1. Chapter 10 Baseline Vital Signs and SAMPLE History

2. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Baseline Vital Signs  Reassessment of Vital Signs  History Taking  SAMPLE History

3. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Baseline Vital Signs  The first measurement of vital signs is sometimes referred to as the baseline vital signs.  Subsequent readings, or values, are compared against the baseline vital signs.

4. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 Baseline Vital Signs  Respiration: Quantity –Does the patient seem to be breathing very fast or slow? –For exact respiratory rate, count number of breaths taken in 1 minute

5. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 Baseline Vital Signs  Respiration: Quantity –Acceptable to count breaths taken in 30 seconds and multiply by 2 –If patient’s breathing is irregular, count respirations for 1 full minute

6. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Baseline Vital Signs

7. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Baseline Vital Signs  Respiration: Quality –In addition to the respiratory rate, note quality of the respiration –Observe respiration: depth, regularity, and any unusual noise or effort –Normal breathing quality: moderate depth, regular, and quiet

8. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Baseline Vital Signs  Respiration: Quality –Labored breathing Discomfort Increased use of chest and neck muscles (accessory muscle use) Nasal flaring

9. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Baseline Vital Signs  Respiration: Quality –Labored breathing Abnormal noises –Stridor –Snoring –Gurgling –Wheezing –Grunting

10. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 Baseline Vital Signs  Pulse –The rate, strength, and regularity of a patient’s pulse can indicate the severity of an illness or injury. –Following these values over time will indicate any change in the patient’s condition or health.

11. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Baseline Vital Signs  Pulse –Common sites for a pulse check Adults: over the radial, femoral, and carotid arteries Infants: brachial pulse (because it is usually easier to find)

12. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Baseline Vital Signs A. Radial B. Femoral C. Carotid D. Brachial

13. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Baseline Vital Signs  Pulse: Quantity –Place the pads of two fingers on the wrist, just below the base of the thumb –Count the number of pulse beats felt in 30 seconds, then multiply by 2

14. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Baseline Vital Signs  Pulse: Quality –Strength of pulse can be strong, bounding, weak, or thready –Regularity of pulse can be regular or irregular

15. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Baseline Vital Signs

16. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 Baseline Vital Signs  Blood pressure –Measured by two methods: Auscultation, using a sphygmomanometer and a stethoscope Palpation –Measured at both the contraction and relaxation phases

17. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 –Reported in two numbers: First (top) number is the systolic pressure Second (lower) number is the diastolic pressure. Baseline Vital Signs

18. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Baseline Vital Signs  Blood pressure –Cuff application Select a proper-sized cuff Fit properly to the patient’s bare upper arm

19. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Baseline Vital Signs  Blood pressure measurement –Auscultation Apply cuff; then find brachial pulse Inflate cuff 20 mm Hg beyond where pulse disappears Place stethoscope on brachial pulse, then slowly release pressure in cuff

20. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Baseline Vital Signs  Blood pressure measurement –Auscultation Read number on dial upon return of the pulse (systolic) Read number on dial when the pulse disappears (diastolic) Report blood pressure as systolic over diastolic

21. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Baseline Vital Signs

22. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 Baseline Vital Signs  Blood pressure measurement –Palpation When blood pressure cannot be heard due to noise interference, estimate it by the palpation method Confirm blood pressure by auscultation as soon as possible since palpation gives only an estimate

23. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 Baseline Vital Signs  Blood pressure measurement –Palpation Palpate the return of the radial pulse during deflation of cuff and note number on gauge as the systolic pressure Diastolic pressure is not available with this method

24. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Stop and Review  Where do you assess for pulse in an infant?  Define systolic pressure.  Define diastolic pressure.

25. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25 Baseline Vital Signs  Skin: Temperature and moisture –Skin condition can indicate the patient’s circulatory status –Use skin-to-skin contact to measure the temperature on the patient’s forehead or abdomen

26. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26 Baseline Vital Signs  Skin: Temperature and moisture –A healthy person normally has warm, dry skin –Temperature: hot, warm, cool, or cold –Moisture: cool and clammy or moist or sweaty

27. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 27 Baseline Vital Signs  Skin: Color –Determine skin color by assessing the nail beds, oral mucosa, or conjunctiva –Normal skin is a healthy pink color from good blood flow –Pallid skin indicates a decreased blood supply

28. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28 Baseline Vital Signs  Skin: Color –A bluish discoloration, or cyanosis, indicates a state of poor oxygenation –Other skin colors may give clues about underlying disease states

29. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29 Baseline Vital Signs –A flush can occur from embarrassment or disease –Jaundiced skin can be caused by liver disease. –Note the pallor, a sign of shock

30. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 30 Baseline Vital Signs  Skin: Capillary refill –Time it takes for the blood to return to the skin when the skin is compressed

31. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 31 Baseline Vital Signs  Skin: Capillary refill –In children Capillaries of a healthy child have a constant supply of oxygenated blood Refill time of less than 2 seconds If more than 2 seconds, the child’s skin is hypoperfused, indicating the child may be in shock

32. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 32 Baseline Vital Signs  Pupil –Black part in the center of the eye –Usually round and changes size in reaction to changing light conditions –Changes in pupillary reaction may mean improvement or deterioration of the patient’s neurologic status, or brain function

33. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 33 Baseline Vital Signs  Pupil –When checking pupil response, shield patient’s eyes from the room light, and use a handheld penlight to assess size, shape, and reaction

34. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 34 Baseline Vital Signs  Pupil: Size and shape –Describe pupil diameter by exact measurement or general terms –Pupil of the eye is normally round

35. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 35 Baseline Vital Signs  Pupil: Size and shape –Consensual response: both pupils are usually the same size and tend to react together when one is exposed to light –Anisocoria: pupils are not of equal size

36. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 36 Baseline Vital Signs –Constricted pupils –Dilated pupils –Anisocoria

37. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 37 Baseline Vital Signs  Pupil: Reactivity –Normal and reactive pupil: constricts briskly when exposed to light and dilates when light is removed –Nonreactive pupil: responds slowly to light or not at all –PERRL: pupils, equal, round, and reactive to light (normal response of the pupils)

38. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 38 Baseline Vital Signs  Pulse oximetry –Normal, 96% to 100%: blood is well oxygenated and respirations are effective –Less than 96%: blood is poorly oxygenated and there may be problems with breathing or circulation –Less than 90%: serious oxygenation problem

39. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 39 Baseline Vital Signs  Pulse oximetry –Accuracy requires an adequate sample of capillary blood –Device should have a lighted bar meter or a green or yellow light indicator that visually confirms that the sample is adequate

40. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 40 Baseline Vital Signs

41. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 41 Reassessment of Vital Signs  Reassess vital signs to determine changes in the patient’s condition  Initial vital signs are normal and patient is stable: reassess every 10 to 15 minutes  Initial vital signs are abnormal or patient is unstable: reassess every 5 minutes

42. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 42 Reassessment of Vital Signs  Medication is administered (including oxygen): reassess within 5 minutes  Carefully document all measurements of vital signs, including the times they were taken

43. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 43 Stop and Review  Describe normal and abnormal pupil size, shape, and reaction.  Describe normal and abnormal skin color, temperature, and condition.  Why is reassessment of vital signs important?

44. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 44 History Taking  Obtaining an accurate history is vitally important  The history often describes the reason for the patient’s present health crisis as well as past successful treatments

45. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 45 History Taking  Patient rapport –Remember, the call may be very stressful for the patient –The EMT should provide: Proper introduction of the crew Proper etiquette Comforting touch

46. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 46 SAMPLE History  Obtain basic information as soon as possible after all life threats have been properly addressed

47. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 47 SAMPLE History  SAMPLE questions: –Signs and symptoms –Allergies –Medications –Past medical and surgical history –Last oral intake –Events leading up to incident or illness

48. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 48 SAMPLE History  Watch this video of an EMT asking SAMPLE questions of a patient

49. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 49 Stop and Review  Identify the components of the SAMPLE history.