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EMT - B > CH 13 Vital SX and Monitoring Devices > Flashcards

CH 13 Vital SX and Monitoring Devices Flashcards

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1
Q

Vital SX

A

Outward sx of what is going on inside the body, including respiration; pulse; skin color; temperature and condition (plus capillary refill in infants and children); pupils; and blood pressure

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2
Q

Tachycardia

A

A rapid pulse; any resting pulse rate above 100 BPM in an adult

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3
Q

Bradycardia

A

A slow pulse; any pulse rate below 60 BPM

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4
Q

NORMAL PULSE RATES (BPM AT REST)

A

Adult : 60-100 Adolescent (11-18) : 60-100 School Age (6-10) : 65-120 (awake; slightly lower when asleep) Preschoolers : 70-120 (awake; slightly lower when asleep) Toddler (1-3) : 80-140 (awake; slightly lower when sleep) Infant (0-12 months) : 100-170 (awake; slightly lower when asleep)

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5
Q

PULSE QUALITY/SIGNIFICANCE POSSIBLE CAUSES

A
  • RAPID, REGULAR, and FULL / Exertion, fright, fever, Hypertension, first stage of Hypovolemia - RAPID. REGULAR and THREADY / Shock, later stages of shock IRREGULAR / Abnormal electrical activity in the heart SLOW / head injury, drugs some poisons, some heart problems, alack of O2 in children NO PULSE / Cardiac arrest (clinical death) **Note - If patient is awake and talking, but has no carotid pulses, ask if the patient has a ventricular assist device
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6
Q

Pulse quality

A

The rhythm (regular or irregular) and force (strong or weak) of the the pulse

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7
Q

Radial Pulse

A

The pulse felt at the wrist

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8
Q

Brachial Pulse

A

The pulse felt in the upper arm

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9
Q

Carotid Pulse

A

The pulse felt along the large carotid artery on either side of the neck

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10
Q

Respiration

A

The act of breathing in and breathing out

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11
Q

Respiratory rate

A

The number of breaths taken in one minute

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12
Q

NORMAL RESPIRATORY RATES (Breaths per minute, at rest)

A

Adult - 12-20 Above 24 : Serious Below 10 : Serious Adolescent (13-18 Years) - 12-20 School Age (6-12 Years) - 18-30 Preschooler (3-5 Years) - 22-34 Toddler (1-3 Years) - 24-40 Infant (0-6 months) - 30-60 (6-12 months) - 24-30 Newborn - 30-60 ( >60 considered Tachypnea)

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13
Q

RESPIRATORY SOUNDS/POSSIBLE CAUSES/INTERVENTIONS

A

* SNORING Possible Causes Airway blocked; Open patient’s airway; INTERVENTION : PROMPT TRANSPORT * WHEEZING Possible Causes: Medical problem such as asthma/assist patient in taking prescribed medications; INTERVENTION : PROMPT TRANSPORT * GURGLING - Possible Causes - Fluids in Airway - INTERVENTION : SUCTION AIRWAY; PROMPT TRANSPORT * CROWING - Possible Causes : Medical problems that cannot be treated on scene - INTERVENTION : PROMPT TRANSPORT

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14
Q

Respiratory Quality

A

The normal or abnormal (shallow, labored or noisy) character of breathing

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15
Q

Respiratory Rhythm

A

The regular or irregular spacing of breaths

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16
Q

SKIN COLOR SIGNIFICANCE/POSSIBLE CAUSES

A

** PINK - Normal in light-skinned patients; normal at inner eyelids, lips and nail beds of dark skinned patients ** PALE - Constricted blood vessels, possibly resulting from blood loss, shock, hypotension, emotional distress ** CYANTOIC (Blue - Gray) - Lack of O2 in blood cells and tissues resulting from inadequate breathing or heart function ** FLUSHED (red) - Exposure to heat, emotional excitement ** JAUNDICED (Yellow) - Abnormalities of the liver ** MOTTLED (Blotchy) - Occasionally in patients with shock

