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LEARNING OBJECTIVES
DEFINITIONS AND PHYSIOLOGY
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HE LOOKS BAD
BY MEASURING THE VITAL SIGNS ONLY
YOU
CAN HAVE A RELIABLE ASSESSMENT OF
CASUALTYS CURRENT CONDITIONS
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REFERENCES
PRE HOSPITAL TRAUMA LIFE SUPPORT (PHTLS)
MILITARY 7th EDITION 2011 ISBN 978-0-323-06503-0
CHAPTER 6, PP. 113-115
CHAPTER 8, PP. 194-196
CHAPTER 20, PP.479-480
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ADDITIONAL SIGNS
TO ASSES THE PATIENTS CONDITION ARE ALSO USEFUL:
CRT CAPILLARY REFILL TIME
SKIN COLORATION (e.g. pale, bluish, waxy or red)
URINE OUTPUT /24h
THE URINE OUTPUT / 24h IS VERY IMPORTANT TO MONITOR ANY
CRITICALLY INJURED PATIENT BUT IT IS BEYOND THE SCOPE OF
THIS COURSE
PULSE OXYMETRY
IT IS BEYOND THE SCOPE OF THIS COURSE
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ABNORMAL TEMPERATURE
PYREXIA (FEVER) IS AN ELEVATION ABOVE THE
NORMAL RANGE > 37.8C / 100F (ORAL)
HEAT IS PRODUCED FASTER THAN THE BODY
CAN ELIMINATE IT
FEVER IS A COMMON SYMPTOM OF INFECTION
OR OTHER ILLNESS
HYPOTHERMIA IS A REDUCTION BELOW THE
NORMAL RANGE. < 36.0C / 98.3F, IT MAY BE
CAUSED BY
SHOCK
STARVATION
PROLONGED ILLNESS
OVER EXPOSURE TO THE ENVIRONMENT
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MEASURING TEMPERATURE
THE TEMPERATURE CAN BE MEASURED AT:
THE MOUTH (ORAL)
THE RECTUM (RECTAL)
THE ARMPITS (AXILLARY)
THE METHOD USED WILL DEPEND ON
THE PATIENTS AGE
THE PATIENTS PHYSICAL CONDITION
EQUIPMENT AVAILABLE
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ORAL TEMPERATURE
IS THE MOST CONVENIENT METHOD
USED FOR RESPONSIVE ADULT PATIENTS
IF THE PATIENT HAS HAD FOOD OR DRINK,
OR HAS BEEN SMOKING, WAIT 15 MINUTES
WHEN HANDLING THERMOMETERS, HOLD
ONLY BY THE STEM END
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RECTAL TEMPERATURE
IS THE MOST ACCURATE METHOD (*), USED FOR
INFANTS AND YOUNG CHILDREN
UNCONSCIOUS / UNRESPONSIVE ADULTS
SUSPECTED HYPOTHERMIA
DO NOT USE ON PATIENTS WHO HAVE A RECTAL
DISORDER
(*) LATEST RESEARCHES INDICATE THAT THE EAR-DRUM
TEMPERATURE IS THE MOST ACCURATE BUT
ARE
EAR-THERMOMETERS AVAILABLE / USEFUL IN THE FIELD?
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AXILLARY TEMPERATURE
USED WHEN TEMPERATURE CANNOT BE TAKEN BY OTHER
METHODS
PROCEDURE:
DRY ARMPIT
PLACE BULB IN CENTRE OF ARMPIT POINTED TOWARD
PATIENTS HEAD
FOLD ARM ACROSS CHEST AND LEAVE FOR AT LEAST 10
MINUTES
REMOVE, READ AND RECORD TEMPERATURE
CLEAN WITH MEDISWAB
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RECORDING TEMPERATURE
ALWAYS USE DECIMALS e.g. 37.1
WRITE THE UNIT Celsius or Fahrenheit e.g. 98.4 F
ALWAYS INDICATE METHOD USED TO TAKE TEMPERATURE e.g. 37.1 C (R) or (O) or (A)
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THERMOMETERS
MOST COMMON TYPES ARE:
ELECTRONIC DIGITAL THERMOMETER
MERCURY FILLED THERMOMETER (BLUE TIP)
OTHER TYPES ARE:
SINGLE-USE CLINICAL THERMOMETER
e.g. 3M TEMPADOT
EAR SCANNING
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THE PULSE
IT IS DEFINED AS THE EXPANSION AND CONTRACTION
OF AN ARTERY CAUSED BY THE HEART BEATING
NORMALLY RHYTHMIC
WHEN THE HEART CONTRACTS BLOOD IS FORCED
INTO THE ARTERIES
THE PULSE WAVE CAUSES AN EXPANSION ALONG
