2/4/2014

EMT Review: Baseline Vital Signs and SAMPLE History

1-5 Baseline Vital Signs and SAMPLE History

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Baseline Vital Signs

The first set of vital signs measured on a patient.

Vital Signs and Measurements

Breathing: observing chest rise and fall. Count the number of breaths in 30 sec. Multiply by 2 for breaths per min. Pulse: palpate the artery with the index and middle finger tips. Count the number of beats in 30 sec. Multiply by 2 for beats per min. Skin: observing color, feel for temperature and condition using the back of your hand without glove covering, and measure capillary refill by depressing on the patient's nail bed and observe for return of color. Pupils: observe size and reaction to penlight. Blood Pressure: Taken using a sphygmomanometer and a stethoscope. Pulse Oximetry: Measured using a pulse oximeter.

MODULE 1: PREPARATORY MODULE 2: AIRWAY MODULE 3: PATIENT ASSESSMENT MODULE 4: EMERGENCIES & OB/GYN MODULE 5: TRAUMA MODULE 6: INFANTS AND CHILDREN MODULE 7: OPERATIONS MODULE 8: ADVANCED AIRWAY MISCELLANEOUS

Normal Vital Signs

Breathing 12-20 per min for adults. 20-30 for small children. >30 for infants and newborns. Adequate chest expansion (1 in.). Clear and effortless. Pulse 60-80 per min for adults. Faster for children and the elderly. Strong and regular.
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Pulse Oximeter Blood Sample

EMT Review: Baseline Vital Signs and SAMPLE History

Skin Pink (palm and sole), Warm and dry. Fast Capillary refill (under 2 sec male adults and children, 3 for females, and 4 in the elderly). Pupils Normal and equal in size. Respond to light. Blood Pressure: 120 / 80 (systolic / diastolic) in adults. Higher in the elderly and lower in children. Pulse Oximetry: 97-100%

Detailed Vital Signs and Symptoms

Breathing
Detailed Normal Rates of Breathing Rate 12per 15-30 20-30 25-40 30-60 20 min Age 11+ 6 - 10 6 months 30 days - 0 - 30 group years years - 5 years 5 months days Shallow breathing: inadequate chest or abdominal wall (children) expansion. Labored breathing: use of accessory muscles. Noisy breathing Snoring: tongue obstruction of the upper airway at the pharynx. Wheezing: constriction of the bronchioles. Gurgling: fluid in the upper airway. Crowing or Stridor (harsh high pitched sound): obstruction of the upper airway at the larynx.

Pulse
Patient Adult Elderly Slow Normal Rapid (bradycardia) (at (tachycardia) if below rest) if above 60 60-80 100 90 60-105 105 60-120 120
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Adolescent 50 Child (512 years) 60

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EMT Review: Baseline Vital Signs and SAMPLE History

Child (1-5 80 years) Infant 120

80-150 150 120150 150

Pulse characteristic

Possible problems / diagnosis

Normal rate, regular rate, and strong Normal person at rest (full) pulse Exertion, fright, fever, high Rapid, regular and blood pressure, initial strong response to injury and bleeding Rapid, regular and weak (also called Indication of shock regular and thready) Head injury, drug use (barbiturate or narcotic), Slow poisons, possible cardiac problem No pulse Cardiac arrest Pulsus paradoxus Severe cardiac or (decrease in pulse respiratory injury, illness or strength during blood loss inhalation) Pulses can be located in the major arteriesCarotid (neck), Femoral (groin), Radial (wrist), Brachial (arm), Popliteal (behind knee), Posterior Tibial (ankle), Dorsalis Pedis (foot).

Skin
Temperature Hot: fever, exposure to heat, localized infection. Warm: normal. Cool: inadequate circulation, shock, or exposure to cold. Cold: extreme exposure to cold. Condition Abnormally Dry: severe dehydration or spinal injury. Dry: normal. Wet or Moist: shock, or heat, cardiac, or diabetic emergencies.
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EMT Review: Baseline Vital Signs and SAMPLE History

Clammy (cool and wet / diaphoretic): indication of shock. Color Pale or mottled: onset of shock. Cyanotic: late sign of shock. Red: anaphylactic or vasogenic shock, poisoning, overdose or other medical condition. Yellow: jaundice, liver problems. Capillary Refill: more reliable for children under 6. Slow cap refill = possible hypoperfusion.

