Vitals and History Taking

1. Vitals and History Taking Hillcrest Fire Training December, 2000

2. Where are we going? • What are vital signs? • How do you take them? • So, what’s normal? • SAMPLE History

3. What are the vitals • They provide information about the status of a patient • Breating (Respirations) • Pulse • Skin • Pupils • Blood Pressure

4. Counting Respirations • Respiration is one inhalation and exhalation. • Determined by counting for 30 sec, and multiplying by 2. • A hand on the stomach/chest may help

5. Normal Respirations • Adult 12-20/min • Child 15-30/min • Infant 25-50/min

6. Respiration Quality • Normal • Shallow (low tidal volume) • Labored • Use of accessory muscles • Flaring • Tripod Breating • Noisy breathing

7. Pulse • Determined by counting for 30 sec and multiplying by 2. • Irregular pulse counted for 60 sec. • Provides information about heart, blood volume and perfusion. • Taken at a pulse point • Don’t use your thumb

8. Central Pulses Carotid Femoral Peripheral Pulses Radial Brachial (children under 1) Posterior Tibial, Dorsalis Pedis Common Pulse Points

9. Pulse Quality • Normal • Bounding • Weak • Thready • Regular/Irregular

10. Normal Pulse Rate • Adult 60-80/min • Child 80-120 • Infant 120-150

11. Color Pink (Normal) Pale Cyanotic (Oxygen problems) Red (CO or heat problems) Yellow (Jaundice) Temperature Warm (Normal) Hot Cool Cold Condition Dry (Normal) Moist Skin

12. Practice • Get pulse and respirations from at least two people • Try to get pulse from carotid, radial, and brachial pulse points

13. Assessing Skin • Color assessed using lips, nail beds, inside of mouth, membranes of the eye • Pull back glove to determine temp and condition • In children under 6 capillary refill is useful for determining perfusion • Refill should take less than 2 seconds

14. Pupils • Size • Constricted • Dilated • Equal/Unequal • Reactivity to light • Can check with pen light or by shielding eyes from light

15. Blood Pressure • Taken with manual or automatic BP cuff • Can be taken by auscultation or palpation

16. Key Terms • Systolic • Pressure when heart is pumping • Diastolic • Pressure when heart is at rest

17. BP by Auscultation • Size using guides on cuff • Position on upper arm hoses pointing down • Inflate 30mmHg past pulse • Position stethoscope over brachial artery • Deflate • Note first sound and last sound • Record as systolic/diastolic (140/80)

18. One last note on Vitals • First set of vitals is the baseline, you are interested in changes • On not sick patients, repeat every 15 minutes • On sick patients, repeat every 5 minutes • Treat patient, not the vital signs or the equipment

19. BP by Auscultation • Size using guides on cuff • Position on upper arm hoses pointing down • Inflate 30mmHg past pulse • Position stethoscope over brachial artery • Deflate • Note first sound and last sound • Record as systolic/diastolic (140/80)

20. BP by Palpation • Size using guides on cuff • Position on upper arm centered over brachial artery • Inflate 30mmHg past pulse • Deflate • Record point at which pulse returns • Record as Systolic/P (135/p)

21. Male Systolic = 100+age until 50 Diastolic =60-90 Female Systolic=90+age until 50 Diastolic = 50-80 Normal Blood Pressure

22. Practice • Get BP from two people • Try at least two techniques for obtaining BP • Auscultation, Palpation, or Automatic Cuff

23. History Taking

24. SAMPLE • Organized technique to obtain pertinent medical informaiton • Can obtain information from patient, family or bystanders • SAMPLE is an acronym

25. SAMPLE • Signs/Symptoms • Allergies • Medications • Past Pertinent Medical Conditions • Last Oral Intake • Events Leading to Injury or Illness

26. Signs/Symptoms • Signs – things you can see or hear • Symptoms – things the patient reports

27. Allergies • Environmental and Medical allergies are important • Medic Alert tags are also useful

28. Medications • Prescription and OTC • Including vitamins, herbal remedies • Birth Control Pills • Illicit Drugs • Always get a list of meds, or take them with • Home O2 rate is also important • What did you take, when, how much?

29. Past Pertinent Medical History • Underlying medical problems • Recent visits to hospitals/doctors • Recent medical procedures • Recent accidents/falls/trauma • Medic Alert tags may be useful • Look for signs of medical equipment in the house

30. Last Oral Intake • What, how much, when • Important for trauma patients, diabetics

31. Events Leading to Call • Get as much information as you can • What happened, what were you doing • Has anything unusual happened? • If this is a chronic problem, what’s different this time?

32. Final SAMPLE notes • Try to ask open ended questions (avoid yes/no questions) • Wait for the patient to respond • 5-10 seconds is not out of line • Note pertinent negatives • Write everything down

33. Practice • Let’s go through a couple of scenarios