Vitals and History Taking Hillcrest Fire Training December, 2000

Where are we going? What are vital signs? How do you take them? So, what’s normal? SAMPLE History

What are the vitals They provide information about the status of a patient Breating (Respirations) Pulse Skin Pupils Blood Pressure

Counting Respirations Respiration is one inhalation and exhalation. Determined by counting for 30 sec, and multiplying by 2. A hand on the stomach/chest may help

Normal Respirations Adult 12-20/min Child 15-30/min Infant 25-50/min

Respiration Quality Normal Shallow (low tidal volume) Labored Use of accessory muscles Flaring Tripod Breating Noisy breathing

Pulse Determined by counting for 30 sec and multiplying by 2. Irregular pulse counted for 60 sec. Provides information about heart, blood volume and perfusion. Taken at a pulse point Don’t use your thumb

Common Pulse Points Central Pulses Carotid Femoral Peripheral Pulses Radial Brachial (children under 1) Posterior Tibial, Dorsalis Pedis

Pulse Quality Normal Bounding Weak Thready Regular/Irregular

Normal Pulse Rate Adult 60-80/min Child Infant

Skin Color Pink (Normal) Pale Cyanotic (Oxygen problems) Red (CO or heat problems) Yellow (Jaundice) Temperature Warm (Normal) Hot Cool Cold Condition Dry (Normal) Moist

Practice Get pulse and respirations from at least two people Try to get pulse from carotid, radial, and brachial pulse points

Assessing Skin Color assessed using lips, nail beds, inside of mouth, membranes of the eye Pull back glove to determine temp and condition In children under 6 capillary refill is useful for determining perfusion Refill should take less than 2 seconds

Pupils Size Constricted Dilated Equal/Unequal Reactivity to light Can check with pen light or by shielding eyes from light

Blood Pressure Taken with manual or automatic BP cuff Can be taken by auscultation or palpation

Key Terms Systolic Pressure when heart is pumping Diastolic Pressure when heart is at rest

BP by Auscultation Size using guides on cuff Position on upper arm hoses pointing down Inflate 30mmHg past pulse Position stethoscope over brachial artery Deflate Note first sound and last sound Record as systolic/diastolic (140/80)

One last note on Vitals First set of vitals is the baseline, you are interested in changes On not sick patients, repeat every 15 minutes On sick patients, repeat every 5 minutes Treat patient, not the vital signs or the equipment

BP by Auscultation Size using guides on cuff Position on upper arm hoses pointing down Inflate 30mmHg past pulse Position stethoscope over brachial artery Deflate Note first sound and last sound Record as systolic/diastolic (140/80)

BP by Palpation Size using guides on cuff Position on upper arm centered over brachial artery Inflate 30mmHg past pulse Deflate Record point at which pulse returns Record as Systolic/P (135/p)

Normal Blood Pressure Male Systolic = 100+age until 50 Diastolic =60-90 Female Systolic=90+age until 50 Diastolic = 50-80

Practice Get BP from two people Try at least two techniques for obtaining BP Auscultation, Palpation, or Automatic Cuff

History Taking

SAMPLE Organized technique to obtain pertinent medical informaiton Can obtain information from patient, family or bystanders SAMPLE is an acronym

SAMPLE Signs/Symptoms Allergies Medications Past Pertinent Medical Conditions Last Oral Intake Events Leading to Injury or Illness

Signs/Symptoms Signs – things you can see or hear Symptoms – things the patient reports

Allergies Environmental and Medical allergies are important Medic Alert tags are also useful

Medications Prescription and OTC Including vitamins, herbal remedies Birth Control Pills Illicit Drugs Always get a list of meds, or take them with Home O 2 rate is also important What did you take, when, how much?

Past Pertinent Medical History Underlying medical problems Recent visits to hospitals/doctors Recent medical procedures Recent accidents/falls/trauma Medic Alert tags may be useful Look for signs of medical equipment in the house

Last Oral Intake What, how much, when Important for trauma patients, diabetics

Events Leading to Call Get as much information as you can What happened, what were you doing Has anything unusual happened? If this is a chronic problem, what’s different this time?

Final SAMPLE notes Try to ask open ended questions (avoid yes/no questions) Wait for the patient to respond 5-10 seconds is not out of line Note pertinent negatives Write everything down

Practice Let’s go through a couple of scenarios