1. 1 Baseline Vital Signs and SAMPLE History Done by: Dr.Ahmed Ismail Presented by: Dr.Anmar Mandourah

2. 11/1/20152 Baseline Vital Signs and SAMPLE History  Assessment is the most essential skill EMT-Bs learn.  During assessment you will: –Gather key information –Evaluate the patient –Learn the history –Learn about the patient’s overall health

3. 11/1/20153 Gathering Key Patient Information  Obtain the patient’s name.  Note the age, gender and race.  Look for identification if the patient is unconscious.

4. 11/1/20154 Baseline Vital Signs  During the assessment, the EMT-B uses many senses and a few basic medical instruments.  First set is known as the baseline vitals.  Repeated vital signs are compared to the baseline.

5. 11/1/20155 Baseline Vital Signs and SAMPLE History  Chief Complaint (CC); Mechanism of Injury (MOI): –Chief complaints are the major signs, symptoms or events that caused the call or complaint –Symptoms: what the patient tells you –Signs: can be seen, heard, felt, smelled or measured

6. 11/1/20156 Obtaining a SAMPLE History  S : Signs and Symptoms of the episode: – What signs and symptoms occurred at onset? – Does the patient report pain?

7. 11/1/20157 Obtaining a SAMPLE History  A : Allergies: –Is the patient allergic to medications, foods or other substance? –What reactions did the patient have to any of them? Note: If the patient has no know allergies, you should note this on the run sheet as “no known allergies” or “NKA” Note: If the patient has no know allergies, you should note this on the run sheet as “no known allergies” or “NKA”

8. 11/1/20158 Obtaining a SAMPLE History  M : Medications: – What medications was the patient prescribed? – What dosage was prescribed? – How often is the patient supposed to take the medication? – What prescription, over-the-counter (OTC) medications, and herbal medications has the patient taken in the last 12 hours? – How much was taken and when?

9. 11/1/20159 Obtaining a SAMPLE History  P : Pertinent past history: – Does the patient have any history of medical, surgical, or trauma occurrences? – Has the patient had a recent illness or injury, fall or blow to the head?

10. 11/1/201510 Obtaining a SAMPLE History  L : Last oral intake: – When did the patient last eat or drink? – What did the patient eat or drink, and how much was consumed? – Did the patient take any drugs or drink alcohol? – Has there been any other oral intake in the last 4 hours?

11. 11/1/201511 Obtaining a SAMPLE History  E : Events leading to injury or illness – What are the key events that led up to this incident? – What occurred between the onset of the incident and your arrival? – What was the patient doing when this illness started? – What was the patient doing when this injury happened?

12. 11/1/201512 O-P-Q-R-S-TO-P-Q-R-S-TO-P-Q-R-S-TO-P-Q-R-S-T  Mnemonic device to help you remember questions you should ask to obtain a patient history. – O : Onset: When did the problem begin and what caused it? – P : Provocation or Palliation: Does anything make it feel better? Worse?

13. 11/1/201513 O-P-Q-R-S-TO-P-Q-R-S-TO-P-Q-R-S-TO-P-Q-R-S-T – Q : Quality: What is the pain like? Sharp, dull, crushing, tearing? – R : Region/Radiation: Where does it hurt? Does the pain move anywhere? – S : Severity: On a scale of 1 to 10, how would you rate your pain? – T : Timing of pain: Has the pain been constant or does it come and go? How long have you had the pain?

14. 11/1/201514 Baseline Vital Signs  Baseline vital signs always include – Respirations, Pulse & Blood Pressure  Other key indicators: – Skin: color, condition, temperature (CCT) – Capillary refill time (in children) – Pupillary response – Level of Consciousness (LOC) – Sometimes Temperature (medical patients)

15. 11/1/201515 Respirations  A patient who is breathing without assistance: spontaneous respirations.  Each complete breath consists of two distinct phases: – Inspiration (inhalation): the chest rises up and out, drawing oxygenated air into the lungs – Expiration (exhalation): the chest returns to its original position, releasing air with an increased carbon dioxide (CO²) level out of the lungs

16. 11/1/201516 Respirations  Rate: –The number of breaths in 30 seconds x 2  Quality: character of breathing: – Rhythm (regular or irregular) – Effort (normal or labored)  Depth: - Tidal Volume (the volume of air that is inspired or expired in a single breath during regular breathing) - Tidal Volume (the volume of air that is inspired or expired in a single breath during regular breathing) -Depth and rate of breathing determines the tidal volume -Depth and rate of breathing determines the tidal volume

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18. 11/1/201518 Respiratory Rate Adults: 12 to 20 breaths/minute (over age 8) Children: 18 to 30 breaths/minute (1 to 8 years of age) Infants: 30 to 60 breaths/minute (under 1 year of age)

19. 11/1/201519 Respirations  Effort (labored): – Unable to speak more than 2-3 words at a time – Assuming a “tripod” position – Assuming a “sniffing” position (children) – Noisy breathing: Stridor Stridor Wheezes, snoring Wheezes, snoring Coughing (productive?) Coughing (productive?)

