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Baseline Vital Signs and Baseline Vital Signs and SAMPLE HistorySAMPLE History

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Given a patient care scenario and the Given a patient care scenario and the proper medical equipment in a clinical proper medical equipment in a clinical environment or field setting, assess a environment or field setting, assess a baseline set of patient vital signs and obtain baseline set of patient vital signs and obtain an accurate SAMPLE history IAW Chapter an accurate SAMPLE history IAW Chapter 5, Emergency Care and Transportation of 5, Emergency Care and Transportation of the Sick and Injured, 9the Sick and Injured, 9thth Edition, American Edition, American Academy of Orthopedic Surgeons (AAOS).Academy of Orthopedic Surgeons (AAOS).

Terminal Learning ObjectiveTerminal Learning Objective

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Given a patient, with a trauma or medically-Given a patient, with a trauma or medically-related complaint, in a pre-hospital related complaint, in a pre-hospital environment, describe the basic principles, environment, describe the basic principles, sequence and components of an accurate sequence and components of an accurate baseline set of vital signs IAW Emergency baseline set of vital signs IAW Emergency Care and Transportation of the Sick and Care and Transportation of the Sick and Injured, 9Injured, 9thth Edition, American Academy of Edition, American Academy of Orthopedic Surgeons (AAOS). Orthopedic Surgeons (AAOS).

Enabling Learning ObjectivesEnabling Learning Objectives

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Given a patient, with a trauma or medically-Given a patient, with a trauma or medically-related complaint, in a pre-hospital related complaint, in a pre-hospital environment, demonstrate the proper environment, demonstrate the proper technique(s) for obtaining a complete set of technique(s) for obtaining a complete set of baseline vital signs and a concise patient baseline vital signs and a concise patient history using the acronym SAMPLE IAW history using the acronym SAMPLE IAW Emergency Care and Transportation of the Emergency Care and Transportation of the Sick and Injured, 9Sick and Injured, 9thth Edition, American Edition, American Academy of Orthopedic Surgeons (AAOS). Academy of Orthopedic Surgeons (AAOS).

Enabling Learning ObjectivesEnabling Learning Objectives

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Baseline Vital Signs and Baseline Vital Signs and SAMPLE HistorySAMPLE History

Assessment is the most essential skill Assessment is the most essential skill EMT-Bs learn.EMT-Bs learn.

During assessment you During assessment you will:will:– Gather key informationGather key information

– Evaluate the patientEvaluate the patient

– Learn the historyLearn the history

– Learn about the patient’s overall healthLearn about the patient’s overall health

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Gathering Key Patient Gathering Key Patient InformationInformation

Obtain the patient’s name.Obtain the patient’s name.

Note the age, gender and Note the age, gender and

race.race.

Look for identification if the Look for identification if the

patient is unconscious.patient is unconscious.

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Baseline Vital SignsBaseline Vital Signs

During the assessment, the EMT-B uses During the assessment, the EMT-B uses many senses and a few basic medical many senses and a few basic medical instruments.instruments.

First set is known as First set is known as the baseline vitals.the baseline vitals.

Repeated vital signs Repeated vital signs are compared to the are compared to the baseline.baseline.

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Baseline Vital Signs and Baseline Vital Signs and SAMPLE HistorySAMPLE History

Chief Complaint (Chief Complaint (CCCC); Mechanism of Injury ); Mechanism of Injury ((MOIMOI):):– Chief complaints are the major signs, Chief complaints are the major signs,

symptoms or events that caused the call or symptoms or events that caused the call or complaintcomplaint

– SymptomsSymptoms: what the patient tells you: what the patient tells you

– SignsSigns: can be seen, heard , felt, smelled or : can be seen, heard , felt, smelled or measured measured Sign or symptom?Sign or symptom?

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Obtaining a SAMPLE HistoryObtaining a SAMPLE History S S :: Signs and Symptoms of the episode:Signs and Symptoms of the episode:

– What signs and symptoms occurred at onset?What signs and symptoms occurred at onset?

– Does the patient report pain?Does the patient report pain?

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Obtaining a SAMPLE HistoryObtaining a SAMPLE History AA :: Allergies:Allergies:

– Is the patient allergic to medications, foods or Is the patient allergic to medications, foods or other substance?other substance?

– What reactions did the patient have to any of What reactions did the patient have to any of them?them?

