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2 Vital Signs Overview LOC = AVPU Pulse Respiration's Blood Pressure Lung Sounds Skin: Color, Texture, Temperature Pupils = Equal, Reactive to Light with Accomodation

3 Pulse Assess for the following: Rate (normal adult ) Rhythm (Regular/Irregular) Quality (Strong, Weak, Thready, Bounding) Location (Radial, Brachial, Carotid)

4 Respirations Rate (Normal Adult 12-20) Rhythm / Pattern Depth / Quality

5 Abnormal Respirations: Cheynes-Stokes Respirations Central Neurogenic Hyperventilation Kussmaul Respirations Ataxic / Biot s Respirations It s an experience thing again. IF YOU DON T KNOW, AT LEAST BE ABLE TO DESCRIBE WHAT YOU HEAR TO THE DOC!!!

6

7 Blood Pressure What s a normal B/P? Systolic = age (up to 140), but not < 80 Diastolic = Not > 90 or Systolic = age in years over 40 Diastolic = Not > 90 Techniques: Ausciltation Palpation

8 Orthostatic Hypotension Definition Orthostatic blood pressure is defined as a systolic blood pressure decrease of at least 20mmHg or diastolic blood pressure decrease of at least 10mmHG within 3 minutes of standing. It may also be associated with an increase in the patient s pulse rate. Notes Is indicative of hypoperfusion. When caring for a patient who begins to experience dizziness related to positional changes, you should immediately lie the patient down.

9 Skin Color PINK = Normal PALE / WHITE,GRAY = Shock FLUSHED ( RED) = CO, B/P, Fever BLUE = Hypoxia ( O 2, ) YELLOW / JAUNDICE = Liver Injury/Failure, Hepatitis, Cirrhosis

10 Skin Texture Wet vs. Dry Temperature Warm, Cool, or Hot Condition Mottled, Turgor

11 Pupils - Eyes PERRLA: Pupils Equal Round, Reactive to Light, with Accommodation Abnormal Conditions Nystagmus, Disconjugate gaze, Irregular shape, Sluggish reaction, Dilation, Pinpoint

12 Pulse Oximetry Normal S p O 2 = 93-99% Hypoxia = < 93% Pulse oximetry may be used as a vital sign tool in order to confirm adequate breathing along with other factors.

13 Blood Glucose Monitoring Indications: ALOC, Dizziness, History of Diabetes, syncope and diaphoresis. Supportive Measures: Oxygen therapy, ABC's and position of comfort. VALUES Normal: mg/dl Mid-Range: mg/dl Low: <60mg/dl High: >150mg/dl DKA: mg/dl Glucometers need to be tested on a regular basis. Test strips need to be Kept in a cool, dry place and have expiration dates. Some test strips use a chip in order to operate. Know the glucometer that you carry and how to operate it!

14 BLOOD GLUCOSE MONITORING Set out glucometer, test strip, lancet, alcohol prep and bandaid. Ideal location is ring or middle finger of non dominant hand. **Newer meters have the ability to test smaller amounts from different locations. Turn on glucometer and place test strip inside according to directions. Wipe desired area with alcohol prep and allow to dry. You may have to milk the pt's finger and try to warm it up. Making a horseshoe by squeezing the tip of the finger very firmly. Using lancet, quick prick of the meaty portion of the horseshoe, be weary of the pt's nailbed. Dispose of lancet in SHARPS CONTAINER

15 BLOOD GLUCOSE CONTINUED... Wipe off first drop of blood. Allow test strip to vacuum blood. The glucometer will count down once enough blood is given. Wipe off excess blood and apply bandaid. Use direct pressure. Document reading on PCR. Things to consider: Make sure that sample taken was usable before cleaning off pt's finger and applying pressure/bandaid. Test strips are VERY sensitive to heat and can actually warp with excessive heat. If pt is on blood thinners, be weary of the site and the potential for bleeding.

16 Pulse Oximetry How does it really work? Why should I care?

17 Common EMS equipment

18 Various forms of pulse ox s

19 Indications for Pulse Oximetry Uses of Pulse Oximetry generally fall into two categories Real Time Indicator of hypoxemia Therapeutic interventions gague

20 How does it work?

21 Beer s Law Light is absorbed by the tissues and does not vary with the cardiac cycle During the cardiac cycle there IS a small increase in arterial blood Light absorption is increased during this phase.

22 Beer s Law for Dummy s SPO 2 Reading More light is absorbed

23

24 Lets Review ABG s

25 ABG s Values at sea level (760 torr or 14.7psig): (PaO2) - 75 to 100 mm Hg (PaCO2) - 35 to 45 mm Hg A ph of 7.35 to 7.45 (SaO2) - 94% to 100% (HCO3) - 22 to 26 meq/liter At altitudes of 3,000 feet and above, the values for oxygen are lower

26 Quick Terminology Review SpO 2 Non invasive oxygen saturation SaO 2 Arterial Oxygen Saturation (oxygen bound to the hemoglobin molecules) PaO 2 Arterial Partial Pressure, oxygen dissolved in the plasma (only about 3% of total content) or PO 2 CaO2 Total amount of oxygen in the blood or the SaO 2 + PaO 2

27 What are the Normal? % sat Good gas exchange 90-95% Mild hypoxia <90% Severe hypoxia Not all patients are the same COPD Anemia

28 Saturation Chart linear Ronald Pristera 2002

29 How is saturation related to oxygen levels? Normal PaO 2 Ronald Pristera 2002

30 Cautions Indirect Assessment of the adequacy of ventilation! Hypoventilation (hypercarbia) may precede decrease in saturations by many minutes. Supplemental oxygen may mask hypoventilation and CO 2 retention.

31 Cautions Pulse Oximetry can give accurate readings down to hemoglobin levels of 5 mg/dl. SpO 2 levels below 70% may produce inaccurate readings. Peripheral circulation must be intact!

32 Practice Pearls Don t introduce yourself via pulse ox ALWAYS CHECK THE MECHANICAL PULSE Consider pulse Oximetry a diagnostic tool, not your surrogate brain. Know the limitations of the technology Treat the patient not their SPO 2

33 Questions?

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