs and Symptoms  A Allergies  M Medications  P Past medical history  L Last oral intake  E Events leading to injury or illness

33. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 32 Signs/Symptoms  Sign  Any condition, medical or trauma, that can been seen and identified by the EMT Bleeding, noisy breathing, and deformities are examples of signs.

34. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 33 Signs/Symptoms  Symptom  Any condition described by the patient that cannot be seen by the EMT Chest pain, nausea, and shortness of breath are examples of symptoms.

35. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 34 Allergies  Medications  Food  Environmental allergies  Consider medical identification tag

36. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 35 Medications  Prescription  Current  Recent  Birth control pills  Nonprescription  Current  Recent  Consider medical identification tag Be careful not to phrase this as “Do you take any drugs?” or “What drugs do you currently take?” The word “drug” has different meanings for different patients.

37. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 36 Pertinent Past History  Medical  Surgical  Trauma  Consider medical identification tag

38. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 37 Last Oral Intake  Solid or liquid  Time  Quantity

39. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 38 Events Leading to Injury or Illness  Chest pain with exertion  Chest pain while at rest

40. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 39 Summary  Baseline Vital Signs  Breathing  Skin  Pupils  Blood Pressure  Vital Sign Reassessment  SAMPLE History