Note: If the patient has no know allergies, Note: If the patient has no know allergies, you should note this on the run sheet as you should note this on the run sheet as “no known allergies” or “NKA” “no known allergies” or “NKA”

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Obtaining a SAMPLE HistoryObtaining a SAMPLE History M M :: Medications:Medications:

– What medications was the patient prescribed?What medications was the patient prescribed?

– What dosage was prescribed?What dosage was prescribed?

– How often is the patient supposed to take the How often is the patient supposed to take the medication? medication?

– What prescription, over-the-counter (OTC) What prescription, over-the-counter (OTC) medications, and herbal medications has the medications, and herbal medications has the patient taken in the last 12 hours?patient taken in the last 12 hours?

– How much was taken and when? How much was taken and when?

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Obtaining a SAMPLE HistoryObtaining a SAMPLE History

P P :: Pertinent past history:Pertinent past history:– Does the patient have any history of medical, Does the patient have any history of medical,

surgical, or trauma occurrences?surgical, or trauma occurrences?

– Has the patient had a recent illness or injury, Has the patient had a recent illness or injury, fall or blow to the head? fall or blow to the head?

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Obtaining a SAMPLE HistoryObtaining a SAMPLE History

L L :: Last oral intake:Last oral intake:– When did the patient last eat or drink?When did the patient last eat or drink?

– What did the patient eat or drink, and how What did the patient eat or drink, and how much was consumed?much was consumed?

– Did the patient take any drugs or drink alcohol?Did the patient take any drugs or drink alcohol?

– Has there been any other oral intake in the last Has there been any other oral intake in the last 4 hours? 4 hours?

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Obtaining a SAMPLE HistoryObtaining a SAMPLE History

E E :: Events leading to injury or illnessEvents leading to injury or illness– What are the key events that led up to this What are the key events that led up to this

incident?incident?

– What occurred between the onset of the What occurred between the onset of the incident and your arrival?incident and your arrival?

– What was the patient doing when this illness What was the patient doing when this illness started?started?

– What was the patient doing when this injury What was the patient doing when this injury happened? happened?

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OO--PP--QQ--RR--SS--TT

Mnemonic device to help you remember Mnemonic device to help you remember questions you should ask to obtain a questions you should ask to obtain a patient history.patient history.– OO : Onset: When did the problem begin and : Onset: When did the problem begin and

what caused it?what caused it?

– PP : Provocation or Palliation: Does anything : Provocation or Palliation: Does anything make it feel better? Worse?make it feel better? Worse?

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OO--PP--QQ--RR--SS--TT

– QQ : Quality: What is the pain like? Sharp, dull, : Quality: What is the pain like? Sharp, dull, crushing, tearing?crushing, tearing?

– RR : Region/Radiation: Where does it hurt? : Region/Radiation: Where does it hurt? Does the pain move anywhere?Does the pain move anywhere?

– SS : Severity: On a scale of 1 to 10, how would : Severity: On a scale of 1 to 10, how would you rate your pain?you rate your pain?

– TT : Timing of pain: Has the pain been constant : Timing of pain: Has the pain been constant or does it come and go? How long have you or does it come and go? How long have you had the pain?had the pain?

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Baseline Vital SignsBaseline Vital Signs Baseline vital signs always include Baseline vital signs always include

– Respirations, Pulse & Blood PressureRespirations, Pulse & Blood Pressure

Other key indicators:Other key indicators:

– Skin: color, condition, temperature (Skin: color, condition, temperature (CCTCCT))

– Capillary refill time (in children)Capillary refill time (in children)

– Pupillary responsePupillary response

– Level of Consciousness (Level of Consciousness (LOCLOC))

– Sometimes Temperature (medical patients)Sometimes Temperature (medical patients)

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RespirationsRespirations

A patient who is breathing without A patient who is breathing without assistance: assistance: spontaneous respirationsspontaneous respirations. .