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17
Q

SKIN TEMPERATURE/CONDITION SIGNIFCANCE/POSSIBLE CAUSES

A

** COOL, CLAMMY - Sign of shock, anxiety ** COLD, MOIST - Body is losing heat ** COLD, DRY - Exposure to cold ** HOT, DRY - High fever, heat exposure ** HOT, MOIST - High fever, heat exposure *** “GOOSE PIMPLES” ACCOMPANIED BY SHIVERING, CHATTERING TEETH, BLUE LIPS AND PALE SKIN - Chills, communicable disease, exposure to cold, pain or fear

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18
Q

Pupil

A

The black center of the eye

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19
Q

Dilate

A

Get larger

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20
Q

Constrict

A

Get smaller

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21
Q

Reactivity

A

In the pupils of the eyes, reacting to light by changing size

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22
Q

PUPIL APPEARANCE SIGNIFICANCE POSSIBLE CAUSES

A

** DILATED (larger than normal) - Fright, blood loss, drugs, prescription eye drops ** CONSTRICTED (smaller than normal) - Drugs (narcotics), prescription eye drops ** UNEQUAL - Stroke, head injury, eye injury, artificial eye, prescription eye drops ** LACK OF REACTIVITY - Drugs, lack of O2 to the brain

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23
Q

Blood pressure

A

The force of blood against the walls of the blood vessels

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24
Q

Systolic Blood Pressure

A

The pressure created when the heart contracts and forces blood out into the arteries

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25
Q

Diastolic Blood Pressure

A

The pressure remaining in the arteries when the left ventricle of the heart is relaxed and refilling

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26
Q

BLOOD PRESSURE NORMAL RANGES - SYSTOLIC

A

** ADULT - Less than or equal to 120 ** ADOLESCENT - About 107-117 ** AGES 1-10 - Mean systolic pressure is 90+(age in years x 2) Example: Mean systolic pressure for 2 y/o is 90 + 2 x 2 = 4 = 94 ***Note - this formula is an average, and individual pressures ** INFANT - ******* Day 0 - Day 10 - 50-70 ********At Day 10 - 90 *******Day 10 - 12 months - 90

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27
Q

BLOOD PRESSURE – SIGNIFICANCE/POSSIBLE CAUSES

A

** HIGH BLOOD PRESSURE – Medical condition, exertion, fright, emotional distress, excitement ** LOW BLOOD PRESSURE – Athlete or other person with normally low blood pressure; blood loss; late sx of shock ** NO BLOOD PRESSURE – Patient with Ventricular Assist Device in Chest; Cardiac Arrest

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28
Q

Sphygmomanometer

A

The cuff and the gauge used to measure blood pressure

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29
Q

Brachial

A

The major artery in the arm

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30
Q

Auscultation

A

Listening. A stethoscope is used to auscultate for characteristic sounds

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31
Q

Palpation

A

Touching or feeling. A pulse or blood pressure may be palpated with the fingertips

32
Q

Blood Pressure Monitor

A

A machine that automatically inflates a blood pressure cuff and measures blood pressure

33
Q

Steps to measuring a BP by Palpation Recorded as XXX/Palp

A
  1. Position the cuff and find the radial pulse 2. Inflate the cuff 3. Deflate the cuff, when you feel the radial pulse return that is your Systolic pressure 4. Record the pressure as XXX/Palp (can also be XXX/P)
34
Q

Pulse Oximeter

A

An electronic device for determining the amount of O2 carried in the blood, known as the O2 saturation or SpO2

35
Q

Oxygen Saturation

A

The ratio of the amount of O2 present in the blood to the amount that could be carried expressed as a percentage

36
Q

How do you record the Pulse Oxygenation? What is it a measurement of/expressed as?

A

SpO2 It is expressed as a percentage (a patients SpO2 is 97%)

37
Q

What are the two (2) factors which determine the pulse QUALITY?

A
  1. rhythm and 2. force
38
Q

What is referred to when speaking about the pulse RHYTHM?

A

Reflects the regularity of the pulse that you are palpating

39
Q

What is referred to when speaking about the pulse FORCE?

A

This refers to the pressure of the pulse wave as it expands the artery that you are palpating

40
Q

In palpation of a pulse, you are ______ the pulse with your _____

A

feeling, fingertips

41
Q

What are the areas that you will palpate a pulse?

