1. Slide 1 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Chapter 5 Baseline Vital Signs and SAMPLE History

2. Slide 2 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Overview  Baseline Vital Signs  Breathing  Skin  Pupils  Blood Pressure  Vital Sign Reassessment  SAMPLE History

3. Slide 3 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Baseline Vital Signs

4. Slide 4 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Trending  The process of comparing sets of vital signs or other assessment information over time A single set of vital signs does not provide as much information as does a trend in the patient’s vital signs.

5. Slide 5 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Vital Signs  Breathing  Skin  Pupils  Blood pressure

6. Slide 6 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Breathing  Assess both rate and quality

7. Slide 7 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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. Slide 8 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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. Slide 9 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Labored Breathing  Accessory muscles may be used during labored breathing Neck muscles Chest muscles Intercostal muscles Abdominal muscles

10. Slide 10 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Labored Breathing  Retractions may indicate labored breathing SternalSupraclavicularIntercostal Substernal

11. Slide 11 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Breathing  Abnormal respiratory sounds  Grunting  Stridor  Snoring  Wheezing  Gurgling  Crowing

12. Slide 12 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Pulse  Pulse points

13. Slide 13 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Pulse  Assess for rate and quality

14. Slide 14 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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

15. Slide 15 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Pulse  Assess the brachial pulse in infants

16. Slide 16 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Skin  Assess color, temperature, and condition  In patients younger than 6 years of age, capillary refill should be evaluated

17. Slide 17 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Skin  Color  Assessed in the nail beds, oral mucosa, and conjunctiva  In infants and children, use the palms of hands and soles of feet

18. Slide 18 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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

19. Slide 19 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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.

20. Slide 20 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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

21. Slide 21 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Skin  Condition  Normal Dry Dry  Abnormal Wet Wet Moist Moist Dry Dry

22. Slide 22 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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.

23. Slide 23 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Pupils  Pupils are assessed by briefly shining a light into the patient’s eyes and determining size and reactivity

24. Slide 24 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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

25. Slide 25 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Pupils  Constricted pupils

26. Slide 26 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Pupils  Dilated pupils

27. Slide 27 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Pupils  Unequal pupils

28. Slide 28 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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

29. Slide 29 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. You might not have time to measure the blood pressure until the patient is en route to the hospital.

30. Slide 30 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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

31. Slide 31 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Blood pressure should be measured in all patients older than 3 years of age.

32. Slide 32 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Video Clip: Measuring Blood Pressure by Ausculatation Video Clip: Measuring Blood Pressure by Ausculatation

33. Slide 33 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Video Clip: Palpation of Blood Pressure Video Clip: Palpation of Blood Pressure

34. Slide 34 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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.

35. Slide 35 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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

36. Slide 36 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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

37. Slide 37 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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.

38. Slide 38 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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.

39. Slide 39 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Allergies  Medications  Food  Environmental allergies  Consider medical identification tag

40. Slide 40 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 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.

41. Slide 41 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Pertinent Past History  Medical  Surgical  Trauma  Consider medical identification tag

42. Slide 42 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Last Oral Intake  Solid or liquid  Time  Quantity

43. Slide 43 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Events Leading to Injury or Illness  Chest pain with exertion  Chest pain while at rest

44. Slide 44 Copyright © 2011, 2006 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Summary  Baseline Vital Signs  Breathing  Skin  Pupils  Blood Pressure  Vital Sign Reassessment  SAMPLE History