1. VITALS
STS
2/3/2015

2. BELLSRP…P
Blood pressure Eyes Lung sounds Level of consciousness Skin signs Respirations Pulse Pulse oximeter

3. Blood pressure What is the normal systolic range for blood pressure?
<120 mmHg is ideal
mmHg is normal but borderline high
What are the two ways to measure blood pressure?
Auscultation and palpation (can only get systolic)
What happens if you don’t hear anything?
Check stethoscope earbud placement
Kinks in the stethoscope tubing
Check bell of the stethoscope by tapping it

4. eyes
What does PERRL stand for? Pupils equal, round, reactive to light What do pinpoint pupils suggest? Possible drug intake (cocaine) What is nystagmus and what does it suggest? Involuntary eye movement; EtOH (but keep in mind there are other possibilities; consider circumstances) What if pupils are unequal? Orbital fracture, concussion, intracerebral hemorrhage, etc. (suspect head injury)

5. Level of consciousness
What are the three parts to the Glasgow Coma Scale? Eyes – 4, Verbal – 5, Motor – 6 Your patient opens eyes to pain, has slurred but comprehensible speech and slaps your hand away when you pinch his arm. What is his GCS grade? Eyes: 2, Verbal: 4, Motor: 5; total = 11 Another way is A&O scale. If patient isn’t A&Ox3, be wary of responses to SAMPLE.

6. Skin signs
If diabetic and patient presents cold and clammy skin, are they hyper- or hypoglycemic? Hypoglycemic (“cold and clammy, need some candy, warm and dry, sugar is high”) What do you do for a patient who is EtOH and has cool, clammy skin? Give a blanket, even if patient reports feeling hot. If it’s a hot day, watch for signs of overheating.

7. Respirations & Pulse
Normal range for adult breathing is… breaths/min Report abnormal breathing rate, rhythm, tidal volume. Report abnormal pulse rate/rhythm. Keep in mind that some people are normally outside this range, e.g. athletes.

8. Pulse oximetER
Under 95%, what do you do? Give O2 via nasal cannula, 6 L/min. Note: pulse ox gives reading for pulse as well. When using pulse ox, wait seconds for reading to stabilize.

9. PRACTICE! 