Baseline Vital Signs
&
SAMPLE History
Accurately Assessing and Recording a Patient’s Vital Signs and Acquiring a SAMPLE History Will Do 2 Things;
- Establish Trends
- Paint the Picture
TOPIC OVERVIEW
- How to Obtain Vital Signs
- Pulse
- Respirations
- Blood Pressure
- Skin
- Pupils
- How to Obtain an Accurate SAMPLE History
- How to Document Vital Signs
GENERAL INFORMATION
- Chief Complaint
- Alert or Not Alert? - Mental Status
- Why Are We Here?
- Age
- Infants / Months -- Neonates / Days
- Sex
- This is Not a Yes / No Question
DEFINITION
- Vital Signs
- Outward Signs of What is Going On Inside the Body.
- Baseline Vital Signs
- The First Set of Measurements You Acquire.
RESPIRATIONS
- Breathing / Respirations
- Assess by Watching Chest Rise & Fall
- Count Breaths for 30 Seconds, Multiply by 2
- 15 Seconds X 4
- Rise & Fall = 1 Breath
- Don’t Tell Patient You’re Counting Breaths
RESPIRATIONS
- Quality of Breathing
- Normal - Average Chest Movement
- Shallow - Slight Chest / Abdominal Movement
- Labored
- Increased Effort / Using Accessory Muscles
- Grunting & Stridor
- Gasping
- Nasal Flaring, Supraclavicular & Intercostal Retraction in Kiddos
- Noisy
- Snoring, Wheezing, Gurgling, Crowing
NORMAL RESPIRATORY RATES
- Adult 12 to 20
- Serious Above 24 or Below 10
- Adolescent 11-14 Years 12 to 20
- School age 6 - 10 Years 15 to 30
- Preschool 3 - 5 Years 20 to 30
- Toddler 1 - 3 Years 20 to 30
- Infant 6 - 12 Months 20 to 30
- Infant 0 - 6 Months 25 to 40
- Newborn 30 to 50
PULSE
- Radial Pulse
- Assessed In All Patients
- Under Age of 1 – Brachial Pulse
- Rate
- # of Beats Over 30 Seconds, Multiply by 2
- 15 Seconds X 4
- Quality
- Strong or Weak
- Regular or Irregular
- Carotid Pulse
- If Peripheral Pulse is Not Palpable
- Never Assess Both Sides of Carotid at Same Time
DEFINITIONS
Normal Adult Range 60 - 100
- Tachycardia
- Above 100 Beats per Minute
- Bradycardia
- Below 60 Beats per Minute
NORMAL PULSE RANGES
- Adult 60 to 100
- Adolescent 11-14 Years 60 to 105
- School age 6 - 10 Years 70 to 110
- Preschool 3 - 5 Years 80 to 120
- Toddler 1 - 3 Years 80 to 130
- Infant 6 - 12 Months 80 to 140
- Infant 0 - 6 Months 90 to 140
- Newborn 120 to 160
SKIN
- Color
- Assess Nail Beds, Oral Mucosa, Conjunctiva
- Infants & Kids
SKIN
Color
- Normal Skin Color - "Pink"
- Abnormal
- Pale - "White/Gray" - Poor Perfusion
- Cyanotic - "Blue" - Hypoxia
- Flushed - "Red" - Heat or CO Poisoning
- Jaundice - "Yellow" - Liver Abnormality
- Mottled - Pale Color Separated by Red Streaks
SKIN
Temperature
- Normal Temperature - "Warm"
- Abnormal
- Hot - Fever or Exposed to Heat
- Cool - Poor Perfusion or Exposed to Cold
- Cold - Exposure to Extreme Cold
SKIN
Condition
- Normal Skin Condition - "Dry"
- Abnormal
- Diaphoretic - Wet - Profuse Sweating
- Moist - When it Shouldn’t Be
- Dry - When it Shouldn’t Be
SKIN
Capillary Refill
- Assess in Kids Less Than 6 Y/O
- Gently Squeeze Blood From Skin or Nail Bed
- Normal Capillary Refill - < 2 Seconds
- Abnormal Refill - > 2 Seconds
PUPILS
- Black Center of Eye
- Normally React to Light & Situation
- Bright Light
- Constricted
- Darkness
- Dilate
- Small % of Population
- Med/Surg Anomaly
- Unequal Size
PUPILS
- Assess Size & Reactivity
- Briefly Shine Light On Eye
- Size
- Dilated – Big
- Normal
- Constricted – Small
- Reaction
- Reactive – Changes With Light Exposure
- Non-Reactive – No Change With Light
- Equal or Unequal to Each Other
BLOOD PRESSURE
- Systolic Blood Pressure
- First Distinct Beat That is Heard
- Pressure On Artery Wall When Heart Contracts
- Diastolic Blood Pressure
- Last Beat That is Heard (Usually a Fading Sound)
- Pressure On Artery Wall When Heart Relaxes
- Systolic Over Diastolic
What Is Normal ?
- To the Age of 40
- Male (at rest)
- Age + 100 = Normal Systolic
- Female (at rest)
- Age + 90 = Normal Systolic
- Hypertension
- >
150 mmHg Systolic or > 90 mmHg Diastolic
- Hypotension
- Below 90 mmHg Systolic
BLOOD PRESSURE
2 Methods
- Auscultation
- Listen / Hear
- Stethoscope
- Brachial Artery
- Palpation
- Feel / Touch
- Fingers
- Radial Pulse
- Cuff in Usual Place
- Acquired In All Patients Over 3 Y/O
- Little Kiddos
- First – If Awake, Good Luck!!!
- If General Appearance is Crappy
- Do More Important Steps Before Worrying About BP
- Kids Compromise Well
- Drop in BP is Too Late
PULSE OXIMETER
- Measures the Amount of Hemoglobin Carrying O2
- 96 to 100% Considered Normal
- 95% and Below Considered Hypoxic
PULSE OXIMETRY
- Not accurate in shock or hypothermia.
- False readings in carbon monoxide poisoning.
- Movement and nail polish can cause inaccurate readings.
- Batteries must be in good condition.
PULSE OXIMETRY
Do not withhold oxygen from a patient who may need it because the oximeter reads "normal."
REASSESSING VITAL SIGNS
- Stable Patient
- Q 15 Minutes – Assessed & Recorded
- Unstable Patient
- Q 5 Minutes – Assessed & Recorded
- Medical Intervention
- Q Time You Do One
- i.e.: Administer a Medication
S.A.M.P.L.E. History
- S Signs & Symptoms
- A Allergies
- M Medications
- P Past Medical History
- L Last Oral Intake
- E Events Leading to Illness/Injury
- Signs & Symptoms
- Sign
- Displayed by Patient
- Identifiable by EMT
- Hear, See, Feel
- Symptom
- Described by Patient
- "I’m S.O.B."
- Allergies
- Medications
- Foods
- Environmental
- Look for Medic Alert
- Bracelet
- Necklace / Chain
- Medications
- Prescription
- Current
- Recent
- B.C. Pills
- Non-Prescription
- Over-the-Counter
- Medic Alert
- Past Medical History
- Medical Problems
- Even if controlled w/ med
- Surgeries
- Trauma
- Medic Alert
- Pertinent Info Only
- Last Oral Intake
- Solid or Liquid
- How Long Ago
- How Much
- PS: No Matter How Drunk They Are, I Bet They Will Say 2 Beers
- Events Leading to
- Watching TV
- Cutting Grass
- Shoveling Snow
- Sex
- What Ever