vitals and history taking

Vitals and History Taking

Hillcrest Fire TrainingDecember, 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 patientBreating (Respirations)PulseSkinPupilsBlood 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/minChild 15-30/minInfant 25-50/min

Respiration Quality

NormalShallow (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 pointDon’t use your thumb

Common Pulse Points

Central Pulses Carotid Femoral

Peripheral Pulses Radial Brachial (children

under 1) Posterior Tibial,

Dorsalis Pedis

Pulse Quality

NormalBoundingWeakThreadyRegular/Irregular

Normal Pulse Rate

Adult 60-80/minChild 80-120Infant 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 peopleTry to get pulse from carotid, radial, and brachial pulse points

Assessing Skin

Color assessed using lips, nail beds, inside of mouth, membranes of the eyePull back glove to determine temp and conditionIn 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 cuffCan 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 cuffPosition on upper arm hoses pointing downInflate 30mmHg past pulsePosition stethoscope over brachial arteryDeflate Note first sound and last soundRecord as systolic/diastolic (140/80)

One last note on Vitals

First set of vitals is the baseline, you are interested in changesOn not sick patients, repeat every 15 minutesOn sick patients, repeat every 5 minutesTreat patient, not the vital signs or the equipment

BP by Auscultation

Size using guides on cuffPosition on upper arm hoses pointing downInflate 30mmHg past pulsePosition stethoscope over brachial arteryDeflate Note first sound and last soundRecord as systolic/diastolic (140/80)

BP by Palpation

Size using guides on cuffPosition on upper arm centered over brachial arteryInflate 30mmHg past pulseDeflate Record point at which pulse returnsRecord 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 peopleTry at least two techniques for obtaining BP Auscultation,

Palpation, or Automatic Cuff

History Taking

SAMPLE

Organized technique to obtain pertinent medical informaitonCan obtain information from patient, family or bystandersSAMPLE is an acronym

SAMPLE

Signs/SymptomsAllergiesMedicationsPast Pertinent Medical ConditionsLast Oral IntakeEvents Leading to Injury or Illness

Signs/Symptoms

Signs – things you can see or hearSymptoms – things the patient reports

Allergies

Environmental and Medical allergies are importantMedic 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 withHome O2 rate is also importantWhat did you take, when, how much?

Past Pertinent Medical History

Underlying medical problemsRecent visits to hospitals/doctorsRecent medical proceduresRecent accidents/falls/traumaMedic Alert tags may be usefulLook for signs of medical equipment in the house

Last Oral Intake

What, how much, whenImportant for trauma patients, diabetics

Events Leading to Call

Get as much information as you canWhat happened, what were you doingHas 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 negativesWrite everything down

Practice

Let’s go through a couple of scenarios