A
  1. Radial 2. Brachial 3. Femoral 4. Carotid 5. Dorsalis Pedis
42
Q

What vital sign is expressed as a percentage?

A

SpO2 (Oxygen Saturation)

43
Q

Which of the following can best help evaluate the extent of hypoxia in a patient (**ALL tools available) 1. Pulse Oximetry 2. Skin Condition 3. Skin Color 4. Pulse Quality

A
  1. Pulse oximetry Is a useful adjunct to determine the extent of hypoxia in a patient. Although skin color and pulse quality can also be affected by hypoxia, they are less specific than pulse oximetry
44
Q

You have a 59 y/o patient who suffered a sudden cardiac arrest. CPR was immediately started, and was successful in restoring breathing, as well as a pulse. Your patient presents a strong carotid pulse in addition to breathing, but the patient remains unconscious. You are expediting transport, in addition to this, you should also: 1. check vital signs again in 5 minutes 2. check the pulse oximetry every 3 minutes 3. continue with chest compressions for 1 minute 4. reassess vital sx after 10 minutes

A
  1. check vital sx again in 5 minutes Reassessing a trauma patient, or an unstable patient’s vital sx every 5 minutes is the standard of care. In this case, another arrest is LIKLEY, so blood pressure and pulse are especially important to check again in 5 minutes along with other vital sx. Ten minutes is too long Pulse oximetry is important but not more important than checking other vital sx the standard is not to check this every 3 minutes Chest compressions are no longer necessary
45
Q

At what intervals should subsequent vital sign assessments be conducted for the responsive, stable medical patient 1. Once during transport 2. Every 5 minutes 3. Every 15 minutes 4. Only if the patient’s mental status changes

A
  1. Every 15 minutes Conduct your reassessment every 15 minutes for stable patients This can be a longer interval for unstable patients because VS are far less likely to change in a stable patient
46
Q

The best sites to assess skin color in adults are in the mucous membranes of the mouth, eyelids and: 1. in the nose 2. in the nailbeds 3. in the ears 4. on the chest

A
  1. in the nailbeds The mucous membranes located in the mouth and eyelids and the nailbeds are the best sites on adult patients to assess skin color and perfusion. Although skin color CAN be assessed in other areas, these specific sites are the most useful
47
Q

Which of the following methods of obtaining a temperature would be most appropriate for use in an ambulance? 1. Rectal measurement 2. Electronic measurement 3. Axial measurement 4. Tympanic measurement

A
  1. Electronic Measurement This is the safest and most hygienic means of measuring temperature in an ambulance. Although axial and rectal temperature measurement can be utilized, electronic measurement would be preferred over these methods. Tympanic measurement is not typically accurate enough for use in the ambulance
48
Q

Your patient is a 26 y/o F who is complaining of respiratory distress. You have completed your primary assessment, obtained a baseline set of VS, and been ordered by medical control to assist the patient with her bronchodilator inhaler. After administering the medication, you should next: 1. complete a detailed physical examination 2. reassess VS 3. ask the patient if she has any allergies 4. continue on the patients hx

A
  1. reassess VS You should repeat VS after EVERY medical intervention. HX and a detailed physical examination can be completed after you reassess VS. You must inquire about allergies before administering a medication
49
Q

APGAR

A

A - Activity (muscle tone) P - Pulse G - Grimace (reflex irritability) A - Appearance (skin color) R - Respiration

50
Q

What are the scores used in the APGAR chart?

A

A - Activity (muscle tone) - Absent = 0; Flexed Limbs = 1 point; Active = 2 PT P - Pulse - Absent = 0; <100BPM = 1 PT; >100 BPM = 2 PT G - Grimace (reflex irritability) - Floppy = 0 ; Minimal response to stimuli = 1 PT; Prompt response to stimulation = 2 PT A - Appearance (skin color) - Blue/Pale = 0; Pink Body, blue extremities = 1 PT; Pink = 2 PT R - Respiration - Absent = 0; Slow/Irregular = 1PT; Vigorous Cry = 2 PT

