1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley CHAPTER Obtaining a Medical History and Vital Signs 11

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: a.Auscultation b.Baseline vital signs c.Blood pressure d.Capillary refill e.Chief complaint f.Cyanotic Objectives (continued)

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: g.Diaphoretic h.Diastolic i.Medical history j.Mental status k.OPQRST l.Palpation Objectives (continued)

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: m.Pulse n.Respiration o.SAMPLE history tool p.Sign q.Stethoscope r.Symptom Objectives (continued)

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: s.Systolic t.Trending u.Vital signs v.Work of breathing Objectives (continued)

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 2.Explain the importance of a thorough medical history. 3.Differentiate between a sign and a symptom. 4.Describe the components of the SAMPLE history tool. 5.Describe the components of the OPQRST assessment tool. 6.Explain the role that monitoring vital signs plays in the overall assessment and care of the patient. Objectives (continued)

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 7.State the characteristics that are obtained and measured when assessing respirations, pulse, blood pressure, skin signs, and pupils. 8.Describe the methods used to assess each of the five vital signs. 9.Differentiate the techniques used to assess a pulse in an infant, child, and adult patient. 10.Differentiate normal and abnormal vital sign values for the infant, child, and adult patient. Objectives (continued)

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 11.Demonstrate the ability to properly obtain and accurately trend and document vital signs. 12.Demonstrate a caring and compassionate attitude with classmates and simulated patient. Objectives

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Topics Obtaining a Medical History Vital Signs

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley OBTAINING A MEDICAL HISTORY

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obtaining a Medical History Medical history: previous medical conditions and events for patient. Signs: something you can see and observe about patient. – Can be pale skin; rapid pulse; open wound to chest. – All are obvious.

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Get down at eye level with your patient and make good eye contact as you begin your medical history.

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obtaining a Medical History Symptom: something patient feels; may complain about. – Can be obvious or very subtle. – Pain, nausea common symptoms.

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Common Signs and Symptoms

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obtaining a Medical History Interviewing Your Patient – An alert patient is the best source of information. – Chief complaint: main medical complaint described by patient. – Family members, bystanders, first responders should all be questioned. (continued)

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obtaining a Medical History Interviewing Your Patient: – Ask questions slowly and clearly. – Allow time for patient to process and respond. – Listen carefully. – Document important details. (continued)

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obtaining a Medical History Interviewing Your Patient – Establish a good rapport  Introduction  Consent  Patient's name  Patient's age  Chief complaint (continued)

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obtaining a Medical History Interviewing Your Patient – SAMPLE history tool:  S — Signs/symptoms  A — Allergies  M — Medications  P — Past pertinent medical history  L — Last oral intake  E — Events leading to the illness or injury (continued)

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SAMPLE HISTORY Class Activity (5 minutes) Scenario 1 Chief Complaint: Chest Pain S: pain, shortness of breath, chest pressure A: peanut allergy M: blood thinners P: Diabetes L: Took aspirin 5 minutes ago E: Watching TV, started having left shoulder pain, left jaw pain

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SAMPLE HISTORY Scenario 2 Chief Complaint: S: A: M: P: L: E:

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obtaining a Medical History Interviewing Your Patient – OPQRST: most commonly used for assessment of pain or discomfort.  O — Onset  P — Provocation  Q — Quality  R — Region/Radiate  S — Severity  T — Time

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley OPQRST Scenario 1 Chief Complaint: O: P: Q: R: S: T:

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley OPQRST Scenario 2 Chief Complaint: O: P: Q: R: S: T:

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obtaining a Medical History Additional Sources of Information – Family members, bystanders, first responders; patient unresponsive or unable to provide medical history. – Medical identification jewelry.

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Consider using bystanders or family members when your patient is unresponsive or unable to provide a medical history on his own.

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It How would you handle questions such as: – Have you been drinking? – Have you taken any drugs that are not prescribed for you? – Is there a chance you could be pregnant?

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley VITAL SIGNS

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Respiration Pulse Blood pressure Skin signs Pupils Perfusion: adequate supply of well- oxygenated blood to all parts of body

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Mental status (Level Of Consciousness [LOC]) or level of responsiveness evaluated using AVPU scale. – A — Alert – V — Verbal, responsive to verbal stimuli – P — Pain, responsive only to painful stimuli – U — Unresponsive, unconscious, or completely unresponsive

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Baseline vital signs: first set of vital signs obtained. Trending: comparing multiple sets of vital signs from same patient over time. Careful analysis of vital signs can alert you to current or developing problems. Do not rush to a conclusion too soon.

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Respiration: Act or process of breathing in (inhaling) and out (exhaling). Evaluate – Rate, depth, sound, ease. Work of breathing – Effort that patient must exert to breathe.

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Assessment Signs—Respirations

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs To assess respirations: – Grasp patient's wrist as if you were going to count pulse rate. Hold his arm firmly against his upper abdomen. – Observe abdomen and chest move in and out. Listen for abnormal sounds. – Count number of breaths patient takes in 15 or 30 seconds. – While counting respirations, note depth and ease of breathing. – Document rate, depth, ease. (continued)

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Normal Respiration Rates

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Emergency Medical Responder assessing respirations on a supine patient.

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley EMT assessing respirations on a seated patient.

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Pulse: remote heartbeat. – Gives insight into circulatory status of patient. – Good pulse indicates blood is moving well throughout body. – Carotid; femoral: central pulses. – Brachial; radial; pedal: peripheral pulses. (continued)

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Locating the carotid pulse point in the neck.

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Locating the radial pulse point in the wrist.

