1. CHAPTER 12 SPORTS MEDICINE II

2. WHAT ARE VITAL SIGNS? Homeostasis: a state of equilibrium within the body maintained through the adaptation of body systems to changes in either the internal and external environment. When injury/illness occurs the body’s ability to maintain homeostasis is impaired – which will show in a person’s Vital Signs. Vital Signs: Assessment of pulse, respiration, blood pressure, and temperature. Important for health care providers to know what are normal and abnormal vital signs.

3. WHAT ARE THE FOUR MAIN VITAL SIGNS? Body Temperature Pulse Blood Pressure Respirations Thermometer Stethoscope or Palpation Sphygmomanometer Watch or Clock

4. PULSE Blood vessels expand and contract every time the heart beats. Blood flows though the vessels and waves of blood cause a rhythmic “thumping” in the arteries. A pulse can only be felt in an artery because arteries are the vessels that carry blood away from the heart to the rest of the body. Pulse: a vital sign; a measurement of the heart beat using the fingers to palpate an artery or a stethoscope to listen to the heartbeat.

5. PULSE A pulse tells us how often the heart beats. A change in pulse indicates a change in a patient’s status. (Ex: Rapid but weak = shock, Absence = cardiac arrest) Most common place to take a pulse is at the radial or carotid pulse.

6. NORMAL PULSE RANGES Pulse rates vary depending on: age, size of patient, physical condition. Recorded in beats per minute (bpm). Adult = 60 – 100 bpm Well Conditioned Athlete = 50 – 60 bpm (Because the heart muscles receive more exercise) Babies to age 1: 100 – 160 bpm Children ages 1 – 10: 60 – 140 bpm Children ages 11 – 17: 60 – 100 bpm

7. PULSE Tachycardia: Pulse rates higher than normal (Above 100 in adults) Bradycardia: Pulse rates lower than normal (Below 60 in adults; different for well conditioned athletes) Rhythm of pulse – regular (doesn’t change) or irregular (speeds up and/or slows down). Strength or quality of pulse – weak or strong. When noting pulse rate on a medical form indicate: 1. Rate – (Ex: 65 bpm) 2. Regularity of rhythm 3. Strength or Quality

8. MEASURING PULSE Place the patient’s hand in a resting position on a surface palm up. Feel along the inside of the wrist with your fingertips, locating the radial pulse below the thumb. Do not use your thumb, as it has a pulse of its own. Look at your watch or clock and find a starting point. Count the beats you feel for 30 seconds and then multiply by 2. If the pulse is irregular, count for a full minute and don’t multiply.

9. RADIAL PULSE Record your own radial pulse. Take turns and record your partner’s radial pulse.

10. MEASURING A CAROTID PULSE Use the pads of your first two fingers, and place them directly over one side of the front of the patient’s neck.

11. MEASURING A CAROTID PULSE Find your own carotid pulse. Count the beats that you feel underneath of your finger tips for 30 seconds and multiply by two. Record your partner’s carotid pulse rate.

12. RESPIRATION Respiration: Breathing; the process of bringing oxygen into the body and expelling carbon dioxide from the body. Oxygen is brought into the body to be utilized by cells. Carbon dioxide is expelled because it is a waste product of the cells. If breathing patterns are altered and the body is deprived of oxygen, serious damage can occur to the vital organs. Absence of respiration indicates a blocked airway or death.

13. RESPIRATION Respiration = consists of one inspiration and one expiration. Age 15 and older: 15 to 20 breaths per minute A well conditioned athlete: 6 – 8 breaths per minute

14. RESPIRATION PATTERNS Abdominal: respirations using primarily the abdominal muscles while the chest is mostly still Apnea: stopped breathing – temporary or permanent Bradypnea: abnormally slow breathing Cheyne-Stokes respiration: irregular breathing pattern of periods of apnea lasting 10-60 seconds followed by periods of fast and slow breathing Decreased: very little air movement in the lungs Dyspnea: difficult or painful breathing; shortness of breath Hyperpnea or tachypnea: breathing that is faster or deeper; hyperventilation Kussmaul’s breathing: deep, gasping respirations Labored breathing: difficult breathing that uses shoulder muscles, neck muscles, and abdominal muscles.

15. MEASURING RESPIRATIONS When a person focuses on their breathing pattern, the rate of respirations is often altered. Therefore, it is best to not tell a patient you are watching their breathing pattern. Look at your watch and find a starting point. Count each time the patient’s chest rises and falls = 1 single respiration. Count respirations for 30 seconds and multiply by 2. If breathing is irregular, count for a full minute

16. BLOOD PRESSURE Blood Pressure (BP): the measurement of the pressure exerted by the circulating blood against the walls of the arteries. Systolic Pressure: the top number of your BP. The BP when the heart contracts. Diastolic Pressure: the bottom number of your BP. The BP when your heart is at rest.

17. BLOOD PRESSURE BP is affected by several factors: Condition of the arteries and the force of the heartbeat. Age, exercise, obesity, food, pain, stress, stimulants, medications. Gender and heredity can influences a person’s BP. Although BP increases with exercise, it helps to lower overall BP because the heart becomes strong and healthy. An unhealthy person’s heart has to work harder to circulate blood throughout the body. Abnormal BP is a sign of various health problems.

18. ABNORMAL BP A systolic value below 100 or above 139 A diastolic value below 65 or above 89 Implications: Hypotension: Low BP; may indicate shock, dehydration, or internal injury. Hypertension: High BP; can exert extreme pressure on blood vessels, can lead to cardiac problems and strokes. Possible causes – obesity, lack of exercise, too much salt in diet, and stress.

19. HOW TO MEASURE BP 1. Ask the patient to roll their sleeve about 6 inches above the elbow. 2. Have them extend their arm, palm up, at heart level. 3. Place the BP Cuff securely around the arm, 2 inches above the bend in the elbow. 4. Be sure that the arrow on the BP cuff is placed over the brachial artery.

20. HOW TO MEASURE BP 5. Place the earpieces of the stethoscope in your ears with the tips pointing slightly forward. 6. Place the diaphragm of the stethoscope over the brachial pulse at the bottom of the BP cuff. 7. Hold the diaphragm with you non-dominant hand. 8. Close the control valve. 9. Quickly squeeze the bulb with your dominant hand until you can no longer hear the pulse (About 140-200)

21. HOW TO MEASURE BP 10. Slowly and steadily open the valve. (This will release the air in the cuff) 11. Listen for the 1 st clear tapping sound. When you hear it note the number on the gauge - (Systolic). 12. Continue to steadily deflate until you hear the last sound, note the number on the gauge – (Diastolic).

22. TEMPERATURE Core temperature: the internal body temperature. The body’s core temperature must remain within a relatively narrow range for its systems to function properly. Normal Temperature = 98.6 degrees F Oral temperature is the preferred method. Tympanic thermometer – in the ear.

23. MEASURING TEMPERATURE Wait at least 15 minutes after patient has had anything to eat or drink. Check to make sure the digital thermometer is working. Place a disposable cover on the thermometer. Place the probe in the patient’s mouth underneath of the tongue. Ask the patient to close their lips. When the thermometer beeps remove it from the patient’s mouth. Dispose of the cover. Record the temperature reading.