Chapter 12

Vital Signs Assessment

Primary survey

Establish Unresponsiveness

• Ask the victim “Are you OK?”

• If no response, active EMS

Check CAB’s

• If not breathing, begin CPR

Determine shock or hemorrhage

• Assess head toe for bleeding or trauma

The secondary survey

• Only begin the secondary survey once the athlete is deemed stable

• Begins with an assessment of vital signs

• Musculoskeletal Assessment

• DOCUMENT EVERYTHING!

Pulse rate Respiratory rate

Blood pressure temperature

Skin color Pupillary reaction

Level of consciousness

Movement in the extremities

Vital Signs

5

The Pulse• Reflects condition of patient’s circulatory

system and cardiac function• Pulse is found in the artery

– Vessel that carries blood away from the heart to the rest of the body

• Absence of a pulse indicates cardiac arrest or death

The Pulse

• Rate, rhythm and quality are assessed– Rate: normal, abnormal– Rhythm: regular, irregular– Quality: weak, strong

The Pulse

• Normal pulse for adults is 60-80 beats per minute (bpm)– Athlete’s may be 50-60 bpm

The Pulse

• Abnormal pulses indicate trauma– Rapid & weak: shock, bleeding, diabetic

coma, heat exhaustion– Rapid and strong: heatstroke, fright– Slow and strong: skull fracture, stroke– No pulse: cardiac arrest, death.

The Pulse

• Higher than average pulse rates = tachycardia

• Lower than average pulse rates = bradycardia

The Pulse

• Can be found in 11 different places on the body– Pulse points

The Pulse

• Radial• Carotid• Brachial• Femoral• Popliteal• Posterior Tibial• Dorsal pedal

The Pulse

• Use two fingers to measure pulse rate, rhythm, and quality– NEVER USE THE THUMB – WHY?

The Pulse

• First beat measured is calculated as zero– 10 sec x 6– 12 sec x 5– 15 sec x 4– 30 sec x 2– 60 sec

Pulse rate Respiratory rate

Blood pressure temperature

Skin color Pupillary reaction

Level of consciousness

Movement in the extremities

Vital Signs

15

Respiration

• Process of exchanging oxygen for carbon dioxide– Takes place in the lungs– Regulated by the brain and CO2 levels in

the bloodstream• Single respiration consists of one

inspiration and one expiration

16

Respiration

• General guidelines for normal rates are:– 15 years and older:

• 12-20 breaths per minute

– Well-trained athlete:• 6-8 breaths per minute

17

Respiratory Patterns

• Abdominal – belly breathing• Apnea – absence of breathing• Tachypnea – rapid breathing• Bradypnea – slow breathing• Cheyne-Stokes respiration – pattern

of rapid deep breathing followed by apnea

18

Respiratory Patterns

• Dyspnea – difficulty breathing• Kussmaul’s breathing – hyperventilation

– Caused by too much CO2 in the blood

• Labored breathing – shown by using shoulders, neck, back muscles to breath

Measuring Respiration

• Respiratory rate & pattern are measured• Count inhalations & exhalations• Watch for chest rise & fall• 30 sec x 2 = breaths per minute• Describe pattern

Measuring Respiration

• Never tell the patient you aremeasuring their respiration– Why?

21

22

Lung Volumes

• The volume of air associated with the phases of the respiratory– Inhalation– exhalation

23

Lung Volumes

• Total Lung Capacity (TLC) – the volume of the lungs at maximal inflation

• Tidal Volume (TV) – the volume of air moved in and out of the lungs during normal breathing

24

Lung Volumes

• Vital capacity (VC) – the volume of air breathed out after maximal inhalation

• Peak Expiratory Flow (PEF) – the highest forced exhalation measured with a peak flow meter

25

26

Peak Flow Meter

• Measures the highest volume of air a person can exhale– Measured in liters per minute (L/min)– Indicates airway function– Used to monitor the effectiveness of

medications (inhalers)

27

Peak Flow Meter

28

Using a PFM

• A baseline “personal best” is established over a 2-3 day period

• Measures are taken and compared to the baseline value

29

Using a PFM

• PEF>80% - person clear to workout without limitations

• 50%<PEF<80% - person should take medication to raise PEF; workout might need to be altered; person should be monitored closely

• PEF<50% - the person should be transported for emergency medical care

Pulse rate Respiratory rate Blood pressure

temperature Skin color

Pupillary reaction Level of consciousness Movement in the extremities

VITAL SIGNS

Blood Pressure

• Measurement of pressure of the blood against walls of arteries

• Systolic & Diastolic measurements– Systolic – heart contraction

• Top number

– Diastolic – heart relaxation• Bottom number

Blood Pressure

• Affected by many factors– Amount of blood in body– Fluid levels (dehydration)– Force of heartbeat– Condition of the arteries

Blood Pressure

• Affected by many factors– Age, exercise, sex, obesity, food, pain,

stress, stimulants, steroids, medications can increase BP

– Weight loss, fasting, depression, blood loss can decrease BP

Blood Pressure

• Hereditary & genetic implications• Exercise increases efficiency of the

heart

Blood Pressure

• Blood pressure is measured in millimeters of Mercury (mm Hg)

• Normal blood pressure:– Systolic = 115-120 mm Hg– Diastolic = 75-80 mm Hg

Blood Pressure

• High blood pressure is hypertension (135/90)– Cardiac problems or stroke

• Low blood pressure is hypotension (110/65)– Hemorrhage, shock, heart attack, internal

bleeding, dehydration

Blood Pressure

Blood pressure

• Measured with a sphygmomanometer and stethoscope

• Process known as auscultation

Measuring Blood Pressure

1. Place cuff around upper arm, just above elbow

2. Stethoscope head is placed in the antecubital fossa (crook of the elbow

Measuring Blood Pressure

3. Inflate bulb to 180-200 mm Hg

4. Open the valve to slowly deflate

Measuring Blood Pressure

5. Listen for heart beat

a. Whooshing noise

6. First sound heard is systolic value

7. Last sound heard is diastolic value

Blood Pressure

43

Measuring Blood Pressure

http://www.youtube.com/watch?v=S648xZDK7b0

Temperature

• Measures thermal activity in the body• Normal body temp is 98.6o F, 37o C

Temperature

• Elevated temperature (>99.1o) can be due to– Disease, pain, fear, nerves

• Decreased temperature (<98.1o)can be due to– Cold exposure, pain, fear, nerves– Accompanied by chills, teeth chattering,

blue lips (cyanosis) pale skin (pallor)

Temperature

• Measured at various sites– Oral– Axillary– Tympanic– Rectal

• Core temperature is reflectedby skin temperature

47

temperature

• Process depends on method– Sterilize

thermometer– Insert into mouth, ear

drum, armpit– Wait 30-90 sec– Document reading