Chp 9 Obtaining Vital Signs and a Medical History Flashcards
Auscultation
the act of listening for sounds made by internal organs such as the lungs and the heart. Also the technique used to listen for pulse sounds when obtaining a blood pressure.
Dilated Pupils
pupils that are larger than normal
Posterior Tibial Pulse
pulse point located over the medial ankle just posterior to the ankle bone
Baseline Vital Signs
the very first set of vital signs obtained on a patient
Dorsalis Pedis (Pedal) Pulse
pulse point located over the anterior foot
Radial Pulse
pulse point located over the lateral aspect of the anterior wrist.
Brachial Pulse
pulse point felt in two locations: on the inside of the upper arm and over the medial aspect of the anterior elbow
Femoral Pulse
pulse point located deep in the groin between the hip and the inside of the upper thigh
SAMPLE
a mnemonic used in obtaining a patient history. The letters stand for Signs and symptoms; Allergies; Medications; Pertinent past medical history; Last oral intake; Events leading to the injury or illness.
Bradycardia
a pulse rate below 60 beats per minute
Flushed
a reddish skin color commonly seen when someone is embarrassed or is suffering a heart related emergency.
Sign
Something that the EMT can see or observe or has a value that can be recorded
Capillary Refill Test
a test used to assess perfusion status in the extremities
General Impression
an element of the patient assessment that includes assessing approximate age, gender, and level of distress
Stridor
a harsh high-pitched sound that generally occurs during inhalation but can also occur during exhalation, indicative of partial upper airway obstruction
Carotid Pulse
the pulse point located on either side of the anterior neck lateral to the trachea
Jaundiced
a yellowish skin color and whites of the eyes indicative of poor liver function.
Symptom
something that is experienced and described by the patient as it pertains to his chief complaint
Chief Complaint
the patient’s perception of the problem in his own words. It is not what the EMT perceives to be the problem
OPQRST
a mnemonic used for the questions asked to get a description of the patient’s illness. The letters stand for: Onset; Provocation; Quality; Region and radiation; Severity; Time
Systolic
the pressure created when the left ventricle contracts and forces blood out into the arteries
Constricted Pupils
pupils that are smaller than normal
Orthostatic Vital Signs
a test in which vital signs are measured before and after a patient moves from a supine to a sitting or a sitting to a standing position.
Tachycardia
a pulse rate greater than 100 beats per minute
Crackles
a fine crackling or bubbling sound heard upon inspiration. The sound is caused as air passes through fluid in the alveoli or by the opening of closed alveoli
Pale
a whitish skin color indicative of poor perfusion
Tidal Volume
the amount of air moved in and out with each breath
Cyanotic
a bluish skin color indicative of poor oxygenation
Palpation
the act of examining by feeling with the hands. Also a technique used for obtaining a blood pressure reading
Trending
the comparing of multiple sets of vital signs over a period of time in order to reveal a trend in the patient’s condition
Diaphoretic
perspiring, sweaty, moist; a characterization of skin condition
PERRL
a mnemonic used to evaluate a patient’s pupils. The letters stand for Pupils Equal and Round Reactive to Light.
Wheezing
a high pitched sound that is indicative of lower airway constriction and can be heard during both inspiration and expiration but is more commonly heard during expiration.
Diastolic
the pressure remaining in the arteries when the left ventricle of the heart is relaxed and refilling
Popliteal Pulse
pulse point located over the posterior aspect of the knee
9-2 Differentiate between a sign and a symptom.
a. A sign is something that the EMT can observe, hear, feel or record. Some signs are: Skin color, temperature, and moisture; pulse rate, strength and regularity; tenderness; blood pressure; bruising; deformities; swelling
b. A symptom is something the patient experiences and must describe to you. A common symptom is pain; the EMT cannot see pain, but can the EMT can see signs of it on the patient’s face. Others are nausea,, fatigue, headache, double vision, light headedness, thirst
9-3 Explain the importance of taking and recording a patient’s vital signs over a period of time to identify trends in the patient’s condition.
a. Vital signs are VITAL to life, they are Respirations (presence, absence, rate, depth, ease and lung sounds); Pulse (presence or absence, rate, strength and rhythm); Blood pressure; skin signs (color, temperature, moisture, capillary refill and turgor); Pupils (size and shape, equality, reactivity to light, and sympathetic movement)
i. Using a baseline set of vitals is important, because as you document subsequent sets of vitals at documented times they show a pattern of what is going on with the patient’s vital systems. This then gives the EMT and advanced medical care an idea of where they patient is heading or what may be wrong.
9-4 Describe the proper technique for assessing breathing.
a. The most important of all vital signs and can be seen as you approach the patient and they are talking to you.
i. Determine that they have a patent airway, they are breathing, it is safe to assume they have a pulse and a blood pressure.
ii. Grab the patient’s wrist as if you were checking their pulse. You then can feel the rise and fall of the chest without having to watch the chest and they don’t alter their breathing rate.