20. 11/1/201520 Pulse Oximetry  Evaluates the effectiveness of oxygenation.  Normal value: 95% - 100%.

21. 11/1/201521Pulse  With each heartbeat, ventricle contract, forcefully ejecting blood from the heart and propelling it into the arteries.  A pulse is the pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries.

22. 11/1/201522 Pulse Carotid Pulse Radial Pulse Carotid Pulse Radial Pulse

23. 11/1/201523 Pulse Brachial Pulse

24. 11/1/201524Pulse  Rate: –Number of beats in 30 seconds x 2  Strength: –Stronger than normal (bounding), strong or weak (thready)  Regularity: –Regular or irregular

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26. 11/1/201526 Normal Pulse Ranges Adults: 60 to 100 beats/minute Children:70 to 120 beats/minute Toddlers:90 to 150 beats/minute Newborns:120 to 160 beats/minute

27. 11/1/201527 The Skin  The condition of the patient’s skin can tell you a lot about the patient’s: – Peripheral circulation and perfusion – Blood oxygen levels – Body temeperature

28. 11/1/201528 The Skin (CCT)  Color: –Pink, pale, blue, red, or yellow  Condition: (moisture) –Dry, moist or wet  Temperature: –Warm, hot or cool

29. 11/1/201529 Capillary Refill  Evaluates the ability of the circulatory system to restore blood to the capillary system (perfusion). – Evaluated at the nail bed (finger) – Depress the finger tip, pressure forcing blood from the capillaries and look for return of blood

30. 11/1/201530 Capillary Refill – As the capillaries refill, should return to its normal deep pink color – Color should be restored within 2 seconds (about the time it takes to say, “Capillary refill” – Invalid test in a cold environment; elderly

31. 11/1/201531 Blood Pressure  Blood pressure is a vital sign.  Pressure of circulating blood against the walls of the arteries.  A drop in blood pressure may indicate: –Loss of blood –Loss of vascular tone –Cardiac pumping problem  Blood pressure should be measured in all patients older than 3 years of age.

32. 11/1/201532 Blood Pressure  Diastolic: –Pressure during relaxing phase of the heart’s cycle  Systolic: –Pressure during contraction  Measured as millimeters of mercury (mmHg).  Recorded as systolic/diastolic.

33. 11/1/201533 Blood Pressure Equipment

34. 11/1/201534 Auscultation of Blood Pressure Auscultation of Blood Pressure  Place cuff on patient's arm (1” above elbow).  Palpate brachial artery and place diaphragm of stethoscope over artery.  Inflate cuff until you no longer hear pulse sounds.  Continue pumping to increase pressure by an additional 20 mmHg.

35. 11/1/201535 Auscultation of Blood Pressure  Note the systolic and diastolic pressures as you let air escape slowly.  As soon as pulse sounds stop, open the valve and release the air quickly.

36. 11/1/201536 Measuring Blood Pressure Palpation Auscultation

37. 11/1/201537 Palpation of Blood Pressure  Secure cuff.  Locate radial pulse.  After the pulse disappears continue to inflate another 30mmHg.  Release air until pulse is felt.  Method only obtains systolic pressure.

38. 11/1/201538 Normal BP Ranges Normal BP Ranges AgeRange Adults90 to 140 mmHg (s) 60 to 90 mmHg (d) Children (1-8)80 to 110 mmHg (s) Infants (up to 1 yr)50 to 90 mmHg (s) *Varies with age and gender.

39. 11/1/201539 Blood Pressure  Hypotension: – BP significantly lower than the normal range – Critical hypotension: BP is no longer able to compensate sufficiently to maintain adequate perfusion  Hypertension: – BP significantly higher than the normal range

40. 11/1/201540 Level of Consciousness A - Alert V - Responsive to Verbal stimulus Verbal stimulus P - Responsive to Pain U - Unresponsive

41. 11/1/201541 Pupil Assessment  P - Pupils  E - Equal  A - And  R - Round  R - Regular in size  L - React to Light

42. 11/1/201542 Abnormal Pupil Reactions  Fixed with no reaction to light.  Dilate with light and constrict without light.  React sluggishly.  Unequal in size.  Unequal with light or when light is removed.

43. 11/1/201543 Reassessment of Vital Signs  The vital signs you obtain serve two important functions: – First set establishes a baseline of respiratory and cardiovascular system status – Serves as a key baseline

44. 11/1/2015 44 Reassessment of Vital Signs  Reassess stable patients every 15 minutes.  Reassess unstable patients every 5 minutes.  Reassess/record VS after all medical interventions.

45. 11/1/2015 45 Questions?