copyright © 2005 mosby, inc. all rights reserved. slide 1 chapter 5 baseline vital signs and sample...

Copyright © 2005 Mosby, Inc. All rights reserved. Slide 2

Chapter 5Chapter 5

Baseline Vital Signs andBaseline Vital Signs andSAMPLE HistorySAMPLE History


OverviewOverview Baseline Vital SignsBaseline Vital Signs

BreathingBreathing SkinSkin PupilsPupils Blood PressureBlood Pressure Vital Sign ReassessmentVital Sign Reassessment

SAMPLE HistorySAMPLE History


Baseline Vital SignsBaseline Vital Signs


Vital SignsVital Signs BreathingBreathing

SkinSkin

PupilsPupils

Blood pressureBlood pressure


BreathingBreathing

Assess both rate and qualityAssess both rate and quality


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


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


BreathingBreathing

Abnormal respiratory soundsAbnormal respiratory sounds Snoring Snoring WheezingWheezing GurglingGurgling


Pulse Pulse

Pulse points Pulse points


PulsePulse

Assess for rate and Assess for rate and qualityquality


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


PulsePulse

Assess the brachial Assess the brachial pulse in infantspulse in infants


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


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


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


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.


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


SkinSkin ConditionCondition

NormalNormal• DryDry

AbnormalAbnormal• WetWet

• MoistMoist

• DryDry


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.


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


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


PupilsPupils

Constricted pupilsConstricted pupils


PupilsPupils

Dilated pupilsDilated pupils


PupilsPupils

Unequal pupilsUnequal pupils


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


You might not have time to measure the blood pressure until

the patient is en route to the hospital.


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


Blood pressure should be measured in all patients older than 3 years of

age.


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.


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



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


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.


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.


AAllergiesllergies

MedicationsMedications

FoodFood

Environmental allergiesEnvironmental allergies

Consider medical identification tagConsider medical identification tag


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.


PPertinent Past Historyertinent Past History MedicalMedical

SurgicalSurgical

TraumaTrauma

Consider medical identification tagConsider medical identification tag


LLast Oral Intakeast Oral Intake

Solid or liquidSolid or liquid

TimeTime

QuantityQuantity


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


SummarySummary

Baseline Vital SignsBaseline Vital Signs BreathingBreathing SkinSkin PupilsPupils Blood PressureBlood Pressure Vital Sign ReassessmentVital Sign Reassessment


copyright © 2005 mosby, inc. all rights reserved. slide 1 chapter 5 baseline vital signs and sample...

Documents

pulse pulse points copyright

soles of feet copyright

brachial pulse

baseline vital signscopyright

number of breaths

number of beats

abdominal wall motionlaboredan

oral mucosa