Overview. Baseline Vital Signs. Chapter 5. Baseline Vital Signs and SAMPLE History. Baseline Vital Signs. SAMPLE History

Transcription

1 Chapter 5 Baseline Vital Signs and SAMPLE History Slide 1 Baseline Vital Signs Breathing Skin Pupils Blood Pressure Overview Vital Sign Reassessment SAMPLE History Slide 2 Baseline Vital Signs Slide 3 1

2 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. Slide 4 Breathing Vital Signs Skin Pupils Blood pressure Slide 5 Breathing Assess both rate and quality Slide 6 2

3 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 Slide 7 Breathing Quality Can be determined while assessing the rate Normal Average chest wall motion, not using accessory muscles Shallow Slight chest or abdominal wall motion Labored An increase in the effort of breathing Often characterized by the use of accessory muscles Noisy An increase in the audible sound of breathing Slide 8 Labored Breathing Accessory muscles may be used during labored breathing Neck muscles Chest muscles Intercostal muscles Abdominal muscles Slide 9 3

4 Labored Breathing Retractions may indicate labored breathing Sternal Supraclavicular Intercostal Substernal Slide 10 Breathing Abnormal respiratory sounds Grunting Stridor Snoring Wheezing Gurgling Crowing Slide 11 Pulse Pulse points Slide 12 4

5 Pulse Assess for rate and quality Slide 13 Rate Pulse Rate is the number of beats felt in 30 seconds multiplied by 2 Quality Strong Weak Regular Irregular If peripheral pulse is not palpable, assess carotid pulse Slide 14 Assess the brachial pulse in infants Pulse Slide 15 5

6 Skin Assess color, temperature, and condition In patients younger than 6 years of age, capillary refill should be evaluated Slide 16 Skin Color Assessed in the nail beds, oral mucosa, and conjunctiva In infants and children, use the palms of hands and soles of feet Slide 17 Skin Color findings Normal Pink Normal perfusion Abnormal Pale Poor perfusion (impaired blood flow) Cyanotic (blue-gray) Inadequate oxygenation or poor perfusion Flushed (red) Exposure to heat or carbon monoxide poisoning Jaundice (yellow) Liver abnormalities Slide 18 6

7 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. Slide 19 Temperature findings Skin Normal skin Warm Abnormal skin temperatures Hot Fever or an exposure to heat Cool Poor perfusion or exposure to cold Cold Extreme exposure to cold Slide 20 Skin Condition Normal Dry Abnormal Wet Moist Dry Slide 21 7

8 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. Slide 22 Pupils Pupils are assessed by briefly shining a light into the patient s eyes and determining size and reactivity Slide 23 Assessment findings Pupils Size Dilated (very big) Normal Constricted (small) Equal or unequal Reactivity Reactive change when exposed to light Nonreactive do not change when exposed to light Equally or unequally reactive Slide 24 8

9 Pupils Constricted pupils Slide 25 Pupils Dilated pupils Slide 26 Pupils Unequal pupils Slide 27 9

10 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 Slide 28 You might not have time to measure the blood pressure until the patient is en route to the hospital. Slide 29 Blood Pressure Two methods of obtaining blood pressure Auscultation Listen for the systolic and diastolic sounds Palpation Measured by feeling for return of pulse with deflation of the cuff Slide 30 10

11 Blood pressure should be measured in all patients older than 3 years of age. Slide 31 Video Clip: Measuring Blood Pressure by Ausculatation Slide 32 Video Clip: Palpation of Blood Pressure Slide 33 11

12 The general assessment of the infant or child patient, such as sickappearing, in respiratory distress, or unresponsive, is more valuable than vital sign numbers. Slide 34 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 Slide 35 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 Slide 36 12

13 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. Slide 37 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. Slide 38 Allergies Medications Food Environmental allergies Consider medical identification tag Slide 39 13

14 Prescription Current Recent Birth control pills Nonprescription Current Recent Medications 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. Slide 40 Medical Pertinent Past History Surgical Trauma Consider medical identification tag Slide 41 Last Oral Intake Solid or liquid Time Quantity Slide 42 14

15 Events Leading to Injury or Illness Chest pain with exertion Chest pain while at rest Slide 43 Summary Baseline Vital Signs Breathing Skin Pupils Blood Pressure Vital Sign Reassessment SAMPLE History Slide 44 15