THE ARTERIES
A PULSE IS MEASURED AS AN AID TO DETERMINING
THE PATIENTS CONDITION BY COMPARING IT WITH
NORMAL HEART RATE
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PULSE SITES
THE PULSE CAN BE PALPATED AT POINTS WHERE AN
ARTERY LIES CLOSE TO THE SKIN OR WHERE IT CROSSES
A BONE:
WRIST (RADIAL)
NECK (CAROTID)
GROIN (FEMORAL)
UPPER ARM (BRACHIAL)
INNER ANKLE (POSTERIOR TIBIAL)
TOP OF THE FOOT (DORSALIS PEDIS)
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BRADYCARDIA
IT IS A PULSE RATE BELOW 60 bpm
PATIENTS WITH HEART DISEASE MAY HAVE A SLOW
HEART RATE DUE TO DRUGS
ATHLETES MAY HAVE A NORMAL PULSE BELOW 60
bpm
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TACHYCARDIA
IT IS A PULSE RATE OVER 100 bpm
PHYSIOLOGICAL CAUSES
EMOTION
EXERCISE
PAIN
PATHOLOGICAL CAUSES
FEVER
SHOCK
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PROCEDURE
LOCATE THE PULSE POINT
PALPATE THE PULSE BY PLACING THE FIRST 2-3 FINGERS
(NOT THE THUMB) ON THE PULSE POINT
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RESPIRATORY RATE
RESPIRATION IS THE PROCESS BY WHICH O2 AND
CO2 ARE INTERCHANGED BY THE BODY
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NORMAL AVERAGE OF
RESPIRATORY RATES
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PATTERNS OF BREATHING
EUPNEA RELAXED, EFFORTLESS, EVENLY
PACED AND AUTOMATIC
ABNORMAL DYSPNEA, TACHYPNEA,
BRADYPNEA, RESPIRATORY DISTRESS, ETC.
SPECIFIC PATTERNS CHEYNE-STOKES,
KUSSMAUL, ETC.
NOISY REGARD ANY NOISY BREATHING AS
OBSTRUCTED BREATHING
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BLOOD PRESSURE
IT IS DEFINED AS THE PRESSURE EXERTED
BY BLOOD ON THE WALLS OF THE VESSELS
ALL PARTS OF THE VASCULAR SYSTEM
ARE UNDER PRESSURE
BLOOD PRESSURE USUALLY REFERS TO
THE ARTERIAL PRESSURE
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BLOOD PRESSURE
THE BLOOD PRESSURE IS THE PRODUCT OF:
FORCE OF CONTRACTION OF THE VENTRICLES
AMOUNT OF BLOOD PUMPED OUT OF THE HEART
RESISTANCE OF THE BLOOD VESSELS TO THE FLOW OF
BLOOD THROUGH THEM
BY MEASURING THE BLOOD PRESSURE, INFORMATION CAN
BE OBTAINED ABOUT:
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FACTORS INFLUENCING BP
PHYSIOLOGICAL
PATHOLOGICAL
AGE
DRUGS
SEX
DISEASE
BODY BUILD
HEMORRHAGE
EXERCISE
INTER-CRANIAL PRESSURE
PAIN EMOTION
CARDIAC TAMPONADE
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EQUIPMENT
SPHYGMOMANOMETER
STETHOSCOPE
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SIMPLIFIED BP MEASUREMENT
IN THE BATTELFIELD (TRAUMA/MASS CASUALTY) BP CAN BE ESTIMATED ACCORDING TO THE
PRESENCE OF DIFFERENT PERIPHERAL PULSES (NO EQUIPMENT IS NEEDED FOR THIS IMMEDIATE
APPROACH)
RADIAL PULSE PRESENT BP AT LEAST 80 mmHg
FEMORAL PULSE PRESENT BP 70 > < 80 mmHg
CAROTID PULSE PRESENT BP 60 > < 70 mmHg
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ABNORMALITIES OF BP
HYPERTENSION
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PROLONGED RETURN
INDICATES A SLOW PERFUSION OF NAIL BEDS BECAUSE OF
SEVERE
HYPOVOLEMIC OR HYPOTHERMIC CONDITIONS
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CYANOSIS e.g. SEVERE BREATHING PROBLEMS AND HEART FAILURES (WHEN HEMOGLOBIN IS POORLY
OXYGENATED, BOTH THE BLOOD AND THE SKIN, ESPECIALLY LIPS AND NAIL BEDS, APPEAR BLUISH)
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