51
Q

Your patient, a 29 y/o F, delivered a healthy baby. You are enroute to the hospital, and have just completed your second round of APGAR of the child, when the mother starts to have a seizure. You should: 1. stop the ambulance and have your partner care for the baby while you repeat the primary assessment on the mother 2. continue your care of the baby, and call to intercept with another unit, so that they can care for the mother 3. call for law enforcement to provide an escort to the ED and escalate to priority transport 4. place the baby on the mothers chest while you complete a primary assessment on the mother

A
  1. stop the ambulance and have your partner care for the baby while you repeat the primary assessment on the mother Because of the change in the mothers condition, you MUST repeat the primary assessment. However, care for the newborn must ALSO continue. You CANNOT wait for another unit as life threatening conditions may be present right now. You also cannot stop the care of the newborn Although priority transport is indicated, a primary assessment/reassessment must occur immediately
52
Q

Capnography

A

A testing method that tells indirectly how well the tissues are using O2. It measures the amount of CO2 (ETCO2) that patient is exhaling

53
Q

How is CO2 abbreviated. What is a normal amount?

A

ETCO2 and is measured in mmHg The normal ETCO2 is 35-45mmHg

54
Q

In a spontaneously breathing patient, capnography is usually performed using: 1. a special nasal cannula 2. a pulse oximeter 3. a bag valve mask with a plastic “collar” 4. a pocket face mask

A
  1. a special nasal cannula The reason for this being that your patient is still spontaneously breathing, therefore no need to use a BVM
55
Q

In a patient where you are ventilating the patient, capnography is performed using: 1. a special nasal cannula 2. a pulse oximeter 3. a bag valve mask with a plastic “collar” 4. a pocket face mask

A
  1. a bag valve mask with a plastic “collar” A pulse oximeter does not give you a ETCO2 reading A special nasal cannula is for those who are “spontaneously breathing” A pocket face mask has no attachments for this measurement
56
Q

At what age do you start measuring blood pressure?

A

Age 3 and older. Blood pressures are difficult to obtain with any accuracy on infants and children younger than 3 Blood pressure on children under the age of 3 have LITTLE BEARING on the patients field management On a patient under the age of three (3), you get more useful information about the condition of an infant, or very young child by observing conditions such as a “sick appearance”, respiratory distress, or unconsciousness

57
Q

What are the six (6) Vital Sx (VS)? What are you looking for in each of these?

A
  1. Pulse - Presence - Strength - Regularity Two main areas you want to palpate for this is: - Carotid - Radial 2. Blood Pressure (BP) - Systolic (Top number/when Ventricle pumps to body) - Diastolic (Bottom number/When the heart is at rest) - Palpation - SYSTOLIC ONLY 3. Skin - Color - Temperature - Condition 4. Respirations - Rate - Depth 5. Pupils - Size - Reactivity 6. Pulse Oximetry
58
Q

When obtaining a BP by Palpation, where are you measuring it? 1. Pedal 2. Carotid 3. Radial 4. Femoral

A
  1. Radial 1. Pump the cuff until you do not have a pulse in the radial 2. Release the cuff 3. While watching the sphygmomanometer dial, you feel for the pulse to return 4. When you feel the pulse return, this is the number of your BP/Palp (ONLY able to get SYSTOLIC Pressure in this manner)
59
Q

Arterial pressure is exerted by the blood when the left ventricle contracts and is detected: 1. when sounds of the pulse disappear during the deflation of the BP cuff 2. by the stethoscope 3. by the rhythm 4. as the first sounds heard when the BP cuff is slowly released

A
  1. as the first sounds heard when the BP cuff is slowly released
60
Q

You are treating a pediatric patient. You are reaching for the Pediatric BP cuff, when you notice that your 9 y/o patient is becoming cyanotic. What should you do? 1. Repeat the primary assessment 2. Check the patients temperature 3. Administer O2 4. Check the BP

A
  1. Repeat the primary assessment Obviously, somewhere earlier in the assessment, there was not an issue, but your patient has taken a turn for the worse, causing the need for you to perform a reassessment of your patient.
61
Q

