Chp 9 Obtaining Vital Signs and a Medical History

Question 1

Auscultation

Answer 1

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.

Question 2

Dilated Pupils

Answer 2

pupils that are larger than normal

Question 3

Posterior Tibial Pulse

Answer 3

pulse point located over the medial ankle just posterior to the ankle bone

Question 4

Baseline Vital Signs

Answer 4

the very first set of vital signs obtained on a patient

Question 5

Dorsalis Pedis (Pedal) Pulse

Answer 5

pulse point located over the anterior foot

Question 6

Radial Pulse

Answer 6

pulse point located over the lateral aspect of the anterior wrist.

Question 7

Brachial Pulse

Answer 7

pulse point felt in two locations: on the inside of the upper arm and over the medial aspect of the anterior elbow

Question 8

Femoral Pulse

Answer 8

pulse point located deep in the groin between the hip and the inside of the upper thigh

Question 9

SAMPLE

Answer 9

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.

Question 10

Bradycardia

Answer 10

a pulse rate below 60 beats per minute

Question 11

Flushed

Answer 11

a reddish skin color commonly seen when someone is embarrassed or is suffering a heart related emergency.

Question 12

Sign

Answer 12

Something that the EMT can see or observe or has a value that can be recorded

Question 13

Capillary Refill Test

Answer 13

a test used to assess perfusion status in the extremities

Question 14

General Impression

Answer 14

an element of the patient assessment that includes assessing approximate age, gender, and level of distress

Question 15

Stridor

Answer 15

a harsh high-pitched sound that generally occurs during inhalation but can also occur during exhalation, indicative of partial upper airway obstruction

Question 16

Carotid Pulse

Answer 16

the pulse point located on either side of the anterior neck lateral to the trachea

Question 17

Jaundiced

Answer 17

a yellowish skin color and whites of the eyes indicative of poor liver function.

Question 18

Symptom

Answer 18

something that is experienced and described by the patient as it pertains to his chief complaint

Question 19

Chief Complaint

Answer 19

the patient’s perception of the problem in his own words. It is not what the EMT perceives to be the problem

Question 20

OPQRST

Answer 20

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

Question 21

Systolic

Answer 21

the pressure created when the left ventricle contracts and forces blood out into the arteries

Question 22

Constricted Pupils

Answer 22

pupils that are smaller than normal

Question 23

Orthostatic Vital Signs

Answer 23

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.

Question 24

Tachycardia

Answer 24

a pulse rate greater than 100 beats per minute

Question 25

Crackles

Answer 25

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

Question 26

Pale

Answer 26

a whitish skin color indicative of poor perfusion

Question 27

Tidal Volume

Answer 27

the amount of air moved in and out with each breath

Question 28

Cyanotic

Answer 28

a bluish skin color indicative of poor oxygenation

Question 29

Palpation

Answer 29

the act of examining by feeling with the hands. Also a technique used for obtaining a blood pressure reading

Question 30

Trending

Answer 30

the comparing of multiple sets of vital signs over a period of time in order to reveal a trend in the patient’s condition

Question 31

Diaphoretic

Answer 31

perspiring, sweaty, moist; a characterization of skin condition

Question 32

PERRL

Answer 32

a mnemonic used to evaluate a patient’s pupils. The letters stand for Pupils Equal and Round Reactive to Light.

Question 33

Wheezing

Answer 33

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.

Question 34

Diastolic

Answer 34

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

Question 35

Popliteal Pulse

Answer 35

pulse point located over the posterior aspect of the knee

Question 36

9-2 Differentiate between a sign and a symptom.

Answer 36

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

Question 37

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.

Answer 37

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.

Question 38

9-4 Describe the proper technique for assessing breathing.

Answer 38

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.

Question 39

9-5 Differentiate between normal respiratory rates for adults, children, infants, and newborns.

Answer 39

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

Question 40

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.

Answer 40

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.

Question 41

9-7 Describe the proper method for auscultating breath sounds to determine their presence, equality, and the likely underlying causes of abnormal breath sounds.

Answer 41

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

Question 42

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

Answer 42

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

Question 43

9-9 Associate pulse abnormalities with possible underlying causes

Answer 43

``` 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)

Question 44

9-10 Differentiate between normal and abnormal findings when assessing a patient’s pulse to include rate, strength, and rhythm.

Answer 44

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Question 45

9-11 Explain systolic and diastolic blood pressure readings and identify potential causes of abnormal findings or changes.

Answer 45

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Question 46

9-12 Describe the proper method for obtaining blood pressure by both palpitation and auscultation.

Answer 46

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Question 47

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.

Answer 47

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Question 48

9-14 Describe the proper method for assessing capillary refill time.

Answer 48

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Question 49

9-15 Explain factors that can affect capillary refill findings.

Answer 49

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Question 50

9-16 Describe the proper assessment of the pupils and associate abnormal findings with potential underlying causes.

Answer 50

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Question 51

9-17 Explain the method for assessment of orthostatic vital signs.

Answer 51

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Question 52

9-18 Explain the criteria for determining the frequency with which vital signs should be reassessed.

Answer 52

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Question 53

9-19 Explain what pulse oximetry measures and describe factors and limitations in interpreting pulse oximetry.

Answer 53

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Question 54

9-20 Determine a patient’s chief complaint

Answer 54

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Question 55

9-21 Use the mnemonics SAMPLE and OPQRST to ensure a complete prehospital patient history.

Answer 55

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Question 56

Adult Normal Pulse rate

Answer 56

60-100

Question 57

School Age 6-10 Normal Pulse Rate

Answer 57

70-110

Question 58

1-5 year old normal Pulse Rate

Answer 58

80-130

Question 59

Infant Normal Pulse Rate

Answer 59

80-140

Question 60

Newborn Normal Pulse Rate

Answer 60

120-160

Question 61

Adult Normal Respiratory rate

Answer 61

10-30 | Average 12-20

Question 62

Child Normal Respiratory Rate

Answer 62

15-30

Question 63

Infant Normal Respiratory Rate

Answer 63

25-50