Baseline Vitals and Sample History Company Drill Instructor Guide Session Reference: 1 Topic: Baseline Vitals and Sample History Company Drill Level of Instruction: 2 Time Required: Three Hours Materials Blood Pressure cuff & stethoscope Pen light Clock or wrist watch with second hand Writing paper Writing pencil Personal protective equipment: gloves References Brady Emergency Care, 11 th Edition, The Maryland Medical Protocols for Emergency Medical Services Providers, Effective July 1, 2011, Maryland Institute for Emergency Medical Services Systems Preparation Motivation The Baseline Vitals and SAMPLE History are part of the essential information necessary to obtain and document in order to give a patient the best possible care in the field. This information can alert the provider to call for additional resources if necessary and can give those accepting care of the patient at the next level of patient care a good idea of what may be going on inside the patient s body.
Objective (SPO) 1-1: Given a live victim; blood pressure cuff; stethoscope; pencil; paper; pen light; clock or wrist watch, the student will be able to demonstrate, from memory and without assistance, the proper procedures in obtaining a set of Baseline Vitals, to include: pulse, respirations, skin color, skin temperature and condition, pupil appearance, blood pressure and be able to document the same at a practical station, as governed by The Maryland Medical Protocols for Emergency Medical Services Providers, Effective January 1, 2002 and the Brady Emergency Care, 7 th Edition, EMT-Basic National Standard Curriculum. The student will also be able to score a 70% or above on a written exam. Objective (SPO) 2-1: Given a live victim, pen and paper, the student will be able to demonstrate, from memory and without assistance, the proper procedure in obtaining a SAMPLE History, to include: signs and symptoms, allergies, medications, past pertinent history, last oral intake and events that lead to the problem, and be able to document the same at a practical station as governed by The Maryland Medical Protocols for Emergency Medical Services Providers, Effective January 1, 2002 and the Brady Emergency Care, 7 th Edition, EMT-Basic National Standard Curriculum. The student will also be able to score a 70% or above on a written exam. 2
Overview: Review of properly obtaining and documenting Baseline Vitals and a SAMPLE History Pulse Respirations Skin color Skin temperature and condition Pupil appearance Blood pressure Signs and symptoms Allergies Medications Past pertinent history Last oral intake Events that lead to problem
Session 1 Baseline Vitals SPO 1-1 EO 1-1-1 EO 1-1-2 EO 1-1-3 EO 1-1-4 EO 1-1-5 EO 1-1-6 SPO 2-1 EO 2-1-1 Given a live victim; blood pressure cuff; stethoscope; pen or pencil; paper; pen light; clock or wrist watch, the student will be able to demonstrate, from memory and without assistance, the proper procedures in obtaining and documenting a set of Baseline Vitals. Demonstrate the method of obtaining, assessing and documenting a pulse rate. Demonstrate the method of obtaining, assessing and documenting a respiratory rate. Demonstrate the method of obtaining and documenting skin color. Demonstrate the method of obtaining and documenting skin temperature and condition. Demonstrate the method of obtaining, assessing and documenting pupil appearance. Demonstrate the method of obtaining and documenting a blood pressure by auscultation and palpation. Given a live victim, pen and paper, the student will be able to demonstrate, from memory and without assistance, the proper procedure in obtaining and documenting a SAMPLE History. Demonstrate the method of obtaining and documenting a SAMPLE History.
Instructional Guide I. Pulse (1-1-1) A. Pulse rate number of heart beats per minute 1. Factors that affect pulse rate B. Pulse types a. Age b. Physical Condition c. Degree of exercise just completed d. Medical condition e. Medication f. Blood Loss g. Stress h. Body temperature i. Fear 1. Tachycardia - rapid rate 2. Bradycardia slow rate C. Pulse quality 1. Rhythm a. Regularity b. intervals between beats constant 2. Force - pressure of pulse wave as it expands artery 3. Full pulse strong wave 4. Thready pulse weak wave
D. Pulse locations 1. Radial a. one year and above c. radial artery lateral side of forearm (thumb) 2. Carotid large artery on either side of neck 3. Brachial upper medial arm 4. Dorsal Pedis - lateral to the large tendon of big toe 5. Posterior tibial - behind medial ankle of foot 6. Femoral - inside thigh of leg E. Demonstrate how to obtain a pulse 1. Finger placement 2. Count by using second hand on watch or clock a. count for 30 seconds x 2 b. count for15 seconds x 4 F. Demonstrate how to document a pulse II. Respirations (1-1-2) A. Respiratory rate number of breaths (in and out) per minute 1. Normal rate 2. Rapid rate 3. Slow rate - all rates can be affected by a. age b. sex
B. Quality c. size d. physical condition e. emotional state f. fear 1. Normal a. chest or abdomen moves average depth with each breath b. not using accessory muscles 2. Shallow - Slight movement of chest or abdomen 3. Labored a. patient has to work hard to move air in and out b. use of accessory muscles c. nasal flaring d. retractions pulling in above collarbones or between ribs (especially in infants & children) 4. Noisy - obstructed breathing 5. Snoring - airway blocked 6. Wheezing - medical problem such as Asthma 7. Gurgling - fluids in the airway 8. Crowing - noisy harsh sound when breathing in C. Demonstrate how to obtain a respiratory rate a. Stethoscope
