Date post: | 30-Dec-2015 |
Category: |
Documents |
Upload: | emily-rodgers |
View: | 214 times |
Download: | 1 times |
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 2
Chapter 5Chapter 5
Baseline Vital Signs andBaseline Vital Signs andSAMPLE HistorySAMPLE History
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 3
OverviewOverview Baseline Vital SignsBaseline Vital Signs
BreathingBreathing SkinSkin PupilsPupils Blood PressureBlood Pressure Vital Sign ReassessmentVital Sign Reassessment
SAMPLE HistorySAMPLE History
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 5
Vital SignsVital Signs BreathingBreathing
SkinSkin
PupilsPupils
Blood pressureBlood pressure
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 6
BreathingBreathing
Assess both rate and qualityAssess both rate and quality
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 7
BreathingBreathing
RateRate Determined by counting the number of breaths in Determined by counting the number of breaths in
a 30-second period and multiplying by 2a 30-second period and multiplying by 2
Care should be taken not to inform the patient—this may cause them to
influence the rate
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 8
BreathingBreathing QualityQuality
Can be determined while assessing the rateCan be determined while assessing the rate• NormalNormal
Average chest wall motion, not using accessory musclesAverage chest wall motion, not using accessory muscles
• ShallowShallow Slight chest or abdominal wall motionSlight chest or abdominal wall motion
• LaboredLabored An increase in the effort of breathingAn increase in the effort of breathing Often characterized by the use of accessory musclesOften characterized by the use of accessory muscles
• NoisyNoisy An increase in the audible sound of breathingAn increase in the audible sound of breathing
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 9
BreathingBreathing
Abnormal respiratory soundsAbnormal respiratory sounds Snoring Snoring WheezingWheezing GurglingGurgling
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 11
PulsePulse
Assess for rate and Assess for rate and qualityquality
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 12
PulsePulse
RateRate Rate is the number of beats felt in 30 seconds Rate is the number of beats felt in 30 seconds
multiplied by 2multiplied by 2 QualityQuality
• StrongStrong• WeakWeak• RegularRegular• IrregularIrregular
If peripheral pulse is not palpable, assess If peripheral pulse is not palpable, assess carotid pulsecarotid pulse
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 13
PulsePulse
Assess the brachial Assess the brachial pulse in infantspulse in infants
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 14
Skin Skin
Assess color, temperature, and conditionAssess color, temperature, and condition
In patients younger than 6 years of age, In patients younger than 6 years of age, capillary refill should be evaluatedcapillary refill should be evaluated
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 15
SkinSkin
ColorColor Assessed in the nail beds, oral mucosa, and Assessed in the nail beds, oral mucosa, and
conjunctivaconjunctiva In infants and children, use the palms of hands In infants and children, use the palms of hands
and soles of feet and soles of feet
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 16
SkinSkin Color findingsColor findings
NormalNormal• Pink Pink
Normal perfusionNormal perfusion
Abnormal Abnormal • PalePale
Poor perfusion (impaired blood flow)Poor perfusion (impaired blood flow)
• Cyanotic (blue-gray)Cyanotic (blue-gray) Inadequate oxygenation or poor perfusionInadequate oxygenation or poor perfusion
• Flushed (red)Flushed (red) Exposure to heat or carbon monoxide poisoningExposure to heat or carbon monoxide poisoning
• Jaundice (yellow)Jaundice (yellow) Liver abnormalitiesLiver abnormalities
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 17
SkinSkin
TemperatureTemperature Assessed by placing Assessed by placing
the back of your hand the back of your hand on the patient’s skinon 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.
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 18
SkinSkin Temperature findingsTemperature findings
Normal skinNormal skin• WarmWarm
Abnormal skin temperaturesAbnormal skin temperatures• HotHot
Fever or an exposure to heatFever or an exposure to heat
• CoolCool Poor perfusion or exposure to coldPoor perfusion or exposure to cold
• ColdCold Extreme exposure to coldExtreme exposure to cold
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 19
SkinSkin ConditionCondition
NormalNormal• DryDry
AbnormalAbnormal• WetWet
• MoistMoist
• DryDry
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 20
Capillary RefillCapillary Refill Assess capillary refill in infants and children younger than 6 Assess capillary refill in infants and children younger than 6
years of age years of age Press on the patient’s skin or nail beds and determine time Press on the patient’s skin or nail beds and determine time
for return to initial colorfor return to initial color Normal capillary refill in infants and children is < 2 secondsNormal capillary refill in infants and children is < 2 seconds Abnormal capillary refill in infants and children is > 2 Abnormal capillary refill in infants and children is > 2
secondsseconds
Capillary refill cannot be accurately assessed under extreme temperature conditions.
