Crucial Signs כל הזכויות שמורות למד"א מרחב ירושלים

Transcription

1 Crucial Signs Dan Drory, MDA Paramedic and Instructor, 2011

2 What are Signs? Sign Objective, measurable Symptom Subjective, evaluated by the patient ( Chest Pain, Difficulties Breathing, Headache )

3 Signs

4 Fever Normal temperature degrees Celsius ( degrees Fahrenheit ) in core. Below 35 deg. ( 95 deg. F ) Hypothermia deg. ( deg. F ) Hyperthermia In Israel the measurement is in celsius

5 Fever - causes Age Infection Environment Fluid management Menstruation Physical activity Time of day

6 Breathing The breathing process is complexed from inhalation and exhalation. By those, our body oxygenates, ventilates, looses\gains heat to the environment Important parameters: Rhythm Depth Noises Excessive use of breathing muscles ( Tripod )

7 How to Look ( at chest rise ) Listen ( Exhale\Inhale ) and Feel ( with your hand ). For 30 seconds. Multiply by two. Now you have Respiration Rate ( number of breaths per minute ). Normal measurements: Adult: RR Child: RR Infant: RR Newborn: RR

8 Pulse Medical definition: elevation of pressure of blood, caused by the heart, upon the inner walls of vessels. Parameters: Rhythm Regularity Power ( by an under trained caretaker only with a blood pressure device )

9 Where should we feel? Locations: Carotid Brachial Radial Femoral Dorsalis Pedis

10 How to? Choose the location Find pulse with 3-4 fingers Count the beats for 15 seconds Multiply by 4 Now you know the BPM ( number of beats per minute ). Don t press too hard. Never check with less then 3 fingers. Attempt to feel the pulse with all of them.

11 Pulse Proper values: Adult: Child: Infant\Newborn: ( 160 when crying )

12 Skin By observing the skin, we can conclude a specific problem. Important parameters: Color Temperature Moisture

13 Skin Signs of the skin: Cyanotic ( blue \ purple ) hypoxemia Pale ( White \ Grey ) Weak perfusion Red high body temperature \ dilated vessels Moist, Cold Sympathetic reaction Dry, Worm Fever, Infection Moist, Worm Physical effort Take under consideration that the last one may be the early symptom for Fever or Spinal injury.

14 Capillary refill Definition: The perfusion of blood to the fingers. Important parameters: Color Speed How to? Apply firm pressure on the nail of the patient The return of normal color shouldn t take more than 2 seconds. Take under consideration that capillary refill at other locations may be different and usually slower. Check for your self. Press the finger nail and time and then press the skin of your palm. Finger nail 2 Sec. Golden standard

15 Blood Pressure Definition: The pressure, applied by the blood upon the vessels. That pressure is build by the heart, the contractility of the vessels and the amount of fluid in side them. The measurement of BP is in mmhg.

16 Blood Pressure Systolic The maximum pressure inside the main arteries after the contraction of the heart. Diastolic The lowest pressure of the blood on the vessels during the relaxation of the ventricles ( just a fraction of the second before the contraction ). Normally it doesn t drop to zero every beat.

17 Methods of measurement Cuff and a stethoscope ( Sys \ Dis value ) Cuff and no stethoscope ( Sys only ) No Cuff and no stethoscope ( General assessment only ) Locations of measurement: Between the elbow and the shoulder Between the knee and the calves

18 Cuff and a stethoscope Find the brachial pulse Place the cuff on and around the brachial artery. Inflate to 180 mmhg Listen for pulse ( if you can still hear, inflate more until you can not ) Deflate slowly ( very ), notice the number on which you can hear the pulse. ( Systolic BP - higher ) Keep deflating until you can not hear, notice the number on which you ve stopped hearing. ( Diastolic BP - lower )

19 Once you have the Sys\Dis To fully evaluate the BP we need to take under consideration the pulse pressure PP = Systolic Diastolic Normal PP is between 30 and 60 mmhg Age Adult Child Infant Systolic Diastolic

20 Blood Pressure how does it work Step by step: 1. Before the inflation of the cuff quiet flow 2. Fully inflated cuff no flow 3. Partial deflation turbulent flow, that s when we hear the pulsation. 4. Fully deflated cuff quiet flow

21 General assessment of BP We can assess the BP by measuring pulse in specific arteries. Radial pulse can be felt: Sys above 80 mmhg Femoral pulse can be felt: Sys above 70 mmhg Carotid pulse can be felt: Sys above 60 mmhg That works only if you can find a pulse at those locations normally!

22 Emphasis Pulse rate is the first line of compensation, and varies greatly. When you check your patient, make sure he\she do not feel being tested. All signs are to be compared to the base line! Only when we do not have the base line information available, we go by the numbers written in books.

23 Questions?