Baseline Vital Signs and SAMPLE History EMT-B/LPC 01 May 06 C191W164/1

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). EMT-B/LPC 01 May 06 C191W164/1

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). EMT-B/LPC 01 May 06 C191W164/1

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). EMT-B/LPC 01 May 06 C191W164/1

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 EMT-B/LPC 01 May 06 C191W164/1

Gathering Key Patient Information Obtain the patient’s name. Note the age, gender and race. Look for identification if the patient is unconscious. EMT-B/LPC 01 May 06 C191W164/1

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. EMT-B/LPC 01 May 06 C191W164/1

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? EMT-B/LPC 01 May 06 C191W164/1

Obtaining a SAMPLE History S : Signs and Symptoms of the episode: What signs and symptoms occurred at onset? Does the patient report pain? EMT-B/LPC 01 May 06 C191W164/1

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” EMT-B/LPC 01 May 06 C191W164/1

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? EMT-B/LPC 01 May 06 C191W164/1

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? EMT-B/LPC 01 May 06 C191W164/1

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? EMT-B/LPC 01 May 06 C191W164/1

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? EMT-B/LPC 01 May 06 C191W164/1

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? EMT-B/LPC 01 May 06 C191W164/1

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? EMT-B/LPC 01 May 06 C191W164/1

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) EMT-B/LPC 01 May 06 C191W164/1

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 EMT-B/LPC 01 May 06 C191W164/1

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 EMT-B/LPC 01 May 06 C191W164/1

EMT-B/LPC 01 May 06 C191W164/1

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) EMT-B/LPC 01 May 06 C191W164/1

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?) EMT-B/LPC 01 May 06 C191W164/1

Pulse Oximetry Evaluates the effectiveness of oxygenation. Normal value: 95% - 100%. EMT-B/LPC 01 May 06 C191W164/1

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. EMT-B/LPC 01 May 06 C191W164/1

Pulse Carotid Pulse Radial Pulse EMT-B/LPC 01 May 06 C191W164/1

Pulse Brachial Pulse EMT-B/LPC 01 May 06 C191W164/1

Pulse Rate: Strength: Regularity: Number of beats in 30 seconds x 2 Stronger than normal (bounding), strong or weak (thready) Regularity: Regular or irregular EMT-B/LPC 01 May 06 C191W164/1

EMT-B/LPC 01 May 06 C191W164/1

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 EMT-B/LPC 01 May 06 C191W164/1

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 EMT-B/LPC 01 May 06 C191W164/1

The Skin (CCT) Color: Condition: (moisture) Temperature: Pink, pale, blue, red, or yellow Condition: (moisture) Dry, moist or wet Temperature: Warm, hot or cool EMT-B/LPC 01 May 06 C191W164/1

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 EMT-B/LPC 01 May 06 C191W164/1

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 EMT-B/LPC 01 May 06 C191W164/1

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. EMT-B/LPC 01 May 06 C191W164/1

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. EMT-B/LPC 01 May 06 C191W164/1

Blood Pressure Equipment EMT-B/LPC 01 May 06 C191W164/1

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. EMT-B/LPC 01 May 06 C191W164/1

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. EMT-B/LPC 01 May 06 C191W164/1

Measuring Blood Pressure Palpation Auscultation EMT-B/LPC 01 May 06 C191W164/1

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. EMT-B/LPC 01 May 06 C191W164/1

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. EMT-B/LPC 01 May 06 C191W164/1

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 EMT-B/LPC 01 May 06 C191W164/1

Level of Consciousness A - Alert V - Responsive to Verbal stimulus P - Responsive to Pain U - Unresponsive EMT-B/LPC 01 May 06 C191W164/1

Pupil Assessment P - Pupils E - Equal A - And R - Round R - Regular in size L - React to Light EMT-B/LPC 01 May 06 C191W164/1

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. EMT-B/LPC 01 May 06 C191W164/1

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 EMT-B/LPC 01 May 06 C191W164/1

Reassessment of Vital Signs Reassess stable patients every 15 minutes. Reassess unstable patients every 5 minutes. Reassess/record VS after all medical interventions. EMT-B/LPC 01 May 06 C191W164/1

Questions? EMT-B/LPC 01 May 06 C191W164/1