Pupils
Dilated: cardiac arrest, use of stimulant drugs like cocaine, amphetamine, LSD. Constricted: central nervous system disorder, use of narcotics. Unequal: Stroke, head injury, artificial eye, eye drops. Nonreactive: Cardiac arrest, brain injury, drug influence.

Blood Pressure
Normal blood pressures Patient Adult Male Systolic (mmHg) 100 + age up to 40 Diastolic (mmHg) 60-85

Adult female 90 + age up to 40 60-85 Adolescent 90 and above 2/3 systolic Child (1-10 80 + (2 x age) 2/3 systolic yrs) +/- 10 Infant (1-12 70 and above 2/3 systolic mo) Hypertension: high blood pressure in an adult is considered over 140 / 85. Pulse pressure: the difference between systolic and diastolic pressure. Normally falls between 25 % and 50 % of systolic pressure. Narrow (low) pulse pressure: shock, cardiac tamponade (blood filling the pericardial sac, compressing the heart), tension pneumothorax (injury to one lung, causing pressure on the heart
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EMT Review: Baseline Vital Signs and SAMPLE History

and the other lung). Wide (high) pulse pressure: head injury. Measuring blood pressure: Using a sphygmomanometer (wrapped around the arm), applying pressure (by pumping) over the brachial artery until a radial pulse can no longer be detected. Over pump 30 mmHg, then slowly release the pressure. Detect for a return of pulse by either auscultation or palpation. Auscultation: listening with a stethoscope for the return of the brachial pulse. The first sound marks the systolic pressure and the last sound (either a disappearance or a notable drop in volume) marks the diastolic pressure. Palpation: palpating for the radial pulse. When the radial pulse returns, this is the systolic pressure. The palpation technique cannot measure diastolic pressure (a "P" is noted in place of the diastolic pressure). The systolic pressure measured is approximately 7 mmHg lower than those obtained by auscultation. Do not over pump more than what is needed- it can be very painful for the patient. Orthostatic Vital Signs Test (Tilt Test): Measures heart rate and blood pressure for a patient while supine and while standing up. A positive result occurs when the heart rate increases 10-20 bpm and the blood pressure decreases 10-20 mmHg up standing up. This indicates significant blood loss.

Pulse Oximetry
Measured over the tip of the index finger, can detect hypoxia, which can be treated by applying oxygen via a nonrebreather mask. Limitations: Directly measures hemoglobin saturation, not oxygen level. Therefore, false readings can occur during carbon monoxide poisoning. Errors in reading can also occur from nail polish and excessive finger movement.

Vital Sign Reassessment

Stable patients: every 15 min Unstable patients: every 5 min
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EMT Review: Baseline Vital Signs and SAMPLE History

The SAMPLE History

Medical history obtained from the patient, family and bystanders
Signs and Symptoms Signs: what you can observe and measure about the patient, such as the vital signs. Symptoms: what the patient describes to you- pain, numbness...etc. You cannot observe these, so you must ask OPQRST Onset: "what were you doing when it started?" Provocation or Palliation: "does anything make it worse? Anything makes it better?" Quality of pain: "can you describe it to me? Is it sharp, dull, constant, intermittent?" Region and Radiation: "where exactly does it hurt? Does the pain extend anywhere else?" (Myocardial infarction produces pain that radiates to the arms and jaw) Severity: "on a scale of 1 to 10, how much does it hurt?" Time: "how long has this been going on? How has this progressed over time?" Allergies: "Do you have any allergies?" This includes medication, food, or other environmental factors. Check for medical alert tags. Medications: "Are you on any medications? Have you taken medications recently?" This includes prescriptions, over-the-counter, birth control pills, illicit drugs (be tactful, indicate that you are not an EMT, not a police officer, and you need the information for treatment purposes), or herbal medicine. Look for medical tags. Pertinent past history: "Have you ever had any illnesses? Operations? Have you ever been admitted to a hospital?" Find out medical problems and past surgical procedures. Last oral intake: "When did you last eat or drink
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something? What was it?" A diabetic patient who hasn't consumed anything for 8 hours may be hypoglycemic. Events leading up to the injury or illness: "What happened? How did this happen?" The events leading up to the injury provide clues for the underlying cause.

Document all pertinent findings from the SAMPLE history on the PCR (Prehospital care report)
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