9-5 Differentiate between normal respiratory rates for adults, children, infants, and newborns.
a. Look for signs of adequate versus inadequate respirations as you approach.
i. Normal rates
1. Adults 12-20 breaths/minute normal
a. Above 29 potentially serious
b. Below 10 potentially serious
2. Adolescent 11-14 y/o 12-20
3. School age 6-10 y/o 15-30
4. Preschool 3-5 y/o 20-30
5. Toddler 1-3 y/o 20-30
6. Infant 6-12 months 20-30
7. Infant 1-5 months 25-40
8. Newborn 30-50
9-6 Differentiate between normal and abnormal findings when assessing a patient’s breathing to include the respiratory rate, depth of respirations, rhythm of respirations, and signs that may indicate respiratory distress or respiratory failure.
a. 4 characteristics of respirations
i. Rate
1. Calculate by counting 30 seconds x 2=minute rate or count 15 seconds x 4= minute rate. If irregular pattern count for full minute.
2. Rates
a. Adult: 10-30 average 12 to 20
b. Children 15-30
c. Infants 25-50
ii. Depth
1. Referred to as Tidal Volume is either normal, deep or shallow
iii. Ease – described as unlabored or Labored (mild, moderate, or severe)
1. Breathing easily shows little if any effort in breathing
2. Respiratory distress uses accessory muscles and labors harder.
a. Distress can be quantified by number of words they can speak before having to take another breath. A patient who can only speak 2-3 words between breaths is in more distress than one who speaks 6-8 word sentences.
3. Look for retractions on inspiration seen in supraclavicular space, intercostal, and below ribs (sub costal). Easier seen in thin adults and pediatrics. Indicates moderate to severe distress.
ii. Respiratory sounds Possible Causes/interventions
Snoring Airway blocked. Open airway; prompt transport
Wheezing Medical issue ie asthma. Med assist, transport
Gurgling Fluids in airway, suction; prompt transport
Crowing (harsh sound on inhalation) Med problem that cannot be treated on scene. Prompt Transport
Gasping Gasping breaths by an unresponsive patient are called agonal breaths and should not be considered normal breaths. Assist ventilations as appropriate.
b. Document; examples 16, unlabored with good tidal volume or 24, labored and deep, 8, irregular and shallow; 32, labored and shallow
c. Auscultate at upper center chest and outer lower chest both sides. Upper center back and outer lower shoulder both sides and under armpits.
9-7 Describe the proper method for auscultating breath sounds to determine their presence, equality, and the likely underlying causes of abnormal breath sounds.
iv. Lung sounds- noisy respirations without a stethoscope are almost always signs of a partial airway obstruction. Some sounds can only be heard with a , stethoscope.
1. Wheezing-asthma, bronchitis, or severe allergy
2. Stridor – common in pediatrics with a swelling of the larynx
3. Crackles – pulmonary edema or pneumonia
9-8 Describe the proper method for assessing a pulse in both responsive and unresponsive adults as well as pediatric patients. Looking for Rate, Strength and Rhythm
a. Responsive 1 year and older is radial pulse
b. Responsive infant is brachial pulse
c. Unresponsive 1 year or older is carotid
d. Unresponsive infant is still brachial
9-9 Associate pulse abnormalities with possible underlying causes
a. Normal Pulse rates (beats per minute at rest) Adult 60-100 Infants and children 11-14 yo Adolescent 60-104 6-10 yo /school age 70-110 3-5 yo preschooler 80-120 1-3 yo Toddler 80-130 6-12 month old Infant 80-140 1-5 month old Infant 90-140 Newborn 120-160
Pulse Quality Significance/Causes
Rapid and regular Exertion, fright, fever, high blood pressure, first stage of blood loss
Rapid and regular Shock, later stages of blood Loss
Slow Drugs, some poisons, some heart problems, lack of oxygen in children, and severe head injury
Irregular Possible abnormal electrical heart activity (arryhmia)
No Pulse Cardiac arrest (clinical death)
9-10 Differentiate between normal and abnormal findings when assessing a patient’s pulse to include rate, strength, and rhythm.
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9-11 Explain systolic and diastolic blood pressure readings and identify potential causes of abnormal findings or changes.
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9-12 Describe the proper method for obtaining blood pressure by both palpitation and auscultation.
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9-13 Describe normal and abnormal findings in the assessment of skin color, temperature, moisture, capillary refill, and color of mucous membranes, and associate abnormal skin findings with potential underlying causes.
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9-14 Describe the proper method for assessing capillary refill time.
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9-15 Explain factors that can affect capillary refill findings.
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9-16 Describe the proper assessment of the pupils and associate abnormal findings with potential underlying causes.
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9-17 Explain the method for assessment of orthostatic vital signs.
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9-18 Explain the criteria for determining the frequency with which vital signs should be reassessed.
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9-19 Explain what pulse oximetry measures and describe factors and limitations in interpreting pulse oximetry.
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9-20 Determine a patient’s chief complaint
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9-21 Use the mnemonics SAMPLE and OPQRST to ensure a complete prehospital patient history.
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Adult Normal Pulse rate
60-100
School Age 6-10 Normal Pulse Rate
70-110
1-5 year old normal Pulse Rate
80-130
Infant Normal Pulse Rate
80-140
Newborn Normal Pulse Rate
120-160
Adult Normal Respiratory rate
10-30
Average 12-20
Child Normal Respiratory Rate
15-30
Infant Normal Respiratory Rate
25-50