Each complete breath consists of two Each complete breath consists of two distinct phases: distinct phases: – Inspiration (inhalation): the chest rises up and Inspiration (inhalation): the chest rises up and

out, drawing oxygenated air into the lungs out, drawing oxygenated air into the lungs

– Expiration (exhalation): the chest returns to its Expiration (exhalation): the chest returns to its original position, releasing air with an increased original position, releasing air with an increased carbon dioxide (COcarbon dioxide (CO²) level out of the lungs²) level out of the lungs

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RespirationsRespirations

Rate:Rate:– The number of breaths in 30 seconds x 2The number of breaths in 30 seconds x 2

Quality: character of breathing:Quality: character of breathing:– Rhythm (regular or irregular)Rhythm (regular or irregular)

– Effort (normal or labored)Effort (normal or labored) Depth:Depth: - Tidal Volume (the amount of air exchanged with each - Tidal Volume (the amount of air exchanged with each

breath)breath) -Depth and rate of breathing determines the tidal -Depth and rate of breathing determines the tidal

volumevolume

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Respiratory RateRespiratory Rate

Adults: 12 to 20 breaths/minuteAdults: 12 to 20 breaths/minute(over age 8)(over age 8)

Children: 18 to 30 breaths/minuteChildren: 18 to 30 breaths/minute(1 to 8 years of age)(1 to 8 years of age)

Infants: 30 to 60 breaths/minuteInfants: 30 to 60 breaths/minute(under 1 year of age)(under 1 year of age)

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RespirationsRespirations Effort (labored):Effort (labored):

– Unable to speak more than 2-3 words at a Unable to speak more than 2-3 words at a timetime

– Assuming a “tripod” positionAssuming a “tripod” position– Assuming a “sniffing” position (children)Assuming a “sniffing” position (children)– Noisy breathing:Noisy breathing:

• StridorStridor• Wheezes, snoringWheezes, snoring• Coughing (productive?) Coughing (productive?)

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Pulse OximetryPulse Oximetry Evaluates the effectiveness of oxygenation.Evaluates the effectiveness of oxygenation. Normal value: 95% - 100%.Normal value: 95% - 100%.

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PulsePulse

With each heartbeat, ventricle contract, With each heartbeat, ventricle contract, forcefully ejecting blood from the heart forcefully ejecting blood from the heart and propelling it into the arteries.and propelling it into the arteries.

A pulse is the pressure A pulse is the pressure wave that occurs as wave that occurs as each heartbeat causes each heartbeat causes a surge in the blood a surge in the blood circulating through the circulating through the arteries. arteries.

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PulsePulse

Carotid Pulse Radial Pulse Carotid Pulse Radial Pulse

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PulsePulse

Brachial PulseBrachial Pulse

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PulsePulse

Rate:Rate:– Number of beats in 30 seconds x 2Number of beats in 30 seconds x 2

Strength:Strength:– Stronger than normal (Stronger than normal (boundingbounding), strong or ), strong or

weak (weak (threadythready))

Regularity:Regularity:– Regular or irregularRegular or irregular

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Normal Pulse RangesNormal Pulse Ranges

Adults: Adults: 60 to 100 beats/minute60 to 100 beats/minute

Children:Children: 70 to 120 beats/minute70 to 120 beats/minute

Toddlers:Toddlers: 90 to 150 beats/minute90 to 150 beats/minute

Newborns:Newborns: 120 to 160 beats/minute120 to 160 beats/minute

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The SkinThe Skin

The condition of the patient’s skin can tell The condition of the patient’s skin can tell you a lot about the patient’s:you a lot about the patient’s:– Peripheral circulation and perfusionPeripheral circulation and perfusion

– Blood oxygen levelsBlood oxygen levels

– Body temeperatureBody temeperature

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The Skin (The Skin (CCTCCT))

Color:Color:– Pink, pale, blue, Pink, pale, blue,

red, or yellowred, or yellow Condition: Condition:

(moisture)(moisture)– Dry, moist or wetDry, moist or wet

Temperature:Temperature:– Warm, hot or coolWarm, hot or cool

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Capillary RefillCapillary Refill

Evaluates the ability of the circulatory Evaluates the ability of the circulatory system to restore blood to the capillary system to restore blood to the capillary system (perfusion).system (perfusion).

– Evaluated at the nail bed (finger) Evaluated at the nail bed (finger)

– Depress the finger tip, pressure forcing blood Depress the finger tip, pressure forcing blood from the capillaries and look for return of bloodfrom the capillaries and look for return of blood

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Capillary RefillCapillary Refill

– As the capillaries refill, As the capillaries refill, should return to its should return to its normal deep pink colornormal deep pink color

– Color should be restored Color should be restored within 2 seconds (about within 2 seconds (about the time it takes to say, the time it takes to say, ““Capillary refillCapillary refill” ”

– Invalid test in a cold Invalid test in a cold environment; elderlyenvironment; elderly

– Used for < 6 years oldUsed for < 6 years old

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Blood PressureBlood Pressure Blood pressure is a vital sign. Blood pressure is a vital sign. Pressure of circulating blood against the Pressure of circulating blood against the

walls of the arteries.walls of the arteries. A drop in blood pressure may indicate:A drop in blood pressure may indicate:

– Loss of bloodLoss of blood

– Loss of vascular toneLoss of vascular tone

– Cardiac pumping problemCardiac pumping problem

Blood pressure should be measured in all Blood pressure should be measured in all patients older than 3 years of age.patients older than 3 years of age.

