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Vitals and History Taking
Hillcrest Fire Training
December, 2000
Where are we going?
What are vital signs?
How do you take them?
So, what’s normal?
SAMPLE History
What are the vitals
They provide information about the status of a patient
Breating (Respirations)
Pulse
Skin
Pupils
Blood Pressure
Counting Respirations
Respiration is one inhalation and exhalation.
Determined by counting for 30 sec, and multiplying by 2.
A hand on the stomach/chest may help
Normal Respirations
Adult 12-20/min
Child 15-30/min
Infant 25-50/min
Respiration Quality
Normal
Shallow (low tidal volume)
Labored Use of accessory musclesFlaringTripod Breating
Noisy breathing
Pulse
Determined by counting for 30 sec and multiplying by 2.
Irregular pulse counted for 60 sec.
Provides information about heart, blood volume and perfusion.
Taken at a pulse point
Don’t use your thumb
Common Pulse Points
Central Pulses Carotid Femoral
Peripheral Pulses Radial Brachial (children
under 1) Posterior Tibial,
Dorsalis Pedis
Pulse Quality
Normal
Bounding
Weak
Thready
Regular/Irregular
Normal Pulse Rate
Adult 60-80/min
Child 80-120
Infant 120-150
Skin
Color Pink (Normal) Pale Cyanotic (Oxygen
problems) Red (CO or heat
problems) Yellow (Jaundice)
Temperature Warm (Normal) Hot Cool Cold
Condition Dry (Normal) Moist
Practice
Get pulse and respirations from at least two people
Try to get pulse from carotid, radial, and brachial pulse points
Assessing Skin
Color assessed using lips, nail beds, inside of mouth, membranes of the eye
Pull back glove to determine temp and condition
In children under 6 capillary refill is useful for determining perfusionRefill should take less than 2 seconds
Pupils
SizeConstrictedDilatedEqual/Unequal
Reactivity to lightCan check with pen light or by shielding eyes from light
Blood Pressure
Taken with manual or automatic BP cuff
Can be taken by auscultation or palpation
Key Terms
Systolic Pressure when heart
is pumping
Diastolic Pressure when heart
is at rest
BP by Auscultation
Size using guides on cuff
Position on upper arm hoses pointing down
Inflate 30mmHg past pulse
Position stethoscope over brachial artery
Deflate
Note first sound and last sound
Record as systolic/diastolic (140/80)
One last note on Vitals
First set of vitals is the baseline, you are interested in changes
On not sick patients, repeat every 15 minutes
On sick patients, repeat every 5 minutes
Treat patient, not the vital signs or the equipment
BP by Auscultation
Size using guides on cuff
Position on upper arm hoses pointing down
Inflate 30mmHg past pulse
Position stethoscope over brachial artery
Deflate
Note first sound and last sound
Record as systolic/diastolic (140/80)
BP by Palpation
Size using guides on cuff
Position on upper arm centered over brachial artery
Inflate 30mmHg past pulse
Deflate
Record point at which pulse returns
Record as Systolic/P (135/p)
Normal Blood Pressure
Male Systolic = 100+age
until 50 Diastolic =60-90
Female Systolic=90+age
until 50 Diastolic = 50-80
Practice
Get BP from two people
Try at least two techniques for obtaining BP Auscultation,
Palpation, or Automatic Cuff
History Taking
SAMPLE
Organized technique to obtain pertinent medical informaiton
Can obtain information from patient, family or bystanders
SAMPLE is an acronym
SAMPLE
Signs/Symptoms
Allergies
Medications
Past Pertinent Medical Conditions
Last Oral Intake
Events Leading to Injury or Illness
Signs/Symptoms
Signs – things you can see or hear
Symptoms – things the patient reports
Allergies
Environmental and Medical allergies are important
Medic Alert tags are also useful
Medications
Prescription and OTC Including vitamins, herbal remedies
Birth Control PillsIllicit DrugsAlways get a list of meds, or take them with
Home O2 rate is also importantWhat did you take, when, how much?
Past Pertinent Medical History
Underlying medical problems
Recent visits to hospitals/doctors
Recent medical procedures
Recent accidents/falls/trauma
Medic Alert tags may be useful
Look for signs of medical equipment in the house
Last Oral Intake
What, how much, when
Important for trauma patients, diabetics
Events Leading to Call
Get as much information as you can
What happened, what were you doing
Has anything unusual happened?
If this is a chronic problem, what’s different this time?
Final SAMPLE notes
Try to ask open ended questions (avoid yes/no questions)
Wait for the patient to respond5-10 seconds is not out of line
Note pertinent negatives
Write everything down
Practice
Let’s go through a couple of scenarios