In adults, direct assessment of the circulatory status of the body can be performed by measuring the blood pressure and the: 1. pulse 2. respiratory rate 3. temperature 4. pulse oximeter

A
  1. pulse
62
Q

Which of the following is an outward sign of what is going on inside of the body? 1. Nausea 2. Vertigo 3. Blood Pressure 4. Headache

A
  1. Blood Pressure
63
Q

Cool skin that is moist is referred to as “cool and clammy.” It is often related to: 1. dehydration 2. frostbite or hypothermia 3. sweating from heat exposure 4. shock or anxiety

A
  1. shock or anxiety
64
Q

A patient’s family member tells you that your patient has diabetes, and the patient is presenting with symptoms that are likely due to hypoglycemia. You decide you need to measure the patient’s blood glucose level. Name the steps of performing the glucose check

A
  1. Prepare your device 2. Prepare your lancet and test strip, cotton swab, tape, and band aid 3. Place your test strip in your monitor 4. Get an alcohol pad ready 5. “Milk” the patient’s finger 6. Clean the patient’s finger with the alcohol 7. Let the alcohol dry 8. Ensure that the meter is on prior to moving to next steps 9. Use the lancet to “prick” the patient’s finger. 10. Wipe away the first drop of blood with your cotton swab 11. Put the second drop of blood onto the test strip in the machine 12. Put the ban aid/cotton swab/whatever you are using to cover the pin prick, tape if needed
65
Q

What is the normal Blood Glucose Reading of a patient?

A

70-100 mg/dl (milligrams per deciliter)

66
Q

When talking about a “normal blood glucose reading”, we are talking about in normal bodies. What should you ask a diabetic patient/family members

A

“What is normal Blood Glucose reading for him/her? Gives a good indication as to what the reading will tell you The “Normal” that is cited is talking about an overall normal, but when diabetics, it is not abnormal for their numbers to differ from those numbers cited

67
Q

The FIRST set of VS obtained are known as what?

A

Baseline VS

68
Q

Where do baseline VS fit into the sequence of patient assessment?

A

Secondary Assessment

69
Q

Vital SX are rechecked every _______ minutes on a stable patient, and every _________ minutes on an unstable patient

A

15, 5

70
Q

Recording and documenting your patient’s first set of VS is very important because, when combined with the follow-on reassessments, it allows for 1. fill in all of the blanks on the patient care report form 2. compare your patient’s condition with other patient’s conditions 3. make an accurate diagnosis of the patient’s illness 4. discover trends and changes in the patient’s condition

A
  1. Discovering trends and changes in the patients condition
71
Q

You have been called to an 82 y/o patient who has been lost in the woods behind her nursing home for several hours on a crisp fall evening. Your reading that you get on the pulse oximeter shows her SpO2 at 82%, but she is presenting with adequate breathing. In order to get an adequate reading you should

A

warm the patient’s hands and try again

72
Q

What three (3) things are you looking for when checking pupils?

A
  1. Size 2. Reactivity 3. Equality
73
Q

Which of the following is NOT a cause for unequal pupils? 1. stroke 2. artificial eye 3. fright 4. eye injury

A
  1. fright unequal pupil possible causes can be: stroke, head injury, eye injury, artificial eye, prescription eye drops
74
Q

The abbreviation mmHG indicates that the blood pressure is measured by which of the following comparisons? 1. Milligrams per deciliter 2. Millimeters per deciliter 3. Beats per minute 4. Atmospheric pressure

A
  1. Millimeters of mercury
75
Q

You are called to the scene of a child who has had an accident. Upon arrival, you find the child presents with pale skin with dark spots of cyanosis. How would you report this skin color? 1. jaundiced 2. flushed 3. cyanotic 4. mottling

A
  1. Mottling
76
Q

You are assessing a 48 y/o M who is unconscious. The scene is safe and your patient is gurgling. What is your next action? 1. open the airway with a head tilt 2. insert an airway adjunct 3. suction the airway 4. quickly check the pulse

A
  1. suction the airway
77
Q

A(n) __________ set of vital sx is important for critical decision making for the EMT 1. repeated 2. unbiased 3. accurate 4. complete

A
  1. accurate

EMT - B (41 decks)

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