1. Chapter 5 Baseline Vital Signs and SAMPLE History

2. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 2 Identify the components of vital signs. Describe methods for obtaining breathing rate. Differentiate among abnormal breathing qualities. Describe how to obtain a pulse rate and determine quality. Objectives (1 of 4)

3. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 3 Differentiate among abnormal pulse qualities. Describe how to obtain skin temperature, color, and condition. Identify how to measure capillary refill in children and infants. Describe how to evaluate pupils. Objectives (2 of 4)

4. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 4 Describe how to obtain a blood pressure reading. Define systolic and diastolic blood pressure. Differentiate between auscultation and palpation when measuring blood pressure. Objectives (3 of 4)

5. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 5 Identify components of a SAMPLE history. Differentiate between a sign and a symptom. State importance of accurately reporting and recording baseline vital signs. Discuss the need to search for additional medical information. Objectives (4 of 4)

6. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 6 Baseline Vital Signs and SAMPLE History Assessment is the most complex skill EMT-Bs learn. During assessment you will: Gather key information. Evaluate the patient. Learn the history. Learn about the patient’s overall health.

7. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 7 Gathering Key Patient Information Obtain the patient’s name. Note the age, gender, and race. Look for identification if the patient is unconscious.

8. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 8 Chief Complaint The major sign and/or symptom reported by the patient Symptoms Problems or feelings a patient reports Signs Conditions that can be seen, heard, felt, smelled, or measured

9. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 9 Baseline Vital Signs (1 of 3) Key signs used to evaluate a patient’s condition First set is known as baseline vitals. Repeated vital signs compared to the baseline

10. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 10 Baseline Vital Signs (2 of 3) Vital signs always include: Respirations Pulse Blood pressure

11. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 11 Baseline Vital Signs (3 of 3) Other key indicators include: Skin temperature and condition in adults Capillary refill time in children Pupils Level of consciousness

12. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 12 Respirations Rate Number of breaths in 30 seconds x 2 Quality Character of breathing Rhythm Regular or irregular Effort Normal or labored Noisy respiration Normal, stridor, wheezing, snoring, gurgling Depth Shallow or deep

13. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 13 Respiratory Rates Adults 12 to 20 breaths/min Children 15 to 30 breaths/min Infants25 to 50 breaths/min

14. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 14 Pulse (1 of 3)

15. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 15 Pulse (2 of 3)

16. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 16 Pulse (3 of 3) Rate Number of beats in 30 seconds x 2 Strength Bounding, strong, or weak (thready) Regularity Regular or irregular

17. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 17 Normal Ranges for Pulse Rate Adults 60 to 100 beats/min Children80 to 100 beats/min Toddlers100 to 120 beats/min Newborns 120 to 140 beats/min

18. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 18 The Skin Color Pink, pale, blue, red, or yellow Temperature Warm, hot, or cool Moisture Dry, moist, or wet

19. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 19 Capillary Refill Evaluates the ability of the circulatory system to restore blood to the capillary system (perfusion). Tested by depressing the patient’s fingertip and looking for return of blood.

20. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 20 Blood Pressure Blood pressure is a vital sign. 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.

21. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 21 Measuring Blood Pressure Diastolic Pressure during relaxing phase of the heart’s cycle Systolic Pressure during contraction Measured as millimeters of mercury (mm Hg) Recorded as systolic/diastolic

22. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 22 Blood Pressure Equipment

23. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 23 Auscultation of Blood Pressure (1 of 2) Place cuff on patient's arm. Palpate brachial artery and place stethoscope. Inflate cuff until you no longer hear pulse sounds. Continue pumping to increase pressure by an additional 20 mm Hg.

24. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 24 Auscultation of Blood Pressure (2 of 2) 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.

25. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 25 Palpation of Blood Pressure Secure cuff. Locate radial pulse. Inflate to 200 mm Hg. Release air until pulse is felt. Method only obtains systolic pressure.

26. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 26 Normal Ranges of Blood Pressure AgeRange Adults100 to 140 mm Hg (s) 60 to 90 mm Hg (d) Children 70 to 100 mm Hg (1 to 8 years)(systolic) Infants60 mm Hg (Newborn to 1 year)(systolic)

27. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 27 Level of Consciousness A - Alert V - Responsive to Verbal stimulus P - Responsive to Pain U - Unresponsive

28. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 28 Glasgow Coma Scale Eye Opening Spontaneous (4) To Voice (3) To Pain (2) None (1) Verbal Response Oriented (5) Confused (4) Verbal (cont.) Inappropriate Words (3) Incomprehensible Words (2) None (1) Motor Response Obeys Commands (6) Motor Response (con’t) Localizes Pain (5) Withdraw (4) Flexion (3) Extension (2) None (1) Total 3-15

29. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 29 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

30. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 30 Pupil Assessment P - Pupils E - Equal A - And R - Round R - Regular in size L - React to Light

31. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 31 Reassessment of Vital Signs Reassess stable patients every 15 minutes. Reassess unstable patients every 5 minutes.

32. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 32 Obtaining a SAMPLE History (1 of 2) S—Signs and Symptoms What signs and symptoms occurred at onset? A —Allergies Is the patient allergic to medications, foods, or other? M— Medications What medications is the patient taking?

33. 5: Baseline Vital Signs and SAMPLE History Emergency Care and Transportation of the Sick and Injured, 8th Edition, AAOS 33 Obtaining a SAMPLE History (2 of 2) P—Pertinent past history Does the patient have any medical history? L—Last oral intake When did the patient last eat or drink? E—Events leading to injury or illness What events led to this incident?