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Pulse – Assess for rate, strength, rhythm. Responsive patient – Check radial pulse. Unresponsive patient – Check carotid pulse. Radial pulse may not be detectable if blood pressure is too low or if there is extremity injury. (continued)

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Pulse rate for adults is between 60 and 100 beats per minute (see Table 11.4). – Tachycardia: Rate above 100, considered rapid. – Bradycardia: Rate below 60, considered slow – Pulse point for infants under the age of one year is brachial pulse in upper arm.

42. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Capillary refill: time it takes for capillaries to refill after being blanched. – Select appropriate finger or toe. – Using thumb and index finger, squeeze pad of finger or toe from both sides. Observe pad as it blanches. – Quickly release pressure; observe color return to pad; document findings.

43. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Checking capillary refill time in the fingers.

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Blood pressure: measurement of pressure of blood against walls of arteries, both when heart beats and when it is at rest. – Systolic: pressure within arteries when heart beats; contraction phase of heart. – Diastolic: pressure that remains in arteries when heart is at rest; resting phase of heart. (continued)

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Reading of 120/80 considered normal blood pressure. Take several readings to identify changes in status. Systolic reading above 140 considered high blood pressure (hypertension).

46. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Normal Blood Pressures

47. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Palpation: using one's hands to touch or feel the body. Auscultation: listening to internal sounds of the body (stethoscope). – Adjust earpieces. – Have patient sit or lie down. – Remove clothing on arm. – Support arm at level of heart.

48. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Adjust the earpieces of the stethoscope so they point forward into the ear canal.

49. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Proper position for taking a blood pressure while seated.

50. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Obtaining a blood pressure on a supine patient.

51. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Auscultation – Select correct-size blood pressure cuff. – Wrap cuff around upper arm. – Apply cuff securely but not too tightly. – Place ends of stethoscope in your ears. – Use fingertips to locate brachial artery. – Position diaphragm of stethoscope over brachial artery pulse site. (continued)

52. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Location of the brachial artery.

53. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Proper placement of the blood pressure cuff.

54. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Auscultation – Close valve and inflate cuff (180 mmHg adult; 120 mmHg child). – Open valve slowly to release pressure from cuff. – Listen carefully as you watch needle move. – Let cuff continue to deflate. – Let rest of air out of cuff quickly. – Record time, arm used, position of person, pressure readings.

55. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Place the cuff snugly around the upper arm.

56. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Palpate the brachial pulse point and place the diaphragm of the stethoscope over the pulse point.

57. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Quickly inflate the cuff then release the pressure to obtain the blood pressure readings.

58. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Document your readings.

59. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Palpation – Not very accurate method. – One reading: approximate systolic pressure. (continued)

60. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Place the cuff and locate the radial pulse.

61. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Inflate the cuff until you feel the radial pulse go away.

62. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Continue inflating cuff to approximately 30 mmHg beyond where the pulse went away.

63. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Release the pressure in the cuff and note the pressure on the gauge when the radial pulse returns.

64. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Palpation – Place cuff and locate radial pulse. – Inflate cuff until you feel radial pulse go away. – Continue inflating cuff to 30 mmHg beyond where pulse went away. – Release pressure in cuff; note pressure on gauge when radial pulse returns.

65. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Skin signs: evaluate color, temperature, and moisture. – Not perfused well: pale or cyanotic (bluish). – Receiving abnormal amount of blood flow: flushed (red). – Yellow: jaundiced. (continued)

66. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Skin signs – Examples of skin signs:  Pink, warm, dry (PWD)  Pale, cool, moist  Flushed, hot, moist  Flushed, hot, dry

67. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Skin Signs

68. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Use the back of an ungloved hand to assess skin temperature and moisture.

69. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Evaluate skin color in dark-skinned patients: – Oral mucosa – Conjunctiva – Nail beds – Palms

70. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Pupils – Note general condition; identify any obvious injury or deformity. – Ensure both pupils are round and same size. – Respond to sudden introduction of light by constricting; dilate when light to pupil is blocked. (continued)

71. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Vital Signs Pupils – PERL stands for:  P — Pupils  E — Equal  R — Reactive  L — Light – See Table 11.7: Pupils.

72. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Pupils

73. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Constricted pupils

74. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Dilated pupils

75. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Unequal pupils

76. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SUMMARY

77. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Good patient assessment: gathering information (history) about patient and chief complaint and obtaining complete and accurate vital signs. Properly introduce yourself and get patient's name right away. Whenever possible, direct your questions to patient.

78. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Speak clearly and confirm that patient hears, understands, and answers each question before asking another. Utilize SAMPLE tool to help guide questions, and always document patient's answers. Obtain set of vital signs to establish good baseline.

79. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Repeat vital signs and compare to previous readings to establish trends in patient's condition. Most vital signs have multiple characteristics; document characteristics for each vital sign.

80. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley REVIEW QUESTIONS

81. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Why is it important to obtain a thorough medical history? 2.What is the difference between a sign and a symptom? 3.What does SAMPLE represent? 4.What does OPQRST represent? 5.What role does monitoring vital signs play in the overall assessment and care of the patient? 6.What are the methods used to assess each of the five vital signs? Review Questions (continued)

82. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 7.What vital information is obtained through assessing respirations, pulse, blood pressure, skin signs, and pupils? 8.How do the techniques used to assess a pulse in an infant, child, and adult patient differ? 9. How do normal and abnormal vital sign values differ for the infant, child, and adult patient? Review Questions

83. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Practical Assessment You will be given a class roster that contains each student's name and a column for each vital sign. Obtain vital signs on three students. Continue this activity at the beginning of every class until you have obtained vital signs from every other student in class. Discuss challenges and results.

84. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Please visit www.bradybooks.com and follow the Resource Central links to access content for this text. www.bradybooks.com