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Blood PressureBlood Pressure

Diastolic:Diastolic:– Pressure during relaxing Pressure during relaxing

phase of the heart’s cyclephase of the heart’s cycle Systolic:Systolic:

– Pressure during contractionPressure during contraction Measured as millimeters Measured as millimeters

of mercury (mmHg).of mercury (mmHg). Recorded as systolic/diastolic.Recorded as systolic/diastolic.

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Blood Pressure EquipmentBlood Pressure Equipment

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Auscultation of Blood PressureAuscultation of Blood Pressure Place cuff on patient's arm (1” above elbow).Place cuff on patient's arm (1” above elbow). Palpate brachial artery and place diaphragm Palpate brachial artery and place diaphragm

of stethoscope over artery.of stethoscope over artery. Inflate cuff until you no Inflate cuff until you no

longer hear pulse sounds.longer hear pulse sounds. Continue pumping to Continue pumping to

increase pressure by increase pressure by an additional 20 mmHg.an additional 20 mmHg.

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Auscultation of Blood PressureAuscultation of Blood Pressure

Note the systolic and Note the systolic and diastolic pressures diastolic pressures as you let air escape as you let air escape slowly.slowly.

As soon as pulse As soon as pulse sounds stop, open the sounds stop, open the valve and release the valve and release the air quickly. air quickly.

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Measuring Blood PressureMeasuring Blood Pressure

PalpationPalpation

AuscultationAuscultation

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Palpation of Blood PressurePalpation of Blood Pressure

Secure cuff.Secure cuff. Locate radial pulse.Locate radial pulse. After the pulse After the pulse

disappears continue to disappears continue to inflate another 30mmHg.inflate another 30mmHg.

Release air until pulse is Release air until pulse is felt.felt.

Method only obtains Method only obtains systolic pressure.systolic pressure.

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Normal BP RangesNormal BP Ranges

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.

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Blood PressureBlood Pressure

HypotensionHypotension: : – BP significantly lower than the normal rangeBP significantly lower than the normal range– Critical hypotension: BP is no longer able to Critical hypotension: BP is no longer able to

compensate sufficiently to maintain adequate compensate sufficiently to maintain adequate perfusion perfusion

HypertensionHypertension::– BP significantly higher than the normal rangeBP significantly higher than the normal range

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Level of ConsciousnessLevel of Consciousness

AA - - AAlertlert

VV - Responsive to - Responsive to

VVerbal stimuluserbal stimulus

PP - Responsive to - Responsive to PPainain

UU - - UUnresponsivenresponsive

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Pupil AssessmentPupil Assessment

PP - - PPupilsupils

EE - - EEqualqual

AA - - AAndnd

RR - - RRoundound

RR - - RRegular in sizeegular in size

LL - React to - React to LLightight

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Abnormal Pupil ReactionsAbnormal Pupil Reactions

Fixed with no reaction Fixed with no reaction to light. to light.

Dilate with light and Dilate with light and constrict without light.constrict without light.

React sluggishly.React sluggishly. Unequal in size.Unequal in size. Unequal with light or Unequal with light or

when light is removed.when light is removed.

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Reassessment of Vital SignsReassessment of Vital Signs

The vital signs you obtain serve two The vital signs you obtain serve two important functions:important functions:

– First set establishes a baseline of respiratory First set establishes a baseline of respiratory and cardiovascular system statusand cardiovascular system status

– Serves as a key baseline Serves as a key baseline

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Reassessment of Vital SignsReassessment of Vital Signs

Reassess Reassess stablestable patients every patients every 1515 minutes. minutes.

Reassess Reassess unstableunstable patients every patients every 55 minutes. minutes.

Reassess/record Reassess/record VS after all medical VS after all medical interventions. interventions.

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Questions?Questions?