Vital Signs (In depth) Flashcards
Vital signs emt measures
Respiration
Pulse
Skin
Pupils
Blood pressure
Pulse oximetry
What are you looking for when taking respiratory vital sign
Rate
Quality
rhythm
what should you base a patients normal Respiratory on?
How the patient presents
What respiratory rate should you begin to provide ventilation
(adult, Infant)
Adult - over 30
Infant - Over 60
not sustainable
To fast for good Tidal volume
Normal respiration signs
at least 1 inch of chest rise
no accessory muscles
normal rate
Exhale 2x as long as inhale
Shallow resporation signs
and treatment
slight chest rise
abnormal chest expansion
PPV by bvm or just PPV
Labored resporation signs
Grunting or stridor
accessory muscles
nasal flaring
Signs of struggle to inhale vs. exhale
Inhale = Accessory muscles
Exhale = abdominal
Noisy resperation signs
on auscultation
wheezing, rhonchi, and crackles (rales).
Trauma patient resperation assessment
looking for
sounds or not
medical patient resperation assessment
looking for
abnormal sounds
what age do you check brachial pulse
1 year or younger
Pulse to assess when pt is unresponsive
carotid and radial at same time
How to take accurate pulse
pt sitting/laying down
irregular for full minute
Pulse description meaning
Rapid, regular, full
Exertion, fright, fever, high blood pressure, or very early stage of blood loss
Pulse description meaning
Rapid, regular, and thready
Reliable sign of shock, often evident in early stage of blood loss
Pulse description meaning
Slow
Head injury
barbiturate/narcotic use
some poisons
possible cardiac problem
hypothyroidism
Pulse description meaning
No pulse
Cardiac arrest
Profund hypotension
What to record for pulse quality
strong
weak
reggular
irregular
pulses paradoxis
decrease in pulse strength during inhalation
Report this to hospital
Pallor signs
vasoconstriction
bloodloss
shock
heart attack
anemia
Diaphorosis
excessive sweating
Pupil Factor cause
Dialated
Cardiac arrest (pupils will also be fixed), drug use such as LSD, amphetamines, or cocaine
Pupil Factor cause
Constricted
Central nervous system disorder or narcotics use
Pupil Factor cause
Unequal
Stroke
head injury
artificial eye
eye drops
eye trauma
Pupil Factor cause
nonreactive
Stroke, head injury, artificial eye (occasionally a normal finding), eye drops, or eye trauma
Pupil Factor cause
Sluggish reaction
hypoxia
drug overdose
inadequate perfusion
Pupil Factor cause
fixed
Cardiac arrest
severe head injury
severe hypoxia,
extremely poor perfusion to the brain
not reactive to light
Good systolic and diastolic ration
distolic is 2/3 of systolic
systolic hypotension indicator
Adult/children
less than 90
systolic hypotension indicator
1-10 yo / infants
toddler = less than 70 + (2 x age)
Infant = Less than 60
Early sign of shock
Tachycardia
weak pulses
cool and clammy skin
Late sign of shock
Hypotension
Pulse pressure equation
systolic - dystolic
* Narrow = less than 25% of systolic
* wide = 50% of systolic
Wide pulse pressure causes
Head injury
narrow pulse pressure causes
less blood being ejected from the left ventricle because of either volume loss or left ventricular failure
shock, cardiac temponade, tension pnuemothorax
Properly placed BP cuff
one inch above antecubital space
level with heart
cover 2/3 of arm
bladder above brachial artery
fit one finger under bottom edge
arm relaxed
BP by palpation
Innacurate
systolic = 7 mmHg lower
age to measure BP
3 YO and above
Chest pain BP steps
Take in both arms
report difference of 20 in systolic
Orthostatic Vital Signs
when to take
Suspected volume loss
Orthostatic Vital Signs
how to take
BP in supine
assisted stand up pt
wait 2 mins
BP standing
Measure HR and BP
Orthostatic Vital Signs
Positive test result
while standing:
* HR increases 10-20
* Systolic decreases 10-20
Orthostatic Vital Signs
Downsides
pt over 60 = not accurate
beta blockers affect results
not for spinal injuries
Pulse oximeter
where on body to place
When to place
finger
toe
earlobe
across the bridge of the nose
in primary assesment
Pulse oximeter
Limitations
Blood loss
poor perfusion
excessive movement
Nail polish
Carbon monoxide
cigarette smokers
Anemia
First BP taken by what device?
when to use the other?
BP cuff and Stethiscope
non invasive blood pressure monitor: After initial reading
Capnometry (EtCO2 Monitor)
and advantages
- EtCO2 = Co2 at end of exhale
- PaCO2 = arterial blood Co2 Pressure
*
good look at alveolar ventilation
Smooth transition of care
- info from on scene personelle = 1 min or less
*
ways to reduce pt anxiety
Bring order to the environment.
Introduce yourself.
Gain patient consent.
Position yourself.
Use communication skills.
Be courteous.
Use touch when appropriate.
Chief complaint
where history begins
why EMS was called
not always primary problem
Active listening techniques
- facilitation = Body language, eye contact
- Reflection = repeating what patient says
- Clarification
- empathetic response
- confrontation = determine accurate information
- Interpretation