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 21
PupilsPupils
Pupils are assessed by Pupils are assessed by briefly shining a light into briefly shining a light into the patient’s eyes and the patient’s eyes and determining size and determining size and reactivity reactivity
PERRLPERRLPPupil upil EEqual qual RRound ound RReactive to eactive to LLightight
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 22
PupilsPupils Assessment findingsAssessment findings
SizeSize• Dilated (very big)Dilated (very big)
• NormalNormal
• Constricted (small)Constricted (small)
• Equal or unequalEqual or unequal
Reactivity Reactivity • Reactive—change when exposed to lightReactive—change when exposed to light
• Nonreactive—do not change when exposed to lightNonreactive—do not change when exposed to light
• Equally or unequally reactiveEqually or unequally reactive
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 23
PupilsPupils
Constricted pupilsConstricted pupils
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 24
PupilsPupils
Dilated pupilsDilated pupils
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 25
PupilsPupils
Unequal pupilsUnequal pupils
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 26
Blood Pressure Blood Pressure
Assess systolic and diastolic pressuresAssess systolic and diastolic pressures Systolic blood pressure is the first distinct sound of Systolic blood pressure is the first distinct sound of
blood flowing through the artery as the pressure in blood flowing through the artery as the pressure in the blood pressure cuff is releasedthe blood pressure cuff is released
Diastolic blood pressure is the point during Diastolic blood pressure is the point during deflation of the blood pressure cuff at which deflation of the blood pressure cuff at which sounds of the pulse beat disappearsounds of the pulse beat disappear
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 27
You might not have time to measure the blood pressure until
the patient is en route to the hospital.
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 28
Blood PressureBlood Pressure
Two methods of obtaining blood pressureTwo methods of obtaining blood pressure AuscultationAuscultation
• Listen for the systolic and diastolic sounds Listen for the systolic and diastolic sounds
PalpationPalpation• Measured by feeling for return of pulse with deflation of Measured by feeling for return of pulse with deflation of
the cuff the cuff
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 29
Blood pressure should be measured in all patients older than 3 years of
age.
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 30
The general assessment of the infant or child patient, such as sick-appearing, in respiratory distress, or unresponsive, is more valuable
than vital sign numbers.
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 31
Vital Sign Reassessment Vital Sign Reassessment
Vital signs should be assessed and recorded Vital signs should be assessed and recorded every 15 minutes (at a minimum) in a stable every 15 minutes (at a minimum) in a stable patientpatient
Vital signs should be assessed and recorded Vital signs should be assessed and recorded every 5 minutes in the unstable patient every 5 minutes in the unstable patient
Vital signs should be assessed following all Vital signs should be assessed following all medical interventionsmedical interventions
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 32
SAMPLE HistorySAMPLE History
SS SSigns and igns and SSymptomsymptoms
AA AAllergiesllergies MM MMedicationsedications PP PPast medical historyast medical history LL LLast oral intakeast oral intake EE EEvents leading to injury or illnessvents leading to injury or illness
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 33
SSigns/igns/SSymptomsymptoms
SignSign Any condition, medical or trauma, that can been seen Any condition, medical or trauma, that can been seen
and identified by the EMTand identified by the EMT
Bleeding, noisy breathing, and deformities are examples of signs.
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 34
SSigns/igns/SSymptomsymptoms
Symptom Symptom Any condition described by the patient that cannot Any condition described by the patient that cannot
be seen by the EMTbe seen by the EMT
Chest pain, nausea, and shortness of breath are examples of symptoms.
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 35
AAllergiesllergies
MedicationsMedications
FoodFood
Environmental allergiesEnvironmental allergies
Consider medical identification tagConsider medical identification tag
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 36
MMedicationsedications PrescriptionPrescription
CurrentCurrent RecentRecent
Birth control pillsBirth control pills NonprescriptionNonprescription
CurrentCurrent RecentRecent Consider medical identification tagConsider 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.
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 37
PPertinent Past Historyertinent Past History MedicalMedical
SurgicalSurgical
TraumaTrauma
Consider medical identification tagConsider medical identification tag
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 38
LLast Oral Intakeast Oral Intake
Solid or liquidSolid or liquid
TimeTime
QuantityQuantity
Copyright © 2005 Mosby, Inc. All rights reserved. Slide 39
EEvents Leading to Injury or Illnessvents Leading to Injury or Illness
Chest pain with exertionChest pain with exertion
Chest pain while at restChest pain while at rest