1. Baseline Vital Signs and SAMPLE History
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2. Terminal Learning Objective
Given a patient care scenario and the proper medical equipment in a clinical environment or field setting, assess a baseline set of patient vital signs and obtain an accurate SAMPLE history IAW Chapter 5, Emergency Care and Transportation of the Sick and Injured, 9th Edition, American Academy of Orthopedic Surgeons (AAOS).
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3. Enabling Learning Objectives
Given a patient, with a trauma or medically-related complaint, in a pre-hospital environment, describe the basic principles, sequence and components of an accurate baseline set of vital signs IAW Emergency Care and Transportation of the Sick and Injured, 9th Edition, American Academy of Orthopedic Surgeons (AAOS).
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4. Enabling Learning Objectives
Given a patient, with a trauma or medically-related complaint, in a pre-hospital environment, demonstrate the proper technique(s) for obtaining a complete set of baseline vital signs and a concise patient history using the acronym SAMPLE IAW Emergency Care and Transportation of the Sick and Injured, 9th Edition, American Academy of Orthopedic Surgeons (AAOS).
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5. Baseline Vital Signs and SAMPLE History
Assessment is the most essential skill EMT-Bs learn.
During assessment you will:
Gather key information
Evaluate the patient
Learn the history
Learn about the patient’s overall health
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6. Gathering Key Patient Information
Obtain the patient’s name.
Note the age, gender and
race.
Look for identification if the
patient is unconscious.
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7. Baseline Vital Signs
During the assessment, the EMT-B uses many senses and a few basic medical instruments.
First set is known as the baseline vitals.
Repeated vital signs are compared to the baseline.
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8. Baseline Vital Signs and SAMPLE History
Chief Complaint (CC); Mechanism of Injury (MOI):
Chief complaints are the major signs, symptoms or events that caused the call or complaint
Symptoms: what the patient tells you
Signs: can be seen, heard , felt, smelled or measured
Sign or symptom?
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9. Obtaining a SAMPLE History
S : Signs and Symptoms of the episode:
What signs and symptoms occurred at onset?
Does the patient report pain?
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10. Obtaining a SAMPLE History
A : Allergies:
Is the patient allergic to medications, foods or other substance?
What reactions did the patient have to any of them?
Note: If the patient has no know allergies, you should note this on the run sheet as “no known allergies” or “NKA”
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11. Obtaining a SAMPLE History
M : Medications:
What medications was the patient prescribed?
What dosage was prescribed?
How often is the patient supposed to take the medication?
What prescription, over-the-counter (OTC) medications, and herbal medications has the patient taken in the last 12 hours?
How much was taken and when?
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12. Obtaining a SAMPLE History
P : Pertinent past history:
Does the patient have any history of medical, surgical, or trauma occurrences?
Has the patient had a recent illness or injury, fall or blow to the head?
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13. Obtaining a SAMPLE History
L : Last oral intake:
When did the patient last eat or drink?
What did the patient eat or drink, and how much was consumed?
Did the patient take any drugs or drink alcohol?
Has there been any other oral intake in the last 4 hours?
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14. Obtaining a SAMPLE History
E : Events leading to injury or illness
What are the key events that led up to this incident?
What occurred between the onset of the incident and your arrival?
What was the patient doing when this illness started?
What was the patient doing when this injury happened?
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15. O-P-Q-R-S-T
Mnemonic device to help you remember questions you should ask to obtain a patient history.
O : Onset: When did the problem begin and what caused it?
P : Provocation or Palliation: Does anything make it feel better? Worse?
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16. O-P-Q-R-S-T
Q : Quality: What is the pain like? Sharp, dull, crushing, tearing?
R : Region/Radiation: Where does it hurt? Does the pain move anywhere?
S : Severity: On a scale of 1 to 10, how would you rate your pain?
T : Timing of pain: Has the pain been constant or does it come and go? How long have you had the pain?
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17. Baseline Vital Signs Baseline vital signs always include
Respirations, Pulse & Blood Pressure
Other key indicators:
Skin: color, condition, temperature (CCT)
Capillary refill time (in children)
Pupillary response
Level of Consciousness (LOC)
Sometimes Temperature (medical patients)
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18. Respirations
A patient who is breathing without assistance: spontaneous respirations.
Each complete breath consists of two distinct phases:
Inspiration (inhalation): the chest rises up and out, drawing oxygenated air into the lungs
Expiration (exhalation): the chest returns to its original position, releasing air with an increased carbon dioxide (CO²) level out of the lungs
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19. Respirations Rate: Quality: character of breathing: Depth:
The number of breaths in 30 seconds x 2
Quality: character of breathing:
Rhythm (regular or irregular)
Effort (normal or labored)
Depth:
- Tidal Volume (the amount of air exchanged with each breath)
-Depth and rate of breathing determines the tidal volume
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20. EMT-B/LPC 01 May 06
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21. Respiratory Rate Adults: 12 to 20 breaths/minute
(over age 8)
Children: 18 to 30 breaths/minute
(1 to 8 years of age)
Infants: 30 to 60 breaths/minute
(under 1 year of age)
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22. Respirations Effort (labored):
Unable to speak more than 2-3 words at a time
Assuming a “tripod” position
Assuming a “sniffing” position (children)
Noisy breathing:
Stridor
Wheezes, snoring
Coughing (productive?)
