Baseline Vital Signs & SAMPLE History CHAPTER 5. Baseline Vital Signs.

Baseline Vital Baseline Vital Signs & Signs & SAMPLE SAMPLE HistoryHistory

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Baseline Vital SignsBaseline Vital SignsBaseline Vital SignsBaseline Vital Signs

Sign:Sign:

Any medical or trauma Any medical or trauma condition displayed by the condition displayed by the patient and identified by the patient and identified by the EMT.EMT.

Examples of signs are hemorrhage, noisy breathing, bone deformities.

Symptom:Symptom:

Any condition described by the Any condition described by the patient that cannot be patient that cannot be observed.observed.

Examples of symptoms are chest pain, shortness of breath, nausea.

Vital Signs Vital Signs Breathing:Breathing: Rate, qualityRate, quality

Pulse:Pulse: Rate, character, rhythmRate, character, rhythm

Skin:Skin: Color, temperature, Color, temperature, conditioncondition

Pupils:Pupils: Reactivity, equalityReactivity, equality

Blood pressureBlood pressure

Average Vital Sign Ranges by Average Vital Sign Ranges by AgeAgeP

120-160

80-140

80-120

70-115

70-115

70-115

70-90

60-80

AGE

Newborn

1 year

3 years

5 years

7 years

10 years

15 years

Adult

R

40-60

30-40

25-30

20-25

20-25

15-20

15-20

12-20

BP

80/40

82/44

86/50

90/52

94/54

100/60

110/64

120/80

Trending:Trending:

The process of comparing sets The process of comparing sets of vital signs or other of vital signs or other assessment information over assessment information over time.time.

Level of Level of ConsciousnessConsciousness

Level of Level of ConsciousnessConsciousness

To assess level of consciousness: To assess level of consciousness:

AA - - AlertAlert and awake; aware of time, place, and awake; aware of time, place, date and persondate and person

VV - - Responds to Responds to verbalverbal stimuli stimuli

PP - - Responds to Responds to painfulpainful stimuli, does not stimuli, does not respond to verbal stimulirespond to verbal stimuli

UU - - Unconscious,Unconscious, does not respond to does not respond to any stimuliany stimuli

BreathingBreathingBreathingBreathing

Respirations:Respirations:

One breath in a single cycle of One breath in a single cycle of breathing in and out.breathing in and out.

Can be determined by counting the number of breaths in 30 seconds and multiplying by two.

Breathing Assessment Breathing Assessment RateRate

Averages 12-20 breaths per minuteAverages 12-20 breaths per minutein adultsin adults

QualityQuality Normal respirations?Normal respirations? Shallow respirations?Shallow respirations? Labored respirations?Labored respirations? Noisy respirations?Noisy respirations?

Patients often breathePatients often breathe

FASTERFASTERwhen they are ill or injured.when they are ill or injured.

Abnormal Respiratory Sounds Abnormal Respiratory Sounds

GruntingGrunting StridorStridor SnoringSnoring WheezingWheezing GurglingGurgling CrowingCrowing

Accessory muscles may be used during labored breathing.

NeckNeckMusclesMuscles

ChestChestMusclesMuscles

IntercostalIntercostalMusclesMuscles

AbdominalAbdominalMusclesMuscles

Retractions may indicate labored breathing.

SternalSternal

SupraclavicularSupraclavicular

IntercostalIntercostal

SubsternalSubsternal

PulsePulsePulsePulse

Key Pulse Points

CarotidCarotid

RadialRadial

BrachialBrachial

FemoralFemoral

PosteriorPosteriorTibialTibial

DorsalisDorsalisPedisPedis

Assessing the Pulse Assessing the Pulse RateRate

Averages 60-80 beats per minute Averages 60-80 beats per minute in adultsin adults

QualityQuality StrengthStrength (strong or weak)(strong or weak)

RhythmRhythm Regular or irregularRegular or irregular

Locating the Radial Pulse

Locating the Carotid Pulse

Palpate the brachial pulse in

an infant.

SkinSkinSkinSkin

Perfusion:Perfusion:

The process of distributing The process of distributing blood to the organs, delivering blood to the organs, delivering oxygen, and removing wastes.oxygen, and removing wastes.

The skin condition is a good indicator of perfusion.

Assessment of the Skin Assessment of the Skin ColorColor (nail beds, oral mucosa, conjunctiva)(nail beds, oral mucosa, conjunctiva)

Pink?Pink? Pale?Pale? Cyanotic?Cyanotic? Flushed?Flushed? Jaundiced?Jaundiced?

TemperatureTemperature Warm?Warm? Hot?Hot? Cool or cold?Cool or cold?

Assessment of the Skin continued Assessment of the Skin continued

ConditionCondition Dry?Dry? Wet or moist?Wet or moist? Abnormally dry?Abnormally dry? Clammy (cool & moist)?Clammy (cool & moist)?

Capillary refill Capillary refill (considered an inaccurate indicator of perfusion in patients over the age of 6 years)(considered an inaccurate indicator of perfusion in patients over the age of 6 years)

Assess skin temperature Assess skin temperature with the back of your with the back of your hand.hand.

Slow CRT may indicate poor perfusion.

PupilsPupilsPupilsPupils

Pupils are normally equal, reactive to light and midsize.

Constricted PupilsConstricted Pupils

Unequal PupilsUnequal Pupils

Dilated PupilsDilated Pupils

To assess the pupils: To assess the pupils: First evaluate in ambient light for constriction or dilation.First evaluate in ambient light for constriction or dilation.

Next, pass a light source across each pupil and note the response.Next, pass a light source across each pupil and note the response.

Each pupil should constrict in the same manner.Each pupil should constrict in the same manner.

Blood PressureBlood PressureBlood PressureBlood Pressure

Blood pressure:Blood pressure:

Measurement of the force the Measurement of the force the blood exerts against the walls of blood exerts against the walls of blood vessels during the heart’s blood vessels during the heart’s contraction and relaxation contraction and relaxation phases.phases.

Systolic: pressure during

contraction Diastolic: pressure during

relaxation

SystolicSystolic

DiastolicDiastolic

Changes in successive

blood pressure readings

may provide valuable clues

about the patient’s

condition.

Measuring BP by Measuring BP by auscultation.auscultation.

Measuring BP by Measuring BP by palpation.palpation.

Vital Sign Vital Sign ReassessmentReassessment

Vital Sign Vital Sign ReassessmentReassessment

Reassess vital signs every Reassess vital signs every 55 minutesminutes for for unstableunstable patients.patients.

Reassess vital signs every Reassess vital signs every 15 minutes15 minutes for for stablestable patients.patients.

SAMPLE HistorySAMPLE HistorySAMPLE HistorySAMPLE History

Patient history:Patient history:

A concise and inclusive set of A concise and inclusive set of information gathered about information gathered about patients and their medical patients and their medical problems.problems.

SSigns and symptomsigns and symptoms

AAllergiesllergies

MMedicationsedications

PPertinent past medical historyertinent past medical history

LLast oral intake (solid or liquid)ast oral intake (solid or liquid)

EEvents leading to injury or illnessvents leading to injury or illness

OOnsetnset

PProvocationrovocation

QQualityuality

RRadiationadiation

SSeverityeverity

TTimeime

SU

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AR

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MA

RY Baseline Vital SignsBaseline Vital Signs

SAMPLE HistorySAMPLE History