7)Baseline Vital Signs And Sample History

1. Baseline Vital Signs and SAMPLE
History

2. Getting Started…
•It all starts with a
complaint…
•Chief Complaint (C/C)
•Why was EMS called?
•Other useful information
•Pt. Age
•Pt. Sex
•Pt. Race

3. Baseline Vital Signs
•Measurement of vital body functions
•Gives a basis for initiating care
•Allows reevaluation of interventions
•Includes:
•Respirations
•Pulse
•Blood pressure
•Temperature
•Pupils

4. Respiratory Evaluation
•Areas of assessment
•Rate. Rhythm. Depth. Quality.
•Rate
•Adult = 12-20 per minute
•Child = 15-30 per minute
•Infant -= 30-60 per minute
•Rhythm
•Regular or irregular
•Depth
•Tidal volume adequate or inadequate
•Amount of air breathed in/out in one ventilation
•Approx 500 mL

5. Respiratory Evaluation cont’d.
•Quality
•Breath sounds
•Present or diminished or absent
•Chest expansion
•Unequal or symmetrical
•Increased effort
•Accessory muscles
•“Seesaw” breathing
•Infants
•Nasal flaring
•Retractions
•Above clavicles, between ribs
•Cyanosis
•Shortness of breath
•Altered mental status

6. Accessory Muscle Use
Nasal Flaring
Retractions

7. Respiratory Evaluation Cont’d
•Noisy
•Increase in audible sound of breathing
•Grunting
•Rhythmic, deep, short and hoarse
•During exhalation
•Gurgling
•Air moving through water
•=Fluid in upper airway
•Wheezing
•High pitched “whistling”
•=Narrow bronchioles (Asthma)
•Crowing/Stridor
•High pitch on inspiration
•= Obstruction at vocal cords/epiglottis
•Snoring
•Tongue blocking airway
•Gasping
•Short, rapid inspiratory phase
•Assoc. with Resp. distress/failure

8. Respiratory Evaluation cont’d.
•Cyanosis
•Blue/pale coloring of skin
•Nail beds
•Lips
•Eyelids
•Why is this seen in these
areas first???
•Indicates poor perfusion

9. Pediatric Considerations
•Mouth/Nose
•Smaller and easily obstructed
•Pharynx
•Tongue is BIG
•Trachea
•Narrower
•Softer and more flexible
•Cricoid Cartilage
•Less developed/Less rigid = easily kinked
•Diaphragm
•Chest is soft
•Depend on diaphragm to do most of the work of breathing
•Seesaw Breathing….

10. Respiratory Rate
•Count the # of respirations in 30 seconds and X
by 2.
•Try not to inform pt
•They could adjust rate

11. Pulse Rate
•Pulse
•Palpable wave of blood sent though arteries after contraction of L
ventricle
•Peripheral
•Radial
•Brachial
•Posterior tibial
•Dorsalis pedis
•Central
•Carotid
•Femoral

12. Pulse Rate
•Evaluation
•Radial pulse
• ALL pt 1 y/o +
•Brachial pulse
• pt less than 1 y/o
•If unresponsive OR peripheral pulse isn't palpable
• Carotid pulse
•NEVER on both sides
•Use index and middle finger
•NO THUMBS

13. Pulse Rate
•Evaluation
•Depress artery and
count rate for 30
seconds and X by 2
•OR 15 seconds and X
by 4
•Less accurate
•Range
•Infant (Birth - 1 year)
•100-160
•Child (2-10 y/o)

• 70-150
•Child (12 y/o+) Adult

•60-100

14. Perfusion/Skin
•Clues to perfusion and oxygenation
•Components
•Color
•Temp
•Moisture
•Capillary Refill

15. Skin Color
•Locations of assessment
•Nail beds, oral mucosa, conjunctiva
•Pediatric
•Palms of hand/Sole of feet
•Normal = Pink
•Abnormal
•Pale
•Poor Perfusion
•Cyanotic
•Blue/grey= Poor oxygenation/perfusion
•Flushed
•Heat or CO exposure
•Jaundiced
•Liver/Gallbladder problems

16. Baseline Vital Signs
Perfusion

17. Temperature
•Place back of gloved hand on pt skin
•Normal = Warm
•Abnormal
•Hot
•Fever/Heat exposure
•Cool
•Poor perfusion/Cold exposure
•Cold
•Extreme cold exposure
•Excessively dead…
•Also check for moisture
•Diaphoresis or extremely dry

18. Capillary Refill
•Evaluation
•Press on pt nail bed until it
is blanched/white
•Release and count time
until pink returns
•Normal
•2 seconds or less
•Abnormal
•More than 2 seconds

19. The Circulatory System Physiology
Blood Pressure
•Blood pressure
•Force exerted from blood on walls of
vessels
•Phases of Cardiac Cycle
•Systolic
•Pressure against the walls when the L
ventricle contracts
•HIGH PRESSURE
•Diastolic
•Pressure against the walls when the L
ventricle relaxes
•Low pressure

20. Auscultating Blood Pressure
•Auscultation
•Listens to systolic/diastolic sounds as artery goes from
collapsed to open
•How to…
•Place cuff just above elbow
•Use marking, line up with brachial artery
•Locate brachial pulse and place your stethoscope
•Close valve
•Inflate until needle stops undulating as pressure increases
(150-220 mmHg)
•Release pressure until you hear a heartbeat =Systolic
•Continue until you hear no sound = Diastolic

21. Blood Pressure Ranges
•Normal ranges
•Systolic = 100 + pt age (140-150mmHg)
•Diastolic= 65-90 mmHg
•Textbook perfect = 120/80
•Expressed as:
•Systolic/Diastolic
•Asses in ALL pt 3 y/o +

22. Palpating Blood Pressure
•How to…
•Place B/P cuff as before
•Palpate radial pulse
•Inflate cuff as normal
•Deflate cuff until you feel the radial artery
•Gives you ONLY the systolic pressure
•Why do it?
•Unable to obtain brachial b/p
•Expressed as
•120/palp or 120/p

23. Pupils
•Why?
•Easy way to assess
neural status
•How?
•Briefly shine a light in the
pt eyes
•Evaluation:
•Diameter
•Reactivity to light
•Equal size

24. Pupils PERRL
•Normal
•PERRL
•“Pupils Equal, Round & Reactive to light”
•Abnormal
•Constricted/pinpoint
•Overdose (opiate i.e. Heroine)
•Dilated
•Severe lack of O2 = Hypoxia
•Brain Death
•Toxic substances
•Unequal
•Brain Injury

25. Dilated
Constricted
Unequal

26. How often to assess
•Stable Pt
•Every 15 min
•Unstable Pt
•Every 5 min
•Following ANY medical intervention

27. SAMPLE History
•Sings/Symptoms
•Sign
•Any condition the EMT
sees
•Symptom
•Any condition described
by the pt

28. SAMPLE History
•Allergies
•Medications
•Food
•Environmental

29. SAMPLE History
•Medications
•Prescription
•Current
•Recent
•Birth control?
•Non-Prescription
•Current
•Recent

30. SAMPLE History
•Past Pertinent Medical History
•Medical
•Surgical
•Trauma

31. SAMPLE History
•Last oral intake
•Time
•Quantity

32. SAMPLE History
•Events leading to injury/illness
•Example
•Pt was dizzy then fell
•Medical – Trauma
•Pt fell and then was dizzy
•Trauma- Medical

33. That does it… Have a GREAT
night!