b. Hand on chest c. Look with eyes d. Use of clock or wrist watch with second hand D. Demonstrate how to document respiratory rate II. Skin Color (1-1-3) A. Skin color 1. Pink a. Normal in light-skinned patients b. Normal at inner eyelids, lips, nail beds of darkskinned patients 2. Pale - Constricted blood vessels possible result of a. Blood loss b. Shock c. Heart attack e. Emotional distress 3. Cyanotic (blue) - Lack of oxygen in blood cells and tissues result of 4. Flushed (red) a. Inadequate breathing b. Inadequate heart function a. Exposure to heat b. High blood pressure c. Emotional excitement
5. Jaundiced (yellow) - Liver abnormalities 6. Mottling (blotchiness) - Occasionally in patients with shock B. Demonstrate how to document skin color IV. Skin Temperature & Condition (1-1-4) 1. Cool and clammy 2. Usual sign of shock 3. Usual sign of anxiety B. Cold and moist - Body is losing heat C. Cold and dry - Exposure to cold D. Hot and dry 1. High fever 2. Heat exposure E. Hot and moist 1. High fever 2. Heat exposure F. Goose pimples, shivering, chattering teeth, blue lips & pale skin 1. Chills 2. Communicable disease 3. Exposure to cold, pain or fear G. Demonstrate how to obtain skin temperature and condition (Use gloved hand) V. Pupil Appearance (1-1-5)
A. Pupil is the black center of the eye - Amount of light that enters the eye changes the size B. Evaluate pupils for 1. Size 2. Equality a. Both equal in size b. Causes of unequal pupils: stroke, head injury, eye injury, artificial eye 3. Reactivity C. Dilated Pupils a. Reacting to light by changing sizes b. Causes for lack of reactivity: drugs, lack of oxygen to the brain 1. Become larger 2. Allow more light into the eye 3. Causes for dilated pupils: fright, blood loss, drugs, treatment with eye drops D. Constricted Pupils 1. Become smaller 2. Large amount of light gets into the eye E. Demonstrate how to evaluate pupils - Use of pen light F. Demonstrate how to document pupil appearance VI. Blood Pressure (1-1-6)
A. Blood Pressure the force of blood against the walls of blood vessels when Left ventricle (lower chamber) of heart contracts and forces blood into circulation B. Systolic force of blood into the arteries when heart contracts 1. Upper number read when taking a blood pressure 2. First number given when reporting a blood pressure 3. Systolic pressure usually parallels pulse rate (When pulse rate increases, systolic does also) 4. Systolic reading is always an even number if reading falls between two lines use the higher reading C. Diastolic pressure remaining in the arteries when the left ventricle of the heart relaxes and refills 1. Lower number read when taking a blood pressure 2. Second number given when reporting a blood pressure 3. Diastolic reading is always an even number if reading falls between two lines use the higher number D. High blood pressure causes 1. Medical condition 2. Exertion 4. Fright 5. Emotional distress or excitement E. Low blood pressure causes 1. Athlete or other person with normally low blood pressure 2. Blood loss 3. Late sign of shock
F. Demonstrate obtaining a blood pressure 1. Auscultation method a. Reading sphygmomanometer b. Placement of cuff c. Stethoscope placement i. Bell (also called Head or Chestpiece) placement ii. Arm placement 2. Palpation method a. Cuff placement b. Hand placement c. Inflate cuff 30 mm of mercury above point where you no longer feel a radial pulse d. Deflate cuff slowly e. Note reading at which the radial pulse returns f. This reading is the systolic reading G. Demonstrate documenting a blood pressure VII. SAMPLE History (2-1-1) A. Signs/Symptoms 1. Why did you call 911 2. What is wrong 3. Document B. Allergies
1. Medications 2. Foods 3. Environment 4. Medical ID tag explaining allergies 5. Document C. Medications 1. Medications currently taking a. Prescribed b. Over the counter c. Recreational 2. If patient answers yes, ask: a. Name of medication b. Dosage and how often taken c. Why they are taking d. Was the medication taken today and when e. After taking was their any relief or change in symptoms 3. Document D. Pertinent past history 1. Currently being treated for any illness 2. Have you been feeling ill 3. Any recent surgeries or injuries
4. Have you been seeing a doctor 5. What is your doctor s name 6. Document E. Last oral intake 1. When did you last eat or drink 2. What did you eat or drink 3. Document F. Events leading to the injury or illness 1. What were you doing before you began feeling this way 2. Document Summary
Review: Properly obtaining and documenting Baseline Vitals and a SAMPLE History Pulse: rate, type, quality Respirations: rate, quality, method of obtaining Skin Color: pink, pale, cyanotic, flushed, jaundiced, mottling Skin temperature and condition: cool/clammy, cold/moist, cold/dry, hot/dry, hot/moist, goose pimples, shivering, chattering teeth, blue lips, pale skin Pupil appearance: size, quality, reactivity Blood pressure: systolic, diastolic, auscultation, palpation Signs and symptoms Allergies Medications Past pertinent history Last oral intake Events that lead to problem 10 Remotivation: The Baseline Vitals and SAMPLE History are part of the essential information necessary to obtain and document in order to give a patient the best possible care in the field. This information can alert the provider to call for additional resources if necessary and can give those accepting care of the patient at the next level of patient care a good idea of what may be going on inside the patient s body. Evaluation