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23. Pulse Oximetry Evaluates the effectiveness of oxygenation.
Normal value: 95% - 100%.
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24. Pulse
With each heartbeat, ventricle contract, forcefully ejecting blood from the heart and propelling it into the arteries.
A pulse is the pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries.
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25. Pulse
Carotid Pulse Radial Pulse
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26. Pulse
Brachial Pulse
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27. Pulse Rate: Strength: Regularity: Number of beats in 30 seconds x 2
Stronger than normal (bounding), strong or weak (thready)
Regularity:
Regular or irregular
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28. EMT-B/LPC 01 May 06
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29. Normal Pulse Ranges Adults: 60 to 100 beats/minute
Children: 70 to 120 beats/minute
Toddlers: 90 to 150 beats/minute
Newborns: 120 to 160 beats/minute
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30. The Skin
The condition of the patient’s skin can tell you a lot about the patient’s:
Peripheral circulation and perfusion
Blood oxygen levels
Body temeperature
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31. The Skin (CCT) Color: Condition: (moisture) Temperature:
Pink, pale, blue, red, or yellow
Condition: (moisture)
Dry, moist or wet
Temperature:
Warm, hot or cool
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32. Capillary Refill
Evaluates the ability of the circulatory system to restore blood to the capillary system (perfusion).
Evaluated at the nail bed (finger)
Depress the finger tip, pressure forcing blood from the capillaries and look for return of blood
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33. Capillary Refill
As the capillaries refill, should return to its normal deep pink color
Color should be restored within 2 seconds (about the time it takes to say, “Capillary refill”
Invalid test in a cold environment; elderly
Used for < 6 years old
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34. Blood Pressure Blood pressure is a vital sign.
Pressure of circulating blood against the walls of the arteries.
A drop in blood pressure may indicate:
Loss of blood
Loss of vascular tone
Cardiac pumping problem
Blood pressure should be measured in all patients older than 3 years of age.
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35. Blood Pressure Diastolic: Systolic:
Pressure during relaxing phase of the heart’s cycle
Systolic:
Pressure during contraction
Measured as millimeters of mercury (mmHg).
Recorded as systolic/diastolic.
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36. Blood Pressure Equipment
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37. Auscultation of Blood Pressure
Place cuff on patient's arm (1” above elbow).
Palpate brachial artery and place diaphragm of stethoscope over artery.
Inflate cuff until you no longer hear pulse sounds.
Continue pumping to increase pressure by an additional 20 mmHg.
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38. Auscultation of Blood Pressure
Note the systolic and diastolic pressures as you let air escape slowly.
As soon as pulse sounds stop, open the valve and release the air quickly.
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39. Measuring Blood Pressure
Palpation
Auscultation
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40. Palpation of Blood Pressure
Secure cuff.
Locate radial pulse.
After the pulse disappears continue to inflate another 30mmHg.
Release air until pulse is felt.
Method only obtains systolic pressure.
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41. Normal BP Ranges Adults 90 to 140 mmHg (s) 60 to 90 mmHg (d)
Age Range
Adults 90 to 140 mmHg (s)
60 to 90 mmHg (d)
Children (1-8) 80 to 110 mmHg (s)
Infants (up to 1 yr) 50 to 90 mmHg (s)
*Varies with age and gender.
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42. Blood Pressure Hypotension: Hypertension:
BP significantly lower than the normal range
Critical hypotension: BP is no longer able to compensate sufficiently to maintain adequate perfusion
Hypertension:
BP significantly higher than the normal range
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43. Level of Consciousness
A - Alert
V - Responsive to
Verbal stimulus
P - Responsive to Pain
U - Unresponsive
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44. Pupil Assessment P - Pupils E - Equal A - And R - Round
R - Regular in size
L - React to Light
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45. Abnormal Pupil Reactions
Fixed with no reaction to light.
Dilate with light and constrict without light.
React sluggishly.
Unequal in size.
Unequal with light or when light is removed.
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46. Reassessment of Vital Signs
The vital signs you obtain serve two important functions:
First set establishes a baseline of respiratory and cardiovascular system status
Serves as a key baseline
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47. Reassessment of Vital Signs
Reassess stable patients every 15 minutes.
Reassess unstable patients every minutes.
Reassess/record VS after all medical interventions